Per una pediatria basata sull'evidenza
L’immunoterapia nelle allergie respiratorie in sei domande (più una)
IMMUNOTHERAPY IN RESPIRATORY ALLERGIC DISEASE
GIORGIO LONGO
Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
Novembre 1998 - pagg. 592 -596
Abstract
The Author presents the state-of-the art of
specific immunotherapy (SIT) for respiratory
allergic diseases. SIT is more efficacious in
allergic diseases due to pollen rather than
to perennial allergens, in children rather
than in adults, in subjects with sensitivity to
only one allergen, in patients with recent
onset of asthma. In asthmatic patients, SIT
provides little adjunctive effect with respect
to environmental prophylaxis and inhaled
steroids. There are data suggesting that
early SIT can favourably affect the natural
history of allergic diseases, but the evidence
is not conclusive. SIT is a rather expensive
and not entirely safe intervention and
puts a considerable burden on the family.
Costs and benefits must be evaluated on
the basis of available evidence and on the
specific problems presented by the patient.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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2. Malling HJ, Weeke B: Immunotherapy. Position paper of the European Academy af Allergology and Clinical Immunology. Allergy 48, Suppl 14, 1993.
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9. Malling HJ: Immunotherapy as an effective tool in allergy treatment. Allergy 53, 461- 472, 1998.
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11. Bousquet J, et al: Nonspecific bronchial hyperreactivity in asthmatic subjects after immunotherapy with a standardized mite extract. Am Rev Respir Dis 135, A135, 1987.
12. Bousquet J, et al: Clinical and immunologic reactivity of patients allergic to grass pollens and multiple pollen species. Clinical and immunologic characteristics. J Allergy Clin Immunol 87, 737-46, 1991.
13. Pène J, et al: Differences in IL-4 release by PBMC are related with heterogeneity of atopy. Immunology 81, 58-64, 1994.
14. Kelly WJW, et al: Atopy in subjects with asthma followed to the age of 28 years. J Allergy Clin Immunol 85, 548-57, 1990.
15. Rabusin M: Is increasing the incidence of skin test positivity for cat dander? Allergy 51, Suppl. 31, S125, 1996.
16. Haugaard L, et al: A controlled dose-response study of immunotherapy with standardized, partially purified extract of house dust mite: clinical efficacy and side effects. J Allergy Clin Immunol 91, 709-22, 1993.
17. Longo G, et al: L’efficacia dell’intervento sull’ambiente (misure antipolvere) nella profilassi dell’asma da dermatofagoide in pediatria. Folia Allergol Immunol Clin 27, 479-486, 1980.
18. Peroni DG, et al: Double-blind trial of house-dust mite immunotherapy in asthmatic children resident at high altitude. Allergy 50, 925-930, 1995.
19. Juniper EF, et al: Comparison of the efficacy and side effect of aqueous steroid nasal spray (budesonide) and allergen-injection therapy (Pollinex-R) in the treatment of seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 85, 606-11, 1990.
20. Wolf H, et al: Short-term immunotherapy (STI) versus symptomatic drug treatment: an open randomized cross over study. Allergy 53, Suppl 43, S207, 1998.
21. Shaiki WA: Immunotherapy vs inhaled budesonide in bronchial asthma: an open, parallel, comparative trial. Clin Exp All 27, 1279-84, 1997.
22. Creticos PS: Ragweed immunotherapy in adult asthma. N Engl J Med 334, 501-6, 1996.
23. Varney VA, et al: Usefulness of immunotherapy in patients with severe summer hay fever uncontrolled by antiallergic drugs. BMJ 302, 265-269, 1991.
24. Adkinson NF jr, et al: A controlled trial of immunotherapy for asthma in allergic children. N Engl J Med 336, 324-31, 1997.
25. Torres Costa JC, et al: Effects of immunotherapy on symptoms, PEFR, spirometry, and airway responsiveness in patients with allergic asthma to house-dust mites (D. pteronyssinus) on inhaled steroid therapy. Allergy 51, 238-44, 1996.
