Allergic rhinitis (AR) is a common chronic childhood disease with considerable social burden and impact on quality of life, frequently necessitating treatment with various combinations of antihistamines and corticosteroids. The allergen immunotherapy (AIT), sometimes known as desensitisation therapy, can modify the IgE-mediated disease process in AR. Through repeated allergen exposure at regular intervals, immunological tolerance can be induced to achieve long-lasting symptom relief. Due to its increasing popularity, the European Academy of Allergy and Clinical Immunology (EAACI) has recently developed a clinical guideline for the use of AIT in AR.

The key recommendation is that a three-year course of AIT can be used for patients with moderate-to-severe pollen induced AR, who are suboptimally controlled on antihistamine and nasal steroids. Both subcutaneous and sublingual routes are effective administration routes. Furthermore, this is shown to have a significant effect in preventing the development of asthma in the short term (for up to two years) following the completion of the AIT treatment.

As a disease-modifying intervention, AIT can also be considered in patients with milder AR, to reduce other medication use and to allow derivation of similar clinical benefits in sustained symptoms relief and asthma prevention. Having taken into consideration its potential adverse effects, disadvantages and costs, the guideline also concludes a favourable risk benefit profile for the use of AIT in managing AR. Nonetheless, it is worth noting that some of the subjects from the prevention studies included in the guideline did not necessarily adopt the ARIA criteria in the grading of AR. Overall, this guideline aims to increase awareness about the efficacy of the AIT. Clinicians are encouraged to develop local care pathways and to actively consider the AIT in the therapeutic armamentarium available for treating AR in the paediatric population.

EAACI guidelines on allergen immunotherapy: prevention of allergy.
Halken S, Larenas-Linnemann D, Roberts G, et al.
PAEDIATRIC ALLERGY AND IMMUNOLOGY
2017;28(8):728-45.
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Shiying Hey

Ninewells Hospital, Dundee, UK.

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