, Volume 8, Issue 6, pp 465-474
Date: 23 Nov 2008

Subcutaneous and sublingual immunotherapy in children: Complete update on controversies, dosing, and efficacy

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For this review, articles on immunotherapy dosing in pediatric respiratory allergy were identified via PubMed, through congressional abstracts for 2008, in reference lists of recent review articles, and via personal communication with experts. In pediatric subcutaneous immunotherapy (SCIT), doses shown to be effective, mostly in aluminium-adsorbed preparations administered every 6 weeks, contain 20 μg of group 5 major allergen, 12 μg Bet v 1, 15 μg Fel d 1, and 5 to 20 μg Der p 1. Evidence indicates that SCIT prevents new sensitizations and asthma onset 7 years after discontinuation and reduces symptoms 12 years after a 5-year SCIT course, even though skin reactivity returns. Consistent evidence of effect exists for sublingual immunotherapy in pediatric respiratory allergy with daily 15-to 25-μg grass group 5 major allergen and 6 μg Bet v 1. Der p/f doses of 0.8/0.4 μg three times weekly (up to 27/57 μg daily) demonstrate inconsistent findings. Evidence of effect exists for SCIT in pediatric allergic rhinitis and asthma as treatment and preventive management. Evidence of effect exists for sublingual immunotherapy in pediatric allergic rhinoconjunctivitis and seasonal asthma. Similar results are doubtful for perennial asthma.