PURPOSE OF THE STUDY.
To review the literature regarding the use of subcutaneous immunotherapy (SCIT) in the treatment of atopic children.
Both MEDLINE and EMBASE were searched using the keywords (immunotherap* or desensit*); and allerg*; and (child* or pediatr*). The time period of January 2006 to April 2011 was used. The authors also searched references from published trials or recent reviews.
Articles that included patients aged 3 to 18 years were included. The patients were proved to have allergic sensitization in the form of respiratory allergy with symptoms of asthma, allergic rhinitis (either seasonal or perennial), or rhinoconjunctivitis. Information regarding clinical efficacy in terms of symptoms, safety of SCIT, and immunologic outcome data was obtained. The quality of the evidence was rated from very low to high.
Of 109 possible candidate articles, 31 articles were included in the analysis. High-quality evidence for SCIT using grass pollen exists for improved symptoms and reduced medication scores up to 7 years after termination of treatment. Moderate evidence that SCIT for grass pollen prevented asthma in children with rhinitis only at the start of the study also exists. Alternaria SCIT improved quality of life, symptom-medication scores, and medication scores. For SCIT with house dust mite, high-quality evidence showed improvement in asthma symptoms and medication scores and reduced visits to the emergency department. Improvements in skin test reactivity were seen with both grass pollen and house dust mite.
Pediatric patients with allergy benefit from treatment with SCIT using house dust mite, Alternaria, and grass pollen.
This review supports the use of subcutaneous immunotherapy in the treatment of pediatric patients with respiratory allergy. While the results of a large randomized trial of pediatric patients with asthma brought into question the benefit of SCIT, this review reassures clinicians that evidence, ranging from low to high quality, exists to support the treatment of atopic respiratory disease in children. Since environmental avoidance is not always possible, the information regarding the benefit of immunotherapy is essential in the pediatric patient population.
- Copyright © 2012 by the American Academy of Pediatrics