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Asllani J, Mitsias D, Konstantinou G, Mesonjesi E, Xhixha F, Shehu E, Christoff G, Noleva K, Makris M, Aggelidis X, Turkalj M, Damir E, Agache I, Tomic‐Spiric V, Stosovic R, Misirligil Z, Kosnik M, Popov TA, Calderon M, Papadopoulos NG. Adverse events in children and adolescents undergoing allergen immunotherapy for respiratory allergies-Report from the Allergen Immunotherapy Adverse Events Registry (ADER), a European Academy of Allergy and Clinical Immunology taskforce. Clin Transl Allergy 2023; 13:e12250. [PMID: 37357552 PMCID: PMC10236500 DOI: 10.1002/clt2.12250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Although it has been shown that allergen immunotherapy (AIT) is well-tolerated in children, systematic and prospective surveillance of AIT safety in real life settings is needed. METHODS The multinational Allergen Immunotherapy Adverse Events Registry (ADER) was designed to address AIT safety in real life clinical practice. Data on children ≤18 years old with respiratory allergies undergoing AIT were retrieved. Patient- and AIT-related features were collected and analyzed. The characteristics of adverse events (AE) and risk factors were evaluated. RESULTS A total of 851 patients, 11.3 ± 3.4 years old, with rhinitis only (47.6%); asthma and rhinitis (44.5%); asthma (7.9%), receiving 998 AIT courses were analyzed. Sublingual immunotherapy (SLIT) accounted for 51% of the courses. In 84.5% of patients only one AIT treatment was prescribed. Pollen was the most frequent sensitizer (57.1%), followed by mites (53.4%), molds (18.2%) and epithelia (16.7%). Local and systemic AEs were reported in 85 patients (9.9%). Most AEs (83.1%) were mild and occurred in <30 min (87%). Respiratory and cutaneous symptoms were more frequent. Only 4 patients (0.47%) had severe AE (none after 6 weeks of maintenance). The risk of AE was higher in patients undergoing SCIT. CONCLUSIONS AIT is safe and well tolerated in children and adolescents with respiratory allergies in real-life clinical practice. Though SCIT is more prone to AE compared to SLIT, overall severe reactions are rare and occur during build-up and early maintenance.
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Affiliation(s)
- Julijana Asllani
- University of MedicineTiranaAlbania
- Allergy and Asthma Medical ClinicTiranaAlbania
| | - Dimitrios Mitsias
- Allergy Department 2 Pediatric ClinicUniversity of AthensAthensGreece
| | - George Konstantinou
- Department of Allergy and Clinical Immunology424 General Military Training HospitalThessalonikiGreece
| | | | - Fatmira Xhixha
- Ambulatory Polyclinic of Specialties, Nr. 3TiranaAlbania
| | - Esmeralda Shehu
- Internal Medicine DepartmentDurres Regional HospitalDurresAlbania
| | | | | | - Michael Makris
- Immunotherapy Outpatient ClinicAllergy Unit2 Department Dermatology and VenereologyNational and Kapodistrian University of AthensUniversity General Hospital ‘Attikon’AthensGreece
| | - Xenofon Aggelidis
- Immunotherapy Outpatient ClinicAllergy Unit2 Department Dermatology and VenereologyNational and Kapodistrian University of AthensUniversity General Hospital ‘Attikon’AthensGreece
| | - Mirjana Turkalj
- Srebrnjak Children's HospitalZagrebCroatia
- Medical School Catholic University of CroatiaZagrebCroatia
- Medical School University J.J. StrossmayerOsijekCroatia
| | - Erceg Damir
- Srebrnjak Children's HospitalZagrebCroatia
- Medical School Catholic University of CroatiaZagrebCroatia
- Medical School University J.J. StrossmayerOsijekCroatia
| | - Ioana Agache
- Faculty of MedicineTransylvania UniversityBrasovRomania
| | - Vesna Tomic‐Spiric
- Clinic of Allergology and ImmunologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Rajica Stosovic
- Clinic of Allergology and ImmunologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Zeynep Misirligil
- İstinye UniversityFaculty of MedicineAnkara Liv HospitalAnkaraTurkey
| | - Mitja Kosnik
- University Clinic of Respiratory and Allergic DiseasesGolnikSlovenia
| | | | - Moises Calderon
- Section of Allergy and Clinical ImmunologyImperial College London‐NHLILondonUK
| | - Nikolaos G. Papadopoulos
- Allergy Department 2 Pediatric ClinicUniversity of AthensAthensGreece
- Lydia Becker Institute of Immunology and InflammationUniversity of ManchesterManchesterUK
