Allergic rhinitis, conjunctivitis, and asthma impact quality of life and cost billions of dollars in lost wages, productivity, and medical expenditures. Allergen immunotherapy is the only therapy that alters the allergen immune response, resulting in fewer symptoms upon natural exposure. This review summarizes recent immunotherapy developments.
Subcutaneous immunotherapy (SCIT) remains a disease modifying treatment for allergic rhinoconjunctivitis and asthma with rare complications of therapy. Recent evidence suggests that SCIT may be effective in select cases of atopic dermatitis, particularly for patients with dust mite sensitivity. Sublingual immunotherapy (SLIT) tablets are now commercially available for grass and ragweed allergy and appear to have a superior safety profile to SCIT with similar long-term effectiveness, because as with SCIT, symptom improvement persists after the SLIT course is completed. SLIT tablets are administered daily at home (after initial supervised dosing) and may be used shortly before and during the target pollen seasons in a precoseasonal fashion (instead of perennial dosing). Research continues into experimental approaches using oral food allergen immunotherapy (OIT) to modify the natural history of food allergies. Although a proportion of patients in OIT trials experience sustained unresponsiveness, many do not and current recommendations limit the use of OIT to research protocols.
Patients have new well tolerated and effective options for more convenient treatment of asthma and allergic rhinoconjunctivitis associated with grass and ragweed allergy. SCIT remains effective for polysensitized patients and may be an option for some patients with atopic dermatitis. Research continues into novel food allergy treatments.
aDepartment of Pediatrics, Children's Hospital at Dartmouth, New Hampshire, USA
bSection of Allergy, Asthma, and Immunology, Department of Pediatrics, Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA
Correspondence to Marcus Shaker, MD, MS, FAAAAI, FAAP Associate Professor of Pediatrics Section of Allergy, Asthma, and Immunology, Dartmouth-Hitchcock Medical Center One Medical Center Drive, Lebanon, NH 03756-0001, USA. Tel: +1 603 653 9885; fax: +1 603 650 0907; e-mail: Marcus.Shaker@dartmouth.edu