Efficacy and Safety of Dust Mite Sublingual Immunotherapy for Pediatric Allergic Rhinitis: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGQian , YASINAbdurehim , QUYa-ming , YONGJun ,  YALKUNYasin

Department of Otolaryngology, First Affiliated Hospital of Xin Jiang Medical University, Urumqi 830054, China;

Corresponding author：

YALKUNYasin, Email: ebhylk@126.com

Keywords：

Allergic rhinitis; Children; House dust mite; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140221

Video：

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Objective To systematically review the efficacy and safety of dust mite sublingual immunotherapy (SLIT) in the treatment of children with allergic rhinitis. Methods Randomized controlled trials (RCTs) about SLIT treating allergic rhinitis in pediatric patients was searched in PubMed, EMbase, CBM, Ovid, The Cochrane Library (Issue 5, 2014), CNKI, VIP and WanFang Data from inception to May 2014. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.3 software. Results A total of nine RCTs including 663 patients were finally included. The results of meta-analysis indicated that:the trial group was superior to the control group in reducing the scores of drug use (SMD=-0.61, 95%CI-0.94 to-0.27, P=0.000 4) and mite-specific serum IgE levels (follow-up time > 22 weeks:SMD=0.71, 95%CI 0.31 to 1.12, P=0.000 5). However, no significant difference was found between the two groups in the scores of nasal symptoms (SMD=0.06, 95%CI-0.13 to 0.25, P=0.55) and the incidence of adverse reaction (OR=1.3, 95%CI 0.89 to 1.90, P=0.17). Conclusion SLIT could decrease the use frequency of antihistamine, β-agonist and nasal spray steroids, and it has less adverse reaction and better safety in the treatment of children with allergic rhinitis. But SLIT could neither effectively alleviate nasal symptoms nor reduce mite-specific serum IgE levels of pediatric patients with allergic rhinitis in a short time.

Citation： ZHANGQian, YASINAbdurehim, QUYa-ming, YONGJun, YALKUNYasin. Efficacy and Safety of Dust Mite Sublingual Immunotherapy for Pediatric Allergic Rhinitis: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(11): 1373-1379. doi: 10.7507/1672-2531.20140221 Copy

