SAN ANTONIO — Sublingual immunotherapy is safe and effective in children younger than 5 years—a group considered ideal for early allergy intervention, according to Italian researchers.
“Immunotherapy has been shown to prevent the onset of asthma in allergic patients. … Therefore, children are optimal candidates,” said Giovanni Passalacqua, M.D., professor of allergy and immunology at the University of Genoa, Italy.
He said concerns about the safety of subcutaneously administered allergy immunotherapy in children make the prospect of sublingual administration particularly appealing.
“Subcutaneous immunotherapy injections can provoke systemic urticaria, angioedema, asthma, or even anaphylaxis—all of which are more difficult to manage in children, compared with adults,” he explained.
“This is new information for us, and quite exciting,” said Clifford Bassett, M.D., medical director of Allergy & Asthma Care of New York.
Both subcutaneous and sublingual allergy immunotherapy remain unapproved for children by the U.S. Food and Drug Administration.
Speaking at the annual meeting of the American Academy of Allergy, Asthma, and Immunology, Dr. Passalacqua outlined his study, which included 126 children aged 3-5 years, with respiratory allergies.
A total of 76 patients (60%) had rhinitis with asthma, 34 (27%) had rhinitis alone, and 16 (13%) had only asthma.
Immunotherapy was prescribed for dust mites in 62% of participants, grasses in 22%, Parietaria species (a nettle of Mediterranean origin) in 12%, Alternaria mold species in 2%, and olive in 2%.
All children received sublingual immunotherapy for 2 years, during which time nine instances of side effects were noted in seven patients (5.6%).
Two mild cases of oral itching and one mild case of abdominal pain were resolved by lowering the dose. The remaining six cases involved moderate GI symptoms, also resolved with a lower dose.
Dr. Passalacqua noted that this side effect profile is similar to that reported in adolescent and adult patients.
Although the study was not an efficacy study, he said 70% of the parents noted improvement in their children's allergy symptoms.