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Sublingual immunotherapy helps kids with allergies

Monday May 6, 2013
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Allergy shots are commonly used to treat children with severe environmental allergies and asthma, but under-the-tongue drops may offer yet another beneficial — and stick-free — option for pediatric allergy sufferers, according to a study.

Researchers with the Johns Hopkins Children’s Center conducted an analysis of 34 previously published clinical trials. The findings suggest both sublingual immunotherapy and subcutaneous immunotherapy are effective in alleviating the bothersome symptoms of allergic rhinitis and asthma.

In addition to being better tolerated by needle-averse children, the oral treatment can be given at home, sparing the family a visit to the doctor’s office, the researchers noted.

"Our findings suggest the needle-free approach is a reasonable way to provide much-needed relief to millions of children who suffer from asthma or seasonal allergies," Julia Kim, MD, MPH, the study’s lead author and a pediatric research fellow at Johns Hopkins Children’s Center, said in a news release.

Subcutaneous immunotherapy, which contains tiny amounts of proteins found in environmental allergens such as dust mites and pollen, is a standard treatment for severe seasonal allergies in children who do not get relief from medication. However, sublingual immunotherapy is not approved for use by the FDA and is only offered off label by some physicians, according to background information for the study, which was published May 6 on the website of the journal Pediatrics.

The needle-free approach is widely available in Europe, where patients commonly are treated with sublingual pills and drops, the researchers noted.

The new research, Kim said, is encouraging enough to prompt a second look at sublingual immunotherapy as a treatment option. The findings come on the heels of another recent Hopkins study, which showed the therapy provides a safe and effective alternative for adult allergy sufferers.

The researchers first looked at 13 studies that involved 920 children and compared the efficacy of subcutaneous immunotherapy to either placebo or standard allergy medication. Overall, they found subcutaneous immunotherapy provides better symptom relief than placebo and standard medication for children with asthma or allergic rhinitis.

The team next analyzed 18 trials involving 1,580 children treated with sublingual immunotherapy, placebo or standard medication for asthma and rhinitis or either condition alone. In this group, the researchers found that sublingual immunotherapy also provided superior relief of asthma symptoms, compared with patients who got the placebo and/or standard drugs. Sublingual immunotherapy also provided better symptom relief than placebo and standard medication in children with allergic rhinitis or rhino-conjunctivitis.

Only three of the 34 studies in the review directly compared subcutaneous immunotherapy and sublingual immunotherapy and, the investigators said, more head-to-head comparisons may shed better light on the comparative effectiveness of the two treatments. However, the researchers added, the results of the 31 other studies indicate both forms of treatment can successfully rid children of coughing, sneezing, runny noses, itchy eyes and wheezing.

The three studies that directly compared subcutaneous immunotherapy versus sublingual immunotherapy for symptom relief of dust mite-induced asthma and rhinitis showed no strong evidence that children given shots fared better than children who received oral drops, Kim said.

Both treatments caused relatively mild side effects, such as itching of the mouth, skin rashes or wheezing. A single severe reaction was reported following an injection.

More than 6 million children in the United States suffer from asthma, while allergic rhinitis affects 40% of American kids.

Read the study abstract: http://pediatrics.aappublications.org/content/early/2013/04/30/peds.2013-0343.abstract.


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