1.	Thompson AK, Juniper E, Meltzer EO. Quality of life in patients withallergic rhinitis. Ann Allerg Asthma Im, 2000, 85(22):338-348.
2.	Asher MI, Montefort S, Bjorksten B, et al. Worldwide time trends in the prevalence of symptom of asthma, allergic rhinocojunctivitis, and eczema in childhood:ISAAC Phases One and Three repeat multicountry cross-section surveys. Lancet, 2006, 368(9537):733-743.
3.	Wong GW, Hui DS, Chan HH, et al. Prevalence of respiratory and atopic disorders in Chinese school children. Clin Exp Allergy, 2001, 31(7):1225-1231.
4.	Zhao J, Bai J, Shen K, et al. Self-reported prevalence of childhood allergic diseases in three cities of China:a multicenter study. BMC Public Health, 2010, 10(22):551.
5.	Li J, Sun B, Huang Y, et al. A multicentre study assessing the prevalence of sensitization in patient with asthma and/or rhinitis in China. Allergy, 2009, 64(5):1083-1092.
6.	王成硕, 张罗, 韩德民, 等.北京地区变应性鼻炎患者吸入变应原谱分析.临床耳鼻咽喉科杂志, 2006, 20(5):204-206.
7.	Adrienne ML, Rodney JS, Sarah K, et al. Sublingual immunotherapy and quality of life. Curr Opin & Otolaryngol Head Neck Surg, 2013, 1(8):252-255.
8.	Linnemann DEL. One hundred years of immnotherapy:review of the first landmark studies. Allergy Asthma Proc, 2012, 33(17):122-128.
9.	Wise SK, Schlosser RJ. Subcutaneous and sublingual immunotherapy for allergic rhinitis:what is the evidence? Am J Rhinol Allergy, 2012, 26(11):18-22.
10.	Wilson D, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis:systematic review and meta-analysis. Allergy, 2005, 60(1):4-12.
11.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0[updated March 2011]. The Cochrane Collaborations, 2011. Available at: http://www.cochrane.org/.
12.	Hirsch Th, Sähn M, Leupold W. Double-blind placebo-controlled study of sublingual immunotherapy with house dust mite extract (D.pt.) in children. Pediatr Allergy Immunol, 1997, 8(9):21-27.
13.	Bahceciler NN, Isik U, Barlan IB, et al. Efficacy of sublingual immunotherapy in children with asthma and rhinitis:a double-blind, placebo-controlled study. Pediatr Pulm, 2001, 32(21):49-55.
14.	Ippoliti F, de Sanctis W, Volterrani A, et al. Immunomodulation during sublingual therapy in allergic children. Pediatr Allergy Immunol, 2003, 14(9):216-221.
15.	Marcucci F, Sensi L, Frati F, et al. Effects on inflammation parameters of a double-blind, placebo controlled one-year course of SLIT in children monosensitized to mites. Allergy, 58(9):657-662, 2003.
16.	曹兰芳, 陆权, 顾洪亮, 等.舌下含服粉尘螨滴剂治疗儿童过敏性哮喘和变应性鼻炎的临床评价.中华儿科杂志, 2007, 45(10):736-741.
17.	Tseng SH, Fu LS, Nong BR, et al. Changes in serum specific IgG4 and IgG4/IgE ratio in mite-sensitized Taiwanese children with allergic rhinitis receiving short-term sublingual swallow immunotherapy:a multicenter, randomized, placebo-controlled trial. Asian Pac J Allergy Immunol, 2008, 26(2-3):105-112.
18.	Yonekura S, Okamoto Y, Sakurai D, et al. Sublingual immunotherapy with house dust extract for house dust-mite allergic rhinitis in children. Allergol Int, 2010, 59(4):381-388.
19.	de Bot CMA, Moed H, Berger MY, et al. Sublingual immunotherapy not effective in house dust mite-allergic children in primary care. Psdiatr Allergy Immunol, 2012, 23(7):150-158.
20.	Aydogan M, Eifan AO, Keles S, et al. Sublingual immunotherapy in children with allergic rhinoconjuncticitis mono-sensitized to house-dust-mites:a double-blind-placebo-controlled randomized trial. Resp Med, 2013, 107(12):1322-1329.
21.	Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA (2) LEN and Allergen). Allergy, 2008, 63(Suppl 86):8-160.
22.	Stoltz DJ, Jackson DJ, Evans MD, et al. Specfic patterns of allergic sensitization in early children and asthma & rhinitis risk. Clin Exp Allergy, 2013, 43(2):233-241.
23.	Bousquet J, Lockey R, Mallingh J. Allergen immuno therapy:ther apeutic v accines for allergic diseases. Aller gy, 1998, 53(6):41-42.
24.	Gary L, Elina T. Sublingual immunotherapy:what we can learn from the European experience. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(3):208-210.
25.	Pipet A, Botturi K, Pinot D, et al. Allergen-specific immunotherapy in allergic rhinitis and asthma. Mechanisms and Proof of Efficacy, 2009, 103(2):800-812.
26.	Désirée L. Sublingual immunotherapy in children:complete and updated review supporting evidence of effect. Curr Opin Allergy Cl, 2009, 9(22):168-176.
27.	Hoek SB, de Groot H, van Wijk RG. Immunotherapy in children and adolescents with allergic rhinoconjunctivitis:a systematic review. Pediatr Allergy Immunol, 2008, 19(2):197-207.
28.	Gianenrico S, Marco C, Giorgio WC. Safety and tolerability of sublingual immunotherapy in clinical trials and real life. Curr Opin Allergy Clin Immunol, 2013, 13(11):656-662.
29.	Penagos M, Compalati E, Tarantini F, et al. Efficacy of sublingual immunotherapy in the treatment of allergic rhinitis in pediatric patients 3 to 18 years of age:a meta-analysis of randomized, placebo controlled, double-blind trials. Ann Allergy Asthma Immunol, 2006, 97(12):141-148.
30.	Compalati E, Passalacqua G, Bonini M, et al. The efficacy of sublingual immunotherapy for house dust mites respiratory allergy:results of a GA2LEN meta-analysis. Allergy, 2009, 64(11):1570-1579.
31.	Bush RK, Swenson C, Fahlberg B, et al. House dust mite sublingual immunotherapy:result of a US trial. J Allergy Clin Immunol, 2011, 127(4):974-981.
32.	Li F, Wu XL, Duan GW, et al. Regulatory T cells for long-lasting effect on asthmatic children caused by dermatophagoides farinae with sublingual imunotherapy. Chin J Appl Clin Pediatr, 2013, 28(9):673-675.
33.	Ferres J, Justicia JL, GarcÍa MP, et al. Efficacy of high-dose sublingual immunotherapy in children allergic to house dust mites in real life clinical practice. Allergol Immunopathol (Madr), 2011, 39(3):122-127.
34.	Rask C, Brimnes J, Lund K. Short dosing interval of sublingual immunotherapy lead to more efficacious treatment in a mouse model of allergic inflammation. Scand J Immunol, 2010, 71(8):403-412.
35.	Palm NW, Rosenstein RK, Medzhitov R. Allergic host defences. Nature, 2012, 484(7395):465-472.
36.	Passalacqua G, Durham SR. Allergic rhinitis and its impact on asthma update:allergen immunotherapy. J Allergy Clin Immunol, 2007, 19(4):881-891.

