REVIEW  NOVEL INSIGHTS INTO PEDIATRIC ALLERGY AND IMMUNOLOGY Free access

Minerva Pediatrica 2020 October;72(5):343-57

DOI: 10.23736/S0026-4946.20.05959-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Allergen Immunotherapy in children with respiratory allergic diseases

Stefania ARASI ¹ ✉, Giovanni B. PAJNO ², Ilenia PANASITI ², Mónica SANDOVAL ³, Montserrat ALVARO-LOZANO ³

¹ Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy; ² Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy; ³ Department of Allergy and Clinical Immunology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain

Allergen immunotherapy (AIT) is a well-established treatment for allergic respiratory diseases. It represents a cornerstone in the clinical management of allergic children since it is the only curative option to date able to modify the natural history of Ig-E mediated allergic diseases. Through a well-defined immunologic mechanism, AIT promotes regulatory T cells and cuts down the immune response induced by allergens. According to current guidelines based on up-to-date evidence, AIT should be offered to children with moderate-severe allergic rhinitis and/or controlled asthma starting from 5 years of age, further to an adequate risk-benefit assessment which includes patient’s adherence to the treatment and a proper selection of the right product. Younger age and mild disease could be considered based on an individual evaluation. Both subcutaneous (SCIT) and sublingual (SLIT) routes of administration have a good efficacy and safety profile with safer outcomes for SLIT compared to SCIT. Only standardized products with documented evidence of clinical efficacy should be used. Although AIT is used worldwide, there are still gaps and limitations, including the lack of reliable biomarkers predictive of the clinical outcome. Novel adjuvants are currently under investigations to boost the strength and efficiency of the immune response, as well as new formulations with better efficacy and better patient’s adherence to the treatment. Herein, we aim to provide an overview of current key evidence with major regard to clinical practice as well as knowledge gaps and future research needs in the context of AIT in children with respiratory allergic diseases.

KEY WORDS: Immunologic desensitization; Allergic rhinitis; Asthma; Child