Ferrando Matteo, Racca Francesca, Madeira Lorena Nascimento Girardi, Heffler Enrico, Passalacqua Giovanni, Puggioni Francesca, Stomeo Niccolò, Canonica Giorgio Walter
Allergy & Respiratory Diseases, DIMI Dept of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
4Department of Biomedical Sciences, Humanitas University, Rozzano, MI Italy.
Clin Mol Allergy. 2018 Mar 6;16:6. doi: 10.1186/s12948-018-0085-8. eCollection 2018.
Allergen immunotherapy (AIT) is the only disease-modifying treatment approved for allergic rhinitis and allergic asthma and represents a suitable therapeutic option, especially in childhood, to modify the progression of respiratory allergic diseases. Starting from the previous "generic class effect" evaluation, as testified by the numerous meta analyses, AIT is now considered a product-specific pathogenic-oriented treatment.
AIT was empirically proposed more than one century ago in the subcutaneous form (SCIT), but the IgE-mediated mechanism of allergy was elucidated only after 50 years of clinical use of the treatment. The sublingual administration (SLIT) was developed during the 1980 ties, to achieve an improvement in safety and convenience. While SCIT is approved in the United States for the treatment of asthmatic patients with more than 12 years, so far few trials evaluated the clinical efficacy and safety of SLIT in children with allergic asthma, although the indications and some aspects remain unclear. Certainly, due to compliance problems, the age below 3 years may be reasonably considered a practical contraindication.
Given that some specific AIT products are effective and approved as drugs (AIFA, EMA, FDA), the use in children is still debated. Some aspects still need robust confirm: (a) the safety of AIT in asthma; (b) the optimal regimen of administration; (c) the role of AIT as preventative treatment for asthma development.
变应原免疫疗法（AIT）是唯一被批准用于治疗过敏性鼻炎和过敏性哮喘的疾病修正疗法，是一种合适的治疗选择，尤其是在儿童中，可改变呼吸道过敏性疾病的进程。从先前众多荟萃分析所证实的“一般类别效应”评估开始，AIT现在被认为是一种针对特定产品的、以病因为导向的治疗方法。
AIT在一个多世纪前就以皮下注射形式（SCIT）被经验性地提出，但在该疗法临床应用50年后才阐明过敏的IgE介导机制。舌下给药（SLIT）是在20世纪80年代开发的，以提高安全性和便利性。虽然在美国，SCIT被批准用于治疗12岁以上的哮喘患者，但到目前为止，很少有试验评估SLIT在过敏性哮喘儿童中的临床疗效和安全性，尽管其适应证和一些方面仍不明确。当然，由于依从性问题，3岁以下儿童可合理地被视为实际禁忌证。
鉴于一些特定的AIT产品作为药物是有效的且已获批准（意大利药品管理局、欧洲药品管理局、美国食品药品监督管理局），但其在儿童中的应用仍存在争议。一些方面仍需要有力证实：（a）AIT在哮喘中的安全性；（b）最佳给药方案；（c）AIT作为哮喘发展预防治疗的作用。