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Paoletti G, Di Bona D, Chu DK, Firinu D, Heffler E, Agache I, Jutel M, Klimek L, Pfaar O, Mösges R, DunnGalvin A, Genuneit J, Hoffmann HJ, Canonica GW. Allergen immunotherapy: The growing role of observational and randomized trial "Real-World Evidence". Allergy 2021; 76:2663-2672. [PMID: 33583050 DOI: 10.1111/all.14773] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although there is a considerable body of knowledge about allergen immunotherapy (AIT), there is a lack of data on the reliability of real-world evidence (RWE) in AIT, and consequently, a lack of information on how AIT effectively works in real life. METHODS To address the current unmet need for an appraisal of the quality of RWE in AIT, the European Academy of Allergy and Clinical Immunology Methodology Committee recently initiated a systematic review of observational studies of AIT, which will use the RELEVANT tool and the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE) to rate the quality of the evidence base as a whole. The next step will be to develop a broadly applicable, pragmatic "real-world" database using systematic data collection. Based on the current RWE base, and perspectives and recommendations of authorities and scientific societies, a hierarchy of RWE in AIT is proposed, which places pragmatic trials and registry data at the positions of highest level of evidence. KEY RESULTS There is a need to establish more AIT registries that collect data in a cohesive way, using standardized protocols. CONCLUSIONS This will provide an essential source of real-world data that can be easily shared, promoting evidence-based research and quality improvement in study design and clinical decision-making.
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Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| | - Danilo Di Bona
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari – Aldo Moro Bari Italy
| | - Derek K. Chu
- Division of Immunology and Allergy Department of Health Research Methods, Evidence and Impact Department of Medicine McMaster University Hamilton ON Canada
- The Research Institute of St. Joe's Hamilton Hamilton ON Canada
| | - Davide Firinu
- Department of Clinical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| | - Ioana Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University of Brasov Brasov Romania
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University and “ALLMED”Medical Research Institute Wroclaw Poland
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy Department of Otorhinolaryngology, Head and Neck Surgery University Hospital MarburgPhilipps‐Universität Marburg Marburg Germany
| | - Ralph Mösges
- Faculty of Medicine Institute of Medical Statistics and Computational Biology (IMSB) University of Cologne and CRI – Clinical Research International Limited Cologne Germany
| | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics & Child Health University College Cork Cork Ireland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry Ulm University Ulm Germany
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty Leipzig University Leipzig Germany
| | - Hans Jürgen Hoffmann
- Department of Clinical Medicine Aarhus University and Department of Respiratory Diseases and AllergyAarhus University Hospital Aarhus Denmark
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
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Abstract
PURPOSE OF REVIEW Real-life (or real-world) studies can provide information that cannot be derived from randomized controlled trials. This approach is currently becoming of relevance for many treatments. In recent years, the real-life method has been applied also to allergen immunotherapy, providing new insights on it. We reviewed herein the available literature on the argument. RECENT FINDINGS Several prospective and retrospective studies on allergen immunotherapy in the real-world setting have been published, mostly in the last 5 years. Most of them focused on adverse events, compliance, and the long term/preventive effects, and evidenced an overall favorable profile for different products and different allergens. SUMMARY Real life study provided novel information and evidenced those aspects of immunotherapy that worth a more detailed approach, without the strict limitations usually imposed by controlled randomized trials.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
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Khan S, Krishna MT, Michaelis LJ, Dawson TC, Marriage D, Thursby-Pelham A, Pur Özyiğit L, Jones C, Regent L, Erlewyn-Lajeunesse M. BSACI Registry for Immunotherapy (BRIT): Providing safe and effective immunotherapy for allergies and urticaria. Clin Exp Allergy 2021; 51:985-988. [PMID: 34337808 DOI: 10.1111/cea.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sujoy Khan
- Immunology & Allergy, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Mamidipudi Thirumala Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Immunology and Immunotherapy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.,IQAS Accreditation Programme, Accreditation Unit, The Royal College of Physicians, London, UK
| | - Louise J Michaelis
- Paediatric Immunology, Allergy & Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Tom C Dawson
