Safety, Efficacy, and Preventive Role of Subcutaneous and Sublingual Allergen Immunotherapy for the Treatment of Pediatric Asthma

Abstract

Allergen-specific immunotherapy is currently the only treatment with the potential to modify and prevent progression of allergic asthma in children. In clinical practice, it is available in two forms: subcutaneous immunotherapy and sublingual immunotherapy. Trials and meta-analyses showed both the safety and the short- and long-term benefits of allergen-specific immunotherapy in asthmatic children. However, its use and role in asthma remains controversial, since studies are largely heterogeneous. This is mainly due to the lack of consensus on the optimal primary outcome to be considered for clinical trials evaluating the efficacy of allergen-specific immunotherapy in asthma. Therefore, well-conducted researchis needed using standardized and validated tools to evaluate key outcomes in asthmatic children.

Keywords: allergen-specific immunotherapy; allergy; asthma; children; grass; house dust mite.

Figure 1

Immune modulation of AIT. The action of AIT on dendritic cells leads to an increased nTregs and iTregs production by the release of IL-12, IL-10, and IL-27. Specific Tregs and B-regulatory cells can modify the immune response from allergic Th2 to Th1 response. Moreover, Tregs downregulate count and function of mucosal mast cells, basophils and eosinophils. AIT through Treg cells enhances specific IgG4 and diminished specific IgE to allergens.