Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria.
Allergy. 2024 Aug;79(8):2065-2087. doi: 10.1111/all.16115. Epub 2024 Apr 8.
The efficacy and safety of preventive allergen immunotherapy (pAIT) in children are currently under investigation. Here, we provide an overview of pAIT with respiratory allergens concerning the prevention of new sensitizations, allergic disease onset and progression as well as further immunomodulatory effects. Three databases were searched for clinical pAIT studies in children. Selected publications were reviewed for preventive outcomes according to prevention level (primary, secondary, and tertiary), allergen type, administration route, dose, and treatment duration. The primary prevention approach appears safe but showed no allergen-specific effect on new sensitizations. Secondary prevention seems feasible and may induce regulatory T cell-mediated immunotolerance. The number of studies at these prevention levels is limited. Tertiary prevention with grass and/or tree pollen-based pAIT has shown efficacy in preventing disease progression from allergic rhinitis/conjunctivitis to asthma. Data on tertiary pAIT with house dust mites and other allergen types are inconclusive. Subcutaneous and sublingual routes appear similarly effective, but head-to-head comparative paediatric studies are scarce. Additionally, there are fewer placebo-controlled studies. Nevertheless, immunomodulatory outcomes of pAIT are encouraging. Currently, limited but favourably suggestive evidence is available for preventing respiratory allergic diseases in children by pAIT. Primary and secondary prevention have potential and warrant further investigation through well-designed studies.
预防性过敏原免疫治疗 (pAIT) 在儿童中的疗效和安全性目前正在研究中。在这里，我们提供了有关预防新致敏、过敏性疾病发作和进展以及进一步免疫调节作用的呼吸道过敏原 pAIT 的概述。我们在三个数据库中搜索了儿童的临床 pAIT 研究。根据预防水平（一级、二级和三级）、过敏原类型、给药途径、剂量和治疗持续时间，对选定的出版物进行了预防效果的审查。初级预防方法似乎是安全的，但对新致敏没有特异性的过敏原作用。二级预防似乎是可行的，并且可能诱导调节性 T 细胞介导的免疫耐受。这些预防水平的研究数量有限。基于草和/或花粉的 pAIT 进行的三级预防已显示出预防从过敏性鼻炎/结膜炎到哮喘的疾病进展的疗效。关于基于屋尘螨和其他过敏原类型的三级 pAIT 的数据尚无定论。皮下和舌下途径似乎同样有效，但缺乏头对头的儿科比较研究。此外，安慰剂对照研究较少。尽管如此，pAIT 的免疫调节作用还是令人鼓舞的。目前，通过 pAIT 预防儿童呼吸道过敏性疾病的有限但有利的证据。一级和二级预防具有潜力，需要通过精心设计的研究进一步研究。