26. Ebner C, et al: Booster immunotherapy (BIT). Allergy 49, 38-42, 1994.
27. Bousquet J, et al: Advances in specific immunotherapy. Clin Exp All 22, 889-896, 1992.
28. Des Roches A, et al: Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. V. Duration of the efficacy of immunotherapy after its cessation. Allergy 51, 430-433, 1996.
29. Quirce S, et al: Occupational asthma. Allergy 53, 633-641, 1988.
30. Platts-Mills TA, et al: Dust mites: immunology, allergic diseases and environmental control. J Allergy Clin Immunol 79, 694-701, 1987.
31. Sullivan TJ: Is asthma curable? Ped Clin North Am 39, 6, 1363-81, 1992.
32. Rackemann FM, et al: Asthma in children. A follow-up study of 688 patients after an interval of twenty years. N Engl J Med 246, 815-63, 1952.
33. Johnstone DE, et al: The value of hyposensitization therapy for bronchial asthma in children: a 14-years study. Pediatrics 49, 793- 802, 1968.
34. Jacobsen L, et al: Prevention of asthma by specific immunotherapy (the PAT-Study). Five years follow up. Allergy 53, Suppl. 43, S169 1988.
35. Dolz I, et al: A double-blind, placebo-controlled study of immunotherapy with grasspollen extract Alutard SQ during a 3 years period with initial rush immunotherapy. Allergy 51, 489-500, 1996.
36. Linna O, et al: A 10-year prognosis for childhood allergic rhinitis. Acta Paediatr 81, 100-2, 1992.
37. Des Roches A, et al: Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. VI. Specific immunotherapy prevents the onset of new sensitizations in children. J Allergy Clin Immunol 99, 450-3, 1997.
38. Des Roches A, et al: Specific immunotherapy prevents the onset of new sensitizations in monosensitized children (abstract). J Allergy Clin Immunol 95, 309, 1995.
39. Holt PG: A potential vaccine strategy for asthma and allied atopic diseases during early childhood. Lancet 344, 456-8, 1994.
40. Holt PG, et al: Primary sensitization to inhalant allergens during infancy. Pediatr Allergy Immunol 1, 3-13, 1990.
41. Global Strategy for Asthma Management and Prevention. NHLBI/WHO workshop report. Publication no.95-3659. National Institutes of Health, Bethesda. MD. 1995.
42. Warner JO, Naspitz CK: Third international pediatric consensus statement on the management of childhood asthma. Ped Pneumol 25, 1-17, 1998.
43. Passalacqua G, et al: Local immunotherapy: pharmacokinetics and efficacy. Allergy 53, 477-484,1998.
44. Tari MG, et al: Efficacy of sublingual immunotherapy in patients with rhinitis and asthma due to house dust mite. A doubleblind study. Allergol et Immunopathol 18, 5, 277-84,1990.
45. Greineder DK: Risk management in allergen immunotherapy. J Allergy Clin Immunol 98, S330-4, 1996.
46. Rogala B: Risk and safety of immunotherapy. Allergy 53, 473-476, 1998.
47. Ownby DR, et al: The appropriate use of skin testing and immunotherapy in young children. J Allergy Clin Immunol 94, 662-5, 1994.
48. Hejjaoui A, et al: Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. IV. Systemic reactions according to the immunotherapy schedule. J Allergy Clin Immunol 85, 473-9, 1990.
49. Businco L, et al: Systemic reactions to specific immunotherapy in children with respiratory allergy: a prospective study. Pediatr Allergy Immunol 6, 44-7, 1995.
50. Cantani A, et al: Specific immunotherapy (SIT) in children. Allergy 51, 365-6, 1996.
51. André C, et al. Allergy 53 (Suppl. 43), S116, 1998.
52. Longo G, Panizon F: Aspetti particolari dell’immunoterapia specifica in età pediatrica: quando cominciare? Asma Allergia Immunopatologia 77, 5-12, 1989.
