The use of subcutaneous immunotherapy (SCIT) has demonstrated efficacy in children with moderate to severe allergic asthma exacerbations, but a thorough assessment of the benefit-to-risk ratio and the patient’s health status is needed, according to the results of a retrospective study conducted in the Allergology Department of a tertiary care center in Paris, France, published in Annals of Allergy, Asthma & Immunology.1
The files of children aged 6 to 18 years who received cluster SCIT for a documented Dermatophagoides pteronyssinus allergic episode between 1990 and 2016 were screened. Children with moderate to severe asthma based on Global Initiative for Asthma (GINA)2 criteria were included for analysis. There was no SCIT performed concurrently for any other allergens.
Trained staff administered injections after checking asthma control during the previous 4 weeks. Cluster SCIT included a build-up phase of 1 cluster day per month for 4 months (cumulative dose of D pteronyssinus: 0.6 to 10 μg of IRIS® [ALK-Abelló; Varennes-en-Argonne, France]). During this phase, between 4 and 8 subcutaneous injections were administered in a single day at 20-minute intervals. This build-up phase was followed by a maintenance phase, in which 1 monthly injection of D pteronyssinus was administered.
Gender, age, history of allergic rhinitis or atopic dermatitis, and parental history of asthma were obtained. Sensitization to any aeroallergens was defined by a specific
immunoglobulin E (IgE) ≥0.35 kU/L.
Overall, 56% of the children analyzed experienced ≥1 adverse reaction while undergoing SCIT, which accounted for 73 adverse reactions (2% of the 3455 performed injections). Moreover, 33% of the children experienced multiple reactions, and 22% experienced a systemic reaction, which accounted for 0.5% of all injections administered. Of children who experienced a systemic reaction, 3% experienced a grade 1 systemic reaction, 19% experienced a grade 2 systemic reaction, and 1 patient experienced a grade 3 systemic reaction that required the use of epinephrine.
A majority of the adverse reactions experienced by the children (89%; 65 of 73 adverse reactions) were recorded during the build-up phase. Furthermore, all of the grade 2 and grade 3 SRs occurred during the build-up phase and resulted in SCIT discontinuation in all patients.
During the maintenance phase, approximately 20% of the children discontinued SCIT — 8% because of uncontrolled asthma, 4% as a result of repeated bothersome local reactions, 7% because of a lack of compliance, and 1% because of a change in living location.
The mean rate of asthma exacerbations declined significantly from 2.1±4.5 to 0.38±0.68 after 1 year of SCIT (P <.001) and to 0.44±0.58 after 3 years (P = .01). The average dose of equivalent of fluticasone propionate (EFP) used decreased significantly from 500 μg/d (range, 375 to 800 μg/d) after 1 year (P <.001) and to 200 μg/d (range, 200-400 μg/d) after 3 years of SCIT (P =.01).
The investigators concluded that the use of SCIT is associated with an early decrease in severe exacerbations of asthma, despite a reduction in EFP dose used, in a pediatric population. A prospective, randomized, placebo-controlled trial is warranted to confirm these results.
Disclosures: ALK-Abelló provided funding for this research.
- Amat F, Sese L, Hayat M, Bourgoin-Heck M, Just J. Subcutaneous allergen immunotherapy may be a suitable treatment for exacerbator allergic asthma [published online May 24, 2018]. Ann Allergy Asthma Immunol. doi: 10.1016/j.anai.2018.05.021
- Global Initiative for Asthma (GINA) Report. Global Strategy for Asthma Management and Prevention 2017. www.ginasthma.org. Accessed July 11, 2017.