Kids Can Get Used to Allergies

Rhinoconjunctivitis allergy therapies make breathing easier for kids

(RxWiki News) Exposure to an allergen in small doses enables some adults to adapt and breathe well again. With the help of two different techniques, the same may work for kids.

Two allergy therapies that expose kids to small amounts of an allergen effectively treated their asthma and rhinitis, a new study found.

Rhinitis involves stuffy noses, runny or drippy noses, sneezing, itching of the nose or eyes and red eyes.

The results show how looking at the proper dose, time frame and age for treating children and teens can optimize their treatment, according to the researchers.

"Talk to an allergist about allergy desensitizing treatments."

Julia Kim, MD, MPH, from the Department of Pediatrics in the Division of General Pediatrics and Adolescent Medicine at Johns Hopkins University School of Medicine, and colleagues reviewed the safety and effectiveness of two different allergy and asthma treatments for children with rhinoconjunctivitis.

Rhinoconjunctivitis is rhinitis in combination with conjunctivitis, or the inflammation of the membrane that covers the white part of the eye.

The researchers looked at 34 studies involving more than 2,500 children with allergic asthma or rhinoconjunctivitis. Two independent reviewers who looked at the evidence and quality of each study selected the articles.

Sublingual immunotherapy (SLIT) and usual care were compared in 18 studies. In sublingual immunotherapy, small doses or drops of an allergen are placed under patients' tongues, which increases their tolerance to that allergen.

Another 13 studies compared how subcutaneous immunotherapy (SCIT) worked compared to usual care. Subcutaneous immunotherapy exposes patients to small doses of what they are allergic to using a shot through the skin. 

Another three studies compared the two immunotherapy techniques with each other.

The researchers took note of the allergens, interventions and outcomes of each study.

They found moderate evidence that subcutaneous immunotherapy improved breathing capability in children with asthma and rhinitis symptoms. There was little evidence that the therapy improved conjunctivitis symptoms.

For sublingual immunotherapy, the evidence strongly supported that the therapy improved kids' asthma symptoms. There was also moderately strong evidence that the therapy improved rhinitis and conjunctivitis symptoms.

"Our systematic review found more evidence to support the use of SLIT than SCIT," the researchers wrote in their report. "This finding may reflect the fact that there are fewer studies evaluating SCIT exclusively in children, and few head-to-head comparisons of SCIT and SLIT."

Through looking at the studies that compared the two immunotherapies together, the researchers also found that three patients who received SLIT had oral itching. And none of the patients had any systemic reactions, which involve the whole body.

Four of the patients who received SCIT had a systemic reaction, including moderate to severe respiratory symptoms. The findings mirror those of previous reviews, according to the researchers.

"Adverse events associated with SCIT include local discomfort, pain, and serious reactions such as rare fatal and near-fatal reactions," the researchers wrote. "Most adverse events reported with SLIT have been local reactions of the oral mucosa, with few serious systemic reactions."

Though the study showed the effectiveness of the treatments, some questions still remain, according to John Oppenheimer, MD, associate editor of the Annals of Allergy, Asthma and Immunology, and dailyRx Contributing Expert.

"Interestingly, despite the fact that immunotherapy is celebrating its 100th year anniversary, many questions remain regarding this therapy," Dr. Oppenheimer said. "In the discussion of this paper, the authors highlight several of these issues, including the need for future studies which examine real world use of immunotherapy in children, as well as long term outcomes, specifically assessing prevention of asthma, as well as the potential for disease modification."

The study authors noted that several of their included studies were at moderate to high risk of bias.

The study, funded by the Agency for Healthcare Research and Quality, was published online May 22 in the journal Pediatrics. No financial conflicts of interest were declared.

Review Date: 
May 27, 2013