TY - JOUR
T1 - Coseasonal Initiation of Allergen Immunotherapy
T2 - A Systematic Review
AU - Creticos, Peter S.
AU - Bernstein, David I.
AU - Casale, Thomas B.
AU - Lockey, Richard F.
AU - Maloney, Jennifer
AU - Nolte, Hendrik
N1 - Funding Information:
Medical writing and editorial assistance was provided by Erin P. Scott, PhD, and Ben Scott, PhD, of Scott Medical Communications, LLC. This assistance was funded by Merck & Co, Inc, Kenilworth, NJ, USA.
Publisher Copyright:
© 2016 American Academy of Allergy, Asthma & Immunology
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background It is unclear whether allergen immunotherapy (AIT) can be safely initiated during the pollen season (coseasonal initiation [CSI]) because of a potential increased risk of systemic allergic reactions. Objective To systematically review publications reporting the safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) CSI to validate or invalidate the perception of increased safety risk. Methods PubMed, EMBASE, Ovid, Literatura Latino Americana em Ciências da Saúde (LILACS), and Cochrane Library databases were searched without limits for studies of any design reporting SCIT or SLIT CSI for pollen allergen. Congress abstracts were included. Results Nineteen eligible studies were identified: 8 SCIT (n = 947 subjects total; n = 340 double-blind placebo-controlled [DBPC]) and 11 SLIT (n = 2668 subjects total; n = 565 DBPC). Study characteristics and safety reporting were heterogeneous. No epinephrine administrations were reported. Discontinuation frequencies were 6% or less and 10% or less with SCIT and SLIT CSI, respectively. In SCIT studies, systemic allergic reaction frequency was 0% to 7% with “up to peak season” or CSI, 0% to 6% with “after peak season” or out-of-season initiation, and 0% to 7% with placebo. In SCIT studies, serious treatment-related adverse event (AE) frequency with CSI ranged from 0% to 2%; few severe AEs were reported. In SLIT studies, systemic allergic reaction frequency ranged from 0% to 4% with CSI, 0% with out-of-season initiation, and 0% to 2% with placebo. Overall, 2 serious treatment-related AEs with SLIT CSI were reported. Severe AE frequency in SLIT studies ranged from 0% to 8% with CSI, 0% to 12% with out-of-season initiation, and 0% to 8% with placebo. