Evidence in immunotherapy for paediatric respiratory allergy: Advances and recommendations.

Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy (AIT). AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT.

SLIT: indications, follow-up, and management

La inmunoterapia específica sublingual (SLIT) ha demostrado ser un tratamiento seguro y eficaz para la alergia respiratoria. Sin embargo, aspectos como la selección del paciente, el empleo de dosis óptimas, sus efectos en el asma y a largo plazo, o el manejo de las reacciones adversas necesitan una mayor investigación. Además, la gran heterogeneidad de estudios realizados con SLIT y la aplicación de los mismos criterios que los que se aplican a la inmunoterapia subcutánea dificultan la obtención de conclusiones precisas y útiles al clínico que prescribe este tratamiento. Por ello, el grupo Quasar (QUality in the Administration of SLIT in Allergic Rhinitis), grupo de alergólogos con amplia experiencia clínica con SLIT, se propuso recoger el estado de la investigación actual y los datos reales disponibles con SLIT. Para ello, se establecieron grupos de trabajo en tres categorías distintas: selección del paciente candidato a recibir SLIT, eficacia del tratamiento y reacciones adversas. Se realizó una búsqueda de artículos representativos para cada tema, localizándose inicialmente en PubMed 850, de los que se seleccionaron y analizaron 314 para extraer la evidencia disponible con SLIT, incorporando finalmente 266 al documento. Se realizó la gradación de la evidencia para cada pregunta clínica según la clasificación de Oxford. El texto resultante fue evaluado hasta en tres ocasiones por todos los miembros del grupo hasta consensuar el documento final que revisa el cuerpo de la evidencia existente hasta el momento sobre SLIT, particularmente con pólenes, sobre los que existe un mayor número de artículos, y, para aquellos aspectos en los que se ha demostrado evidencia insuficiente, propone una alternativa consensuada entre los miembros del grupo Quasar. Finalmente, se proponen algoritmos de selección del paciente candidato para SLIT y de manejo de reacciones adversas (AU)

Specific sublingual immunotherapy (SLIT) has been proved to be a safe and effective approach in respiratory allergy. However, further research is required on aspects such as patient selection, use of optimal dosing, effects on asthma, long-term effects, and management of adverse reactions. In addition, the widely heterogeneous nature of studies on SLIT performed to date and the application of the criteria for subcutaneous immunotherapy make it difficult for the prescribing clinician to draw accurate and useful conclusions. Therefore, the QUASAR Group (QUality in the Administration of SLIT in Allergic Rhinitis), which comprises allergologists with broad clinical experience in SLIT, investigated the latest research findings and available data on this approach. Working parties were formed in 3 different categories: selection of candidates for SLIT, treatment efficacy, and adverse reactions. We performed a PubMed search for articles that were representative of each category and found 850. From these, we finally selected 266 articles, which were reviewed to retrieve data on SLIT. Evidence for each clinical question was graded according to the Oxford classification. The resulting text was evaluated on 3 occasions by all the members of the group until the final version was agreed upon. In this version, we review available evidence on SLIT, particularly with pollens, which is the subject of most articles. In areas where evidence is insufficient, an alternative agreed upon by the members of the QUASAR group is presented. Finally, we propose algorithms for selecting candidates for SLIT and for management of adverse events (AU)

SLIT: indications, follow-up, and management.

Specific sublingual immunotherapy (SLIT) has been proved to be a safe and effective approach in respiratory allergy. However, further research is required on aspects such as patient selection, use of optimal dosing, effects on asthma, long-term effects, and management of adverse reactions. In addition, the widely heterogeneous nature of studies on SLIT performed to date and the application of the criteria for subcutaneous immunotherapy make it difficult for the prescribing clinician to draw accurate and useful conclusions. Therefore, the QUASAR Group (QUality in the Administration of SLIT in Allergic Rhinitis), which comprises allergologists with broad clinical experience in SLIT, investigated the latest research findings and available data on this approach. Working parties were formed in 3 different categories: selection of candidates for SLIT, treatment efficacy, and adverse reactions. We performed a PubMed search for articles that were representative of each category and found 850. From these, we finally selected 266 articles, which were reviewed to retrieve data on SLIT. Evidence for each clinical question was graded according to the Oxford classification. The resulting text was evaluated on 3 occasions by all the members of the group until the final version was agreed upon. In this version, we review available evidence on SLIT, particularly with pollens, which is the subject of most articles. In areas where evidence is insufficient, an alternative agreed upon by the members of the QUASAR group is presented. Finally, we propose algorithms for selecting candidates for SLIT and for management of adverse events.