1. Thompson AK, Juniper E, Meltzer EO. Quality of life in patients withallergic rhinitis. Ann Allerg Asthma Im, 2000, 85(22):338-348.
2. Asher MI, Montefort S, Bjorksten B, et al. Worldwide time trends in the prevalence of symptom of asthma, allergic rhinocojunctivitis, and eczema in childhood:ISAAC Phases One and Three repeat multicountry cross-section surveys. Lancet, 2006, 368(9537):733-743.
3. Wong GW, Hui DS, Chan HH, et al. Prevalence of respiratory and atopic disorders in Chinese school children. Clin Exp Allergy, 2001, 31(7):1225-1231.
4. Zhao J, Bai J, Shen K, et al. Self-reported prevalence of childhood allergic diseases in three cities of China:a multicenter study. BMC Public Health, 2010, 10(22):551.
5. Li J, Sun B, Huang Y, et al. A multicentre study assessing the prevalence of sensitization in patient with asthma and/or rhinitis in China. Allergy, 2009, 64(5):1083-1092.
6. 王成硕, 张罗, 韩德民, 等.北京地区变应性鼻炎患者吸入变应原谱分析.临床耳鼻咽喉科杂志, 2006, 20(5):204-206.
7. Adrienne ML, Rodney JS, Sarah K, et al. Sublingual immunotherapy and quality of life. Curr Opin & Otolaryngol Head Neck Surg, 2013, 1(8):252-255.
8. Linnemann DEL. One hundred years of immnotherapy:review of the first landmark studies. Allergy Asthma Proc, 2012, 33(17):122-128.
9. Wise SK, Schlosser RJ. Subcutaneous and sublingual immunotherapy for allergic rhinitis:what is the evidence? Am J Rhinol Allergy, 2012, 26(11):18-22.
10. Wilson D, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis:systematic review and meta-analysis. Allergy, 2005, 60(1):4-12.
11. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0[updated March 2011]. The Cochrane Collaborations, 2011. Available at: http://www.cochrane.org/.
12. Hirsch Th, Sähn M, Leupold W. Double-blind placebo-controlled study of sublingual immunotherapy with house dust mite extract (D.pt.) in children. Pediatr Allergy Immunol, 1997, 8(9):21-27.
13. Bahceciler NN, Isik U, Barlan IB, et al. Efficacy of sublingual immunotherapy in children with asthma and rhinitis:a double-blind, placebo-controlled study. Pediatr Pulm, 2001, 32(21):49-55.
14. Ippoliti F, de Sanctis W, Volterrani A, et al. Immunomodulation during sublingual therapy in allergic children. Pediatr Allergy Immunol, 2003, 14(9):216-221.
15. Marcucci F, Sensi L, Frati F, et al. Effects on inflammation parameters of a double-blind, placebo controlled one-year course of SLIT in children monosensitized to mites. Allergy, 58(9):657-662, 2003.
16. 曹兰芳, 陆权, 顾洪亮, 等.舌下含服粉尘螨滴剂治疗儿童过敏性哮喘和变应性鼻炎的临床评价.中华儿科杂志, 2007, 45(10):736-741.
17. Tseng SH, Fu LS, Nong BR, et al. Changes in serum specific IgG4 and IgG4/IgE ratio in mite-sensitized Taiwanese children with allergic rhinitis receiving short-term sublingual swallow immunotherapy:a multicenter, randomized, placebo-controlled trial. Asian Pac J Allergy Immunol, 2008, 26(2-3):105-112.
18. Yonekura S, Okamoto Y, Sakurai D, et al. Sublingual immunotherapy with house dust extract for house dust-mite allergic rhinitis in children. Allergol Int, 2010, 59(4):381-388.
19. de Bot CMA, Moed H, Berger MY, et al. Sublingual immunotherapy not effective in house dust mite-allergic children in primary care. Psdiatr Allergy Immunol, 2012, 23(7):150-158.
20. Aydogan M, Eifan AO, Keles S, et al. Sublingual immunotherapy in children with allergic rhinoconjuncticitis mono-sensitized to house-dust-mites:a double-blind-placebo-controlled randomized trial. Resp Med, 2013, 107(12):1322-1329.
21. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA (2) LEN and Allergen). Allergy, 2008, 63(Suppl 86):8-160.
22. Stoltz DJ, Jackson DJ, Evans MD, et al. Specfic patterns of allergic sensitization in early children and asthma & rhinitis risk. Clin Exp Allergy, 2013, 43(2):233-241.
23. Bousquet J, Lockey R, Mallingh J. Allergen immuno therapy:ther apeutic v accines for allergic diseases. Aller gy, 1998, 53(6):41-42.
24. Gary L, Elina T. Sublingual immunotherapy:what we can learn from the European experience. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(3):208-210.
25. Pipet A, Botturi K, Pinot D, et al. Allergen-specific immunotherapy in allergic rhinitis and asthma. Mechanisms and Proof of Efficacy, 2009, 103(2):800-812.
26. Désirée L. Sublingual immunotherapy in children:complete and updated review supporting evidence of effect. Curr Opin Allergy Cl, 2009, 9(22):168-176.
27. Hoek SB, de Groot H, van Wijk RG. Immunotherapy in children and adolescents with allergic rhinoconjunctivitis:a systematic review. Pediatr Allergy Immunol, 2008, 19(2):197-207.
28. Gianenrico S, Marco C, Giorgio WC. Safety and tolerability of sublingual immunotherapy in clinical trials and real life. Curr Opin Allergy Clin Immunol, 2013, 13(11):656-662.
29. Penagos M, Compalati E, Tarantini F, et al. Efficacy of sublingual immunotherapy in the treatment of allergic rhinitis in pediatric patients 3 to 18 years of age:a meta-analysis of randomized, placebo controlled, double-blind trials. Ann Allergy Asthma Immunol, 2006, 97(12):141-148.
30. Compalati E, Passalacqua G, Bonini M, et al. The efficacy of sublingual immunotherapy for house dust mites respiratory allergy:results of a GA2LEN meta-analysis. Allergy, 2009, 64(11):1570-1579.
31. Bush RK, Swenson C, Fahlberg B, et al. House dust mite sublingual immunotherapy:result of a US trial. J Allergy Clin Immunol, 2011, 127(4):974-981.
32. Li F, Wu XL, Duan GW, et al. Regulatory T cells for long-lasting effect on asthmatic children caused by dermatophagoides farinae with sublingual imunotherapy. Chin J Appl Clin Pediatr, 2013, 28(9):673-675.
33. Ferres J, Justicia JL, GarcÍa MP, et al. Efficacy of high-dose sublingual immunotherapy in children allergic to house dust mites in real life clinical practice. Allergol Immunopathol (Madr), 2011, 39(3):122-127.
34. Rask C, Brimnes J, Lund K. Short dosing interval of sublingual immunotherapy lead to more efficacious treatment in a mouse model of allergic inflammation. Scand J Immunol, 2010, 71(8):403-412.
35. Palm NW, Rosenstein RK, Medzhitov R. Allergic host defences. Nature, 2012, 484(7395):465-472.
36. Passalacqua G, Durham SR. Allergic rhinitis and its impact on asthma update:allergen immunotherapy. J Allergy Clin Immunol, 2007, 19(4):881-891.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Dust Mite Sublingual Immunotherapy for Pediatric Allergic Rhinitis: A Meta-Analysis

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