Efficacy and safety of allergen immunotherapy in children.

OBJECTIVE: To determine the efficacy and safety of immunotherapy in children with allergic rhinitis and allergic asthma. DATA SOURCES: Current Contents database for 1967 to 2005. STUDY SELECTION: The expert opinion of the author was used to select studies for inclusion in this review.
RESULTS: Meta-analyses have confirmed the clinical effectiveness of allergen immunotherapy in patients with allergic rhinitis and asthma; however, most studies involved immunotherapy with a single allergen. Special considerations of safety regarding immunotherapy in children are also necessary, since fatalities have been reported. Fatal reactions occur primarily in patients with asthma and particularly those whose asthma is not well controlled. There is probably increased risk during the build-up phase and with the first injection from a new vial. Injections at home or in clinics without adequate supervision also constitute an increased risk of a fatal outcome.
CONCLUSIONS: Specific immunotherapy has been demonstrated to have some protective effect against the development of additional sensitivities in the monosensitized child and to reduce the risk of developing asthma in children with allergic rhinitis. Because of the modification of the underlying immune process, the beneficial effects of immunotherapy persist for a long but not yet fully determined period after the cessation of treatment. This persisting effect makes immunotherapy an attractive supplement to symptomatic treatment of children with allergic asthma and allergic rhinitis. The treatment is not without risk, however, especially in the child with asthma, so it should be administered with caution.