Reviews and feature articleGuideline recommendations on the use of allergen immunotherapy in house dust mite allergy: Time for a change?
Section snippets
Specific guideline recommendations for AR
All reviewed guidelines on treatment of AR included AIT as a possible treatment for selected patients with AR (Table I).3, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 Some specified that AIT with HDM extracts was effective in both adults and children.6, 7, 8 Several guidelines included SLIT as an option for treatment of AR in adults6 or both adults and children,9, 10, 11 and some specified that SLIT with HDM allergens was effective and safe in patients with AR.3, 7, 12 The Allergic Rhinitis and its
Evidence needed to support AIT treatment recommendations for HDM allergy is emerging
The recently published outcomes of large, randomized, double-blind, placebo-controlled AIT field studies in patients with HDM-induced AA (MITRA: MT-04, EudraCT 2010-018621-19; ALK-Abelló, Hørsholm, Denmark5) and HDM-induced AR in Europe (MERIT: MT-06, EudraCT 2011-002277-38, ALK-Abelló4; VO57.07, EudraCT 2011-002277-38, Stallergenes, Antony, France38) the United States (MK-8237-001; Merck, White House Station, NJ39), and Japan (Torii Pharmaceuticals, Tokyo, Japan40) show that 3 different HDM
Could data from new, well-designed, high-quality studies provide sufficient evidence for a recommendation in guidelines?
Well-designed and well-conducted trials are a key step in obtaining regulatory approval for new treatments; however, trial populations do not always closely represent the type of patients encountered in routine care.42 More than half of asthmatic patients do not achieve control with their current pharmacotherapy, and even patients with well-controlled asthma experience, on average, 6 worsenings per year (defined as occasions when asthma symptoms were bothersome or hindering).43 Similarly, not
Conclusions
Even though AIT was first described more than a century ago and up to 50% of patients with HDM-induced AR also have AA, specific treatment recommendations for AIT in patients with AA, AR, or both caused by HDM allergy remain unclear. This has largely been due to the relatively low quality of the body of evidence supporting the use of AIT in this context, which has complicated quantification of AIT's effect. Reasons include heterogeneity in study design and reporting of outcomes, a lack of
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Cited by (26)
Allergen immunotherapy using NPP: Perspectives for the treatment and prevention of respiratory allergies; the case of pollinosis
2019, Revue Francaise d'AllergologieSublingual immunotherapy in children
2018, Allergologia et ImmunopathologiaEfficacy and Safety of Subcutaneous and Sublingual Immunotherapy for Allergic Rhinoconjunctivitis and Asthma
2017, Otolaryngologic Clinics of North AmericaCitation Excerpt :When assessing bronchial reactivity after specific allergen challenge, 8 of 11 (72.7%) studies found statistically significant improvement after SCIT, but results were inconsistent in 11 studies assessing pulmonary function tests.21 For these reasons, several guidelines recommend dust mite SCIT as an effective option for allergic asthma,25–27 although there is no consensus on the use SCIT in asthma therapy in adults.28 There is more support for dust mite SCIT in children, as there is evidence suggesting that allergy plays a stronger role in childhood asthma.26
Advances and highlights in allergen immunotherapy: On the way to sustained clinical and immunologic tolerance
2017, Journal of Allergy and Clinical ImmunologyCitation Excerpt :A recent World Allergy Organization statement indicates the need for product-specific evidence-based AIT.5 In the past, we were used to honoring meta-analyses for their high scientific status; however, there is some criticism on flaws in technique and also wrong conclusions from meta-analyses.6-8 Meta-analyses should provide the highest level of evidence for the efficacy of a medical treatment or intervention.
Supported by ALK-Abelló.
Disclosure of potential conflict of interest: M. Calderón has consultant arrangements with ALK-Abelló, HAL Allergy, Allergopharma, Merck, and Stallergenes Greer. J. Bousquet has received personal fees for scientific and advisory boards from Almirall, Meda, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, and Uriach and has received personal fees for lectures from Almirall, AstraZeneca, Chiesi, GlaxoSmithKline, Meda, Menarini, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, and Uriach. L.-O. Cardell has a board membership and has received grants and payment for lectures from ALK-Abelló. D. Hernandez Fernandez de Rojas is a member of an advisory board for house dust mite sublingual immunotherapy for ALK-Abelló. J. Kleine-Tebbe is a member of advisory boards for ALK-Abelló, Novartis, Leti, and Bencard; has consultant arrangements with Merck and Circassia; has received grants from Circassia, Leti, and Stallergenes Greer; and has received payment for lectures from Allergopharma, ALK-Abelló, Bencard, HAL Allergy, Leti, Lofarma, Novartis, and Stallergenes Greer. P. Demoly has received a consulting fee or honorarium from ALK-Abelló, Stallergenes Greer, Thermo Fisher Scientific, Chiesi, AstraZeneca, Meda, Menarini, and Allergopharma. G. W. Canonica declares that he has no relevant conflicts of interest.