2. Malling HJ, Weeke B: Immunotherapy. Position paper of the European Academy af Allergology and Clinical Immunology. Allergy 48, Suppl 14, 1993.
3. Frew AJ: Injection immunotherapy. British Society for Allergy and Clinical Immunology Working Party. BMJ 307, 919-23, 1993.
4. Bousquet J, Lockey RF, Malling HJ: WHO Position Paper. Allergen Immunotherapy: therapeutic vaccines for allergic diseases. Allergy 53, Suppl 44, 1998.
5. Bousquet J: Specific immunotherapy in asthma: is it effective? J Allergy Clin Immunol 94, 1-11 1994.
6. Barnes PJ: Is immunotherapy for asthma worthwhile? N Engl J Med 334, 531-532, 1996.
7. Panizon F: Immunoterapia specifica: vale la pena? Riv It Ped 23, 771-772, 1997.
8. Longo G: È utile l’immunoterapia specifica nell’asma? Medico e Bambino 15, 435-437, 1996.
9. Malling HJ: Immunotherapy as an effective tool in allergy treatment. Allergy 53, 461- 472, 1998.
10. Bousquet J: Specific immunotherapy with a standardized Dermatophagoides pteronyssinus extract. II. Prediction of efficacy of immunotherapy. J Allergy Clin Immunol 82, 971-7, 1988;.
11. Bousquet J, et al: Nonspecific bronchial hyperreactivity in asthmatic subjects after immunotherapy with a standardized mite extract. Am Rev Respir Dis 135, A135, 1987.
12. Bousquet J, et al: Clinical and immunologic reactivity of patients allergic to grass pollens and multiple pollen species. Clinical and immunologic characteristics. J Allergy Clin Immunol 87, 737-46, 1991.
13. Pène J, et al: Differences in IL-4 release by PBMC are related with heterogeneity of atopy. Immunology 81, 58-64, 1994.
14. Kelly WJW, et al: Atopy in subjects with asthma followed to the age of 28 years. J Allergy Clin Immunol 85, 548-57, 1990.
15. Rabusin M: Is increasing the incidence of skin test positivity for cat dander? Allergy 51, Suppl. 31, S125, 1996.
16. Haugaard L, et al: A controlled dose-response study of immunotherapy with standardized, partially purified extract of house dust mite: clinical efficacy and side effects. J Allergy Clin Immunol 91, 709-22, 1993.
17. Longo G, et al: L’efficacia dell’intervento sull’ambiente (misure antipolvere) nella profilassi dell’asma da dermatofagoide in pediatria. Folia Allergol Immunol Clin 27, 479-486, 1980.
18. Peroni DG, et al: Double-blind trial of house-dust mite immunotherapy in asthmatic children resident at high altitude. Allergy 50, 925-930, 1995.
19. Juniper EF, et al: Comparison of the efficacy and side effect of aqueous steroid nasal spray (budesonide) and allergen-injection therapy (Pollinex-R) in the treatment of seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 85, 606-11, 1990.
20. Wolf H, et al: Short-term immunotherapy (STI) versus symptomatic drug treatment: an open randomized cross over study. Allergy 53, Suppl 43, S207, 1998.
21. Shaiki WA: Immunotherapy vs inhaled budesonide in bronchial asthma: an open, parallel, comparative trial. Clin Exp All 27, 1279-84, 1997.
22. Creticos PS: Ragweed immunotherapy in adult asthma. N Engl J Med 334, 501-6, 1996.
23. Varney VA, et al: Usefulness of immunotherapy in patients with severe summer hay fever uncontrolled by antiallergic drugs. BMJ 302, 265-269, 1991.
24. Adkinson NF jr, et al: A controlled trial of immunotherapy for asthma in allergic children. N Engl J Med 336, 324-31, 1997.
25. Torres Costa JC, et al: Effects of immunotherapy on symptoms, PEFR, spirometry, and airway responsiveness in patients with allergic asthma to house-dust mites (D. pteronyssinus) on inhaled steroid therapy. Allergy 51, 238-44, 1996.
