Evidence for Immunotherapy in Pediatric Asthma Lacking

Children with allergic asthma who are treated with subcutaneous immunotherapy (SCIT) may not experience a significant change in symptoms compared with patients treated with placebo, but they may experience a reduction in asthma exacerbations, according to a study published in BMJ Open. In addition, these children may not experience the same beneficial effects in reducing asthma exacerbations and symptoms when treated with sublingual immunotherapy (SLIT).

Researchers performed a systematic review of the literature regarding the use of both SCIT and SLIT in the treatment of childhood asthma. A total of 6 systematic reviews and randomized controlled trials were searched and apprised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to determine the benefits and/or clinical outcomes related to the use of SCIT or SLIT in this patient population.

The evidence found gave researchers great concern regarding the quality of the studies. Researchers found the randomization processes to be poor, information regarding follow up lacking, failure to follow up with patients, and a lack of consistency in double-blind and placebo-controlled trial designs.

Study results demonstrated no effect on asthma symptoms in children treated with SCIT in 4 studies. A decrease in asthma exacerbations (pooled risk ratio, 0.47; 95% CI, 0.31-0.72) in children treated with immunotherapy (n=253) compared with placebo (n=153) was found in 5 studies. 

Children treated with SLIT did not have improvements in asthma symptoms, asthma exacerbation rates, quality of life, or lung function. Of note, a meta-analysis of the results of each study could not be performed because the studies used different symptom scales, rendering them incomparable and therefore unreliable.

Researchers concluded that the effectiveness of SCIT and SLIT in children with asthma cannot be confidently determined as the overall quality of evidence in the studies was very low and had to be downgraded because of a lack of valid applicable evidence on outcomes, a high risk for bias, failure to follow up, lack of information on follow-up, lack of allocation concealment, and the heterogeneous nature of the studies. Limited valid applicable evidence could be found regarding the clinical effectiveness of SCIT and SLIT therapy, and therefore these therapies are not recommended as treatment options in children with asthma.

Reference

van de Griendt E-J, Tuut MK, de Groot H, Brand PLP. Applicability of evidence from previous systematic reviews on immunotherapy in current practice of childhood asthma treatment: a GRADE (Grading of Recommendations Assessment, Development and Evaluation) systematic review. BMJ Open. 2017;7(12):e016326.