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Preventing progression of allergic rhinitis: the role of specific immunotherapy
  1. Alessandro Fiocchi1,
  2. Adam T Fox2
  1. 1Department of Child and Maternal Medicine, Melloni Paediatria, University of Milan Medical School, Fatebenefratelli/Melloni Hospital, Milan, Italy
  2. 2Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Adam T Fox, Department of Paediatric Allergy, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; adam_fox{at}btinternet.com

Abstract

Allergic rhinitis and asthma are examples of allergic airways disease. Despite their differing symptomatology, both disorders affect the mucosal lining of the respiratory tract and are linked by common underlying cellular processes, thus, using the ‘united airways’ approach, they can be considered part of the same allergic disease. The conditions are often comorbid, and there is evidence to suggest that allergic rhinitis in children is a significant risk factor for subsequent development of asthma. Management strategies that target the underlying cause of allergic rhinitis in children have the potential to offer additional symptom control above that of symptomatic medications, and prevent disease progression. Specific immunotherapy (SIT) is the only currently available treatment that is proven to target the disease in this way. SIT affects the underlying cause of allergic rhinitis, producing changes in antibody responses to allergens. It has been shown to be effective in the reduction of allergic rhinitis symptoms in both children and adults, with effects being sustained for several years after treatment completion. Furthermore, a number of trials provide evidence that SIT may prevent the development of new sensitisations and asthma in children and adults with allergic rhinitis. One such open-label, randomised controlled study in children/adolescents (the Preventive Allergy Treatment Study) showed that significantly fewer patients who received 3 years of SIT for grass/birch pollen-induced allergic rhinitis had developed asthma 10 years after treatment initiation versus controls. Some clinical guidelines acknowledge this potential asthma preventive effect in children and the need for additional data from double-blind, placebo-controlled trials to support these findings.

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Footnotes

  • Search criteria The studies included in this review were selected based on their perceived quality and relevance to the topic, following a collaboration between the authors and the review sponsor, ALK-Abelló A/S. No formal search criteria were employed in study selection.

  • Funding Production of this review was sponsored by ALK-Abelló A/S. ALK-Abelló A/S was allowed the opportunity to comment on the manuscript.

  • Competing interests AF has not received consulting or lecture fees in the last 3 years. Revenues from his consulting activities were received from ALK-Abelló, Heinz Baby Food, Merck Sharp & Dohme, Nestlé Baby food, Numico, Ordesa, Pierre Fabre, Stallergènes and UCB SA. These revenues were entirely devolved to Allegria – the Italian Foundation for Pediatric Allergy and Asthma Research. ATF reports receiving consulting or lecture fees from SHS International, ALK-Abelló, Medelo, Schering-Plough, AstraZeneca, Merck Sharp & Dohme, Novartis, GSK, Lactofree, Mead Johnson and Dorling Kindersley, and conference expenses from Nestlé and ALK-Abelló.

  • Provenance and peer review Commissioned; externally peer reviewed.

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