Original articleInterventionsComparison of the long-term efficacy of 3- and 5-year house dust mite allergen immunotherapy
Introduction
Allergen specific immunotherapy (SIT) is the only treatment of allergy modifying the immune response.[1], [2] Immunotherapy alleviates the symptoms, prevents the onset of new sensitizations, and reduces the risk of developing asthma. Moreover, its clinical efficacy lasts many years.3
An adequate SIT treatment should ideally produce a long-term therapeutic benefit after its completion. The results obtained in some trials suggest that the duration of the treatment might influence the duration of the clinical effect after completion of SIT.[4], [5], [6] The recommended duration of SIT treatment relies on empiric data and is not well documented. To our knowledge, there are only 2 trials that prospectively explore the currently recommended duration limits of SIT,[7], [8] but the long-term efficacy of SIT was not assessed in these studies. However, no publications have compared how the duration of SIT might influence the long-term efficacy of immunotherapy.
Our objective was to compare the long-term efficacy of 3 and 5 years of house dust mite (HDM) SIT in children with asthma. Efficacy was assessed on the basis of a steroid-sparing effect, asthma symptoms score, lung function, asthma remission, methacholine challenge, and the Paediatric Asthma Quality of Life Questionnaire (PAQLQ).
Section snippets
Patients
Ninety boys and girls with IgE-dependent asthma caused by sensitization only to HDMs (Dermatophagoides farinae [n = 5] or Dermatophagoides pteronyssinus [n = 7] or both [n = 78]) were randomly selected (computer-generated allocation schedule) from an outpatient population at our allergy clinic center who fulfilled the inclusion criteria (n = 180 potential study candidates). We included patients who completed a 3-year course of SIT (SIT3 group, n = 30), those who completed a 5-year course of SIT
Patients
Eighty-four children completed the study; only 6 (7%) dropped out, all from the SIT5 group. In all cases, the reason for dropping out was lost to follow-up (family moved or family changed health care provider): 2 patients in the first year of the prospective phase and 4 patients during the second year. Baseline characteristics of the patients who completed the study are listed in Table 1. The minimal ICS dose controlling the symptoms at the beginning of the retrospective phase of the study was
Discussion
To our knowledge, this is the first trial that prospectively explores the long-term effect of different durations of SIT after its discontinuation. Current immunotherapy guidelines[16], [17] suggest that SIT should be discontinued on an individual basis; the usual duration ranges from 3 to 5 years. Data suggest that SIT administration is effective in the treatment of respiratory allergy, and its efficacy continues after treatment discontinuation.[18], [19] However, trials specifically designed
References (26)
- et al.
Long-lasting effects of sublingual immunotherapy as add-on treatment in moderate persistent asthma due to birch pollen
J Allergy Clin Immunol
(2010) - et al.
Effect of different antiasthmatic treatments on exercise-induced bronchoconstriction in children with asthma
J Allergy Clin Immunol
(2008) - et al.
Effectiveness of specific immunotherapy in the treatment of hymenoptera venom hypersensitivity: a meta-analysis
Clin Ther
(2000) - et al.
Characterization of within-subject responses to fluticasone and montelukast in childhood asthma
J Allergy Clin Immunol
(2005) - et al.
Immunological mechanisms of allergen-specific immunotherapy
Nat Rev Immunol
(2006) - et al.
Mechanisms of allergen-specific immunotherapy
J Allergy Clin Immunol
(2007) - et al.
Subcutaneous immunotherapy and pharmacotherapy in seasonal allergic rhinitis: a comparison based on meta-analyses
J Allergy Clin Immunol
(2011) - et al.
Immunotherapy with a standardized Dermatophagoides pteronyssinus extract, V: duration of the efficacy of immunotherapy after its cessation
Allergy
(1996) - et al.
SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial
J Allergy Clin Immunol
(2012) - et al.
Three years of specific immunotherapy may be sufficient in house dust mite respiratory allergy
J Allergy Clin Immunol
(2011)
Comparative effect of pre-coseasonal and continuous grass sublingual immunotherapy in children
Allergy
Validity of the Pediatric Asthma Quality of Life Questionnaire in Polish children
Pediatr Allergy Immunol
Seasonal variability of nonspecific bronchial responsiveness in asthmatic patients with allergy to house dust mites
Allergy Asthma Proc
Cited by (55)
The Art of Immunotherapy
2024, Journal of Allergy and Clinical Immunology: In PracticeThe role of house dust mite immunotherapy in Indonesian children with chronic rhinosinusitis allergy: A randomized control trial
2021, HeliyonCitation Excerpt :Previous studies stated that 54% of pediatric and adult patients experienced improvements in sleep disorders after HDM immunotherapy [42]. Similar condition was also found in children who experienced HDM allergy where they experienced improved sleep, especially in the immunotherapy group [43]. In another study, it was found that participant's sleep improved after receiving HDM immunotherapy with various allergy responses, including rhinitis [44], asthma [45], atopic dermatitis atopic, bronchial hyper-responsiveness [46], and conjunctivitis [47].
Guidelines for the prescription of allergen immunotherapy and patient follow-up — Clinical questions and revision of the literature
2021, Revue Francaise d'Allergologie48 - Modern Molecular Therapies for Application in Managing Childhood Asthma
2019, Kendig's Disorders of the Respiratory Tract in ChildrenAllergen-Specific Immunotherapy for Respiratory Allergy in Children: Unmet Needs and Future Goals
2017, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Indeed, there is no rigorous experimental evidence on the best duration of SLIT and SCIT, and the usual indication of 3 to 5 years is based on sparse clinical data and historical practice. An open controlled 15-year follow-up of adult subjects treated with SLIT for 3, 4, or 5 years suggested that a 4-year course would be the best option, and 1 controlled trial in children showed that a 3-year course is equivalent to a 5-year course.25,26 Although allergic patients are commonly polysensitized in clinical practice, most controlled studies of SCIT and SLIT were carried out with a single allergen extract.
Disclosures: Authors have nothing to disclose.
Funding Sources: This study was funded by grant 503/2-056-01 from the Medical University of Lodz, Lodz, Poland.