26. Ebner C, et al: Booster immunotherapy (BIT). Allergy 49, 38-42, 1994.
27. Bousquet J, et al: Advances in specific immunotherapy. Clin Exp All 22, 889-896, 1992.
28. Des Roches A, et al: Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. V. Duration of the efficacy of immunotherapy after its cessation. Allergy 51, 430-433, 1996.
29. Quirce S, et al: Occupational asthma. Allergy 53, 633-641, 1988.
30. Platts-Mills TA, et al: Dust mites: immunology, allergic diseases and environmental control. J Allergy Clin Immunol 79, 694-701, 1987.
31. Sullivan TJ: Is asthma curable? Ped Clin North Am 39, 6, 1363-81, 1992.
32. Rackemann FM, et al: Asthma in children. A follow-up study of 688 patients after an interval of twenty years. N Engl J Med 246, 815-63, 1952.
33. Johnstone DE, et al: The value of hyposensitization therapy for bronchial asthma in children: a 14-years study. Pediatrics 49, 793- 802, 1968.
34. Jacobsen L, et al: Prevention of asthma by specific immunotherapy (the PAT-Study). Five years follow up. Allergy 53, Suppl. 43, S169 1988.
35. Dolz I, et al: A double-blind, placebo-controlled study of immunotherapy with grasspollen extract Alutard SQ during a 3 years period with initial rush immunotherapy. Allergy 51, 489-500, 1996.
36. Linna O, et al: A 10-year prognosis for childhood allergic rhinitis. Acta Paediatr 81, 100-2, 1992.
37. Des Roches A, et al: Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. VI. Specific immunotherapy prevents the onset of new sensitizations in children. J Allergy Clin Immunol 99, 450-3, 1997.
38. Des Roches A, et al: Specific immunotherapy prevents the onset of new sensitizations in monosensitized children (abstract). J Allergy Clin Immunol 95, 309, 1995.
39. Holt PG: A potential vaccine strategy for asthma and allied atopic diseases during early childhood. Lancet 344, 456-8, 1994.
40. Holt PG, et al: Primary sensitization to inhalant allergens during infancy. Pediatr Allergy Immunol 1, 3-13, 1990.
41. Global Strategy for Asthma Management and Prevention. NHLBI/WHO workshop report. Publication no.95-3659. National Institutes of Health, Bethesda. MD. 1995.
42. Warner JO, Naspitz CK: Third international pediatric consensus statement on the management of childhood asthma. Ped Pneumol 25, 1-17, 1998.
43. Passalacqua G, et al: Local immunotherapy: pharmacokinetics and efficacy. Allergy 53, 477-484,1998.
44. Tari MG, et al: Efficacy of sublingual immunotherapy in patients with rhinitis and asthma due to house dust mite. A doubleblind study. Allergol et Immunopathol 18, 5, 277-84,1990.
45. Greineder DK: Risk management in allergen immunotherapy. J Allergy Clin Immunol 98, S330-4, 1996.
46. Rogala B: Risk and safety of immunotherapy. Allergy 53, 473-476, 1998.
47. Ownby DR, et al: The appropriate use of skin testing and immunotherapy in young children. J Allergy Clin Immunol 94, 662-5, 1994.
48. Hejjaoui A, et al: Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. IV. Systemic reactions according to the immunotherapy schedule. J Allergy Clin Immunol 85, 473-9, 1990.
49. Businco L, et al: Systemic reactions to specific immunotherapy in children with respiratory allergy: a prospective study. Pediatr Allergy Immunol 6, 44-7, 1995.
50. Cantani A, et al: Specific immunotherapy (SIT) in children. Allergy 51, 365-6, 1996.
51. André C, et al. Allergy 53 (Suppl. 43), S116, 1998.
52. Longo G, Panizon F: Aspetti particolari dell’immunoterapia specifica in età pediatrica: quando cominciare? Asma Allergia Immunopatologia 77, 5-12, 1989.