Wallace Dana V
From the Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida and.
Allergy Asthma Proc. 2025 Sep 1;46(5):362-381. doi: 10.2500/aap.2025.46.250058.
Allergen immunotherapy (AIT) is the only disease-modifying treatment for allergic rhinitis (AR), allergic asthma, and, potentially, atopic dermatitis (AD) in children. Despite demonstrated efficacy, AIT remains underutilized in the United States. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) both reduce symptoms and medication use, although much supporting evidence comes from non-U.S. studies by using extracts not approved domestically. Moreover, most U.S. trials of multiallergen SCIT lack rigorous placebo controlled data. The objectives were to examine current evidence on pediatric AIT, evaluate clinical efficacy and safety, and highlight key research gaps, particularly within the U.S. context. A literature search was conducted by using terms that included pediatric AIT, SCIT, SLIT tablets; SLIT drops; and off-label SLIT. The review focused on AIT for AR, asthma, and AD in children, with comparative analysis of SCIT and SLIT in terms of efficacy, safety, and preventative potential. Both SCIT and SLIT are effective for AR and, to a lesser extent, asthma and AD. SLIT tablets offer the advantages of at-home use and a favorable safety profile but in the U.S. are limited to single allergens, which poses challenges for patients who were polysensitized. AIT shows potential for tertiary prevention, such as delaying asthma onset or reducing new sensitizations, although more U.S.-based pediatric data are needed. SCIT carries a risk of systemic reactions; SLIT maintains excellent safety. Knowledge gaps remain with regard to optimal treatment duration, extract formulation, and multiallergen use in children who are polyallergic. AIT is a valuable disease-modifying option for pediatric allergic diseases, but broader U.S. adoption is hindered by regulatory, reimbursement, and evidence limitations. Shared decision-making is critical to align treatment with patient needs. High-quality U.S.-based studies are essential to optimize care and long-term outcomes for children who are allergic.
变应原免疫疗法（AIT）是治疗儿童过敏性鼻炎（AR）、过敏性哮喘以及可能的特应性皮炎（AD）的唯一疾病改善疗法。尽管已证实其有效性，但在美国，AIT的使用仍未得到充分利用。皮下免疫疗法（SCIT）和舌下免疫疗法（SLIT）均可减轻症状并减少药物使用，不过许多支持证据来自美国以外使用国内未获批提取物的研究。此外，美国大多数多变应原SCIT试验缺乏严格的安慰剂对照数据。本研究的目的是审查有关儿科AIT的现有证据，评估临床疗效和安全性，并突出关键研究差距，特别是在美国背景下。通过使用包括儿科AIT、SCIT、SLIT片剂、SLIT滴剂和非标签SLIT等术语进行文献检索。该综述聚焦于儿童AR、哮喘和AD的AIT，并对SCIT和SLIT在疗效、安全性和预防潜力方面进行比较分析。SCIT和SLIT对AR均有效，对哮喘和AD的有效性稍低。SLIT片剂具有居家使用的优势和良好的安全性，但在美国仅限于单一变应原，这给多敏化患者带来了挑战。AIT显示出三级预防的潜力，如延迟哮喘发作或减少新的致敏，但需要更多基于美国的儿科数据。SCIT存在全身反应风险；SLIT安全性良好。在最佳治疗持续时间、提取物配方以及多过敏儿童的多变应原使用方面仍存在知识空白。AIT是治疗儿科过敏性疾病的一种有价值的疾病改善选择，但在美国更广泛的应用受到监管、报销和证据方面的限制。共同决策对于使治疗符合患者需求至关重要。高质量的基于美国的研究对于优化过敏儿童的护理和长期结局至关重要。