- Paediatric Department, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Deborah Marriage
- Department of Paediatrics, Bristol Royal Hospital for Children, Bristol, UK
| | | | - Leyla Pur Özyiğit
- Department of Allergy, University Hospitals Leicester NHS Trust, Leicester, UK
| | | | | | - Mich Erlewyn-Lajeunesse
- Department of Paediatric Allergy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Wraith DC, Krishna MT. Peptide allergen-specific immunotherapy for allergic airway diseases-State of the art. Clin Exp Allergy 2021; 51:751-769. [PMID: 33529435 DOI: 10.1111/cea.13840] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/13/2022]
Abstract
Allergen-specific immunotherapy (AIT) is the only means of altering the natural immunological course of allergic diseases and achieving long-term remission. Pharmacological measures are able to suppress the immune response and/or ameliorate the symptoms but there is a risk of relapse soon after these measures are withdrawn. Current AIT approaches depend on the administration of intact allergens, often comprising crude extracts of the allergen. We propose that the challenges arising from current approaches, including the risk of serious side-effects, burdensome duration of treatment, poor compliance and high cost, are overcome by application of peptides based on CD4+ T cell epitopes rather than whole allergens. Here we describe evolving approaches, summarize clinical trials involving peptide AIT in allergic rhinitis and asthma, discuss the putative mechanisms involved in their action, address gaps in evidence and propose future directions for research and clinical development.
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Affiliation(s)
- David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mamidipudi T Krishna
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Yu W, Mao L, Pan Q, He T, Yu M. Efficacy of Sublingual Administration of Dermatophagoides Farinae Drops for Treatment of Pediatric Allergic Rhinitis Accompanied by Adenoid Hypertrophy and Improvement of Immune Function. Med Sci Monit 2019; 25:333-340. [PMID: 30633736 PMCID: PMC6338006 DOI: 10.12659/msm.911982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/15/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the efficacy of sublingual administration of Dermatophagoides farinae drops for the treatment of allergic rhinitis (AR) accompanied by adenoid hypertrophy and the effect on immune function in children. MATERIAL AND METHODS Eosinophil counts in peripheral blood before and after treatment were determined; serum levels of immunoglobulin E (IgE), total IgE (T-IgE), immunoglobulin G4 (IgG4), interleukin-2 (IL-2), and interleukin-6 (IL-6) before and after treatment were detected by enzyme-linked immunosorbent assay. RESULTS The total effective rate in the study group was significantly higher than that in the control group (P<0.05). In both the study and control groups, symptom scores, medication scores, eosinophil counts in the peripheral blood, and serum levels of IgE, T-IgE, and IL-6 were significantly lower than those before treatment (P<0.05), while the serum levels of IgG4 and IL-2 were significantly higher than those before treatment (P<0.05). After treatment, symptom scores, medication scores, eosinophil counts in the peripheral blood, and serum levels of IgE, T-IgE, and IL-6 in the study group were significantly lower than those in the control group (P<0.05), while the serum levels of IgG4 and IL-2 were significantly higher in the study group than those in the control group (P<0.05). CONCLUSIONS Sublingual administration of D. farinae drops improved the clinical symptoms of pediatric AR caused by Dermatophagoides mites and improved the immune functions in children.
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Affiliation(s)
- Wangbo Yu
- Department of Otorhinolaryngology – Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Lifang Mao
- Department of Integrated Western and Chinese Colorectal and Anal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Qingchun Pan
- Department of Otorhinolaryngology – Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Tao He
- Department of Otorhinolaryngology – Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Ming Yu
- Department of Otorhinolaryngology – Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, P.R. China
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Susibalan BD, Abdullah B, Mat Lazim N, Abdul Kadir A. Efficacy of snakehead fish (Channa striatus) in subjects with allergic rhinitis: a randomized controlled trial. ORIENTAL PHARMACY AND EXPERIMENTAL MEDICINE 2018; 18:209-215. [DOI: 10.1007/s13596-018-0327-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/12/2018] [Indexed: 10/16/2023]
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