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Review
. 2018;5(3):275-290.
doi: 10.1007/s40521-018-0176-2. Epub 2018 Aug 31.

Duration of Allergen Immunotherapy for Long-Term Efficacy in Allergic Rhinoconjunctivitis

Martin Penagos  1 , Aarif O Eifan  1 , Stephen R Durham  1 , Guy W Scadding  1
Affiliations
Review

Duration of Allergen Immunotherapy for Long-Term Efficacy in Allergic Rhinoconjunctivitis

Martin Penagos et al. Curr Treat Options Allergy. 2018.

Abstract

Rationale: Subcutaneous and sublingual immunotherapy are effective for allergic rhinitis. An important question is whether allergen immunotherapy provides a sustained clinical effect after treatment cessation. In view of potential side effects, cost and the necessary patient commitment, long-term benefit is an important consideration for the recommendation of immunotherapy over standard pharmacotherapy.

Purpose of review: In this review, we analyse the existing evidence for long-term effects of both routes of administration in the context of double-blind, placebo-controlled, randomised clinical trials that included a follow-up phase of at least 1 year after treatment cessation.

Recent findings: Overall, evidence suggests that 3 years of either subcutaneous or sublingual immunotherapy result in clinical benefit and immunological changes consistent with allergen-specific tolerance sustained for at least 2-3 years after treatment cessation.

Summary: The data presented here support recommendations in international guidelines that both routes of administration should be continued for a minimum of 3 years. Gaps in the evidence remain regarding the long-term efficacy of immunotherapy for perennial rhinitis and studies performed in children.

Keywords: Allergen immunotherapy; Allergic rhinitis; Biomarkers; Long term efficacy; Mechanisms; Subcutaneous; Sublingual.

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Conflict of interest statement

SR Durham has received consultancy fees from manufacturers of allergy vaccines, including ALK Abello Denmark, Allergy Therapeutics UK, Anergis Switzerland, Asics Biotech Belgium, Biomay Austria, and from Boehringer Ingelheim Germany and Glaxo Smith Kline UK and lecture fees from Med Update GmBH Germany. GW Scadding has received lecture fees from ALK Abello Denmark and Glaxo Smith Kline UK. M Penagos has received personal fees from Stallergenes and ALK outside the submitted work. Aarif O. Eifan declares that he has no competing interests.This article contains reference to studies of clinical trials and mechanistic studies in human subjects undergoing allergen immunotherapy that were performed by the authors of this manuscript. All such studies were performed with approval of the national ethics committee in UK and with the written informed consent of the participants.

Figures

Fig. 1
Fig. 1
Effects of sublingual immunotherapy on combined symptom and medication scores in two 5-year, double-blind, placebo-controlled, randomised controlled trials. a Five-grass tablet [33]. b Phleum pratense tablet [30].
See this image and copyright information in PMC

References

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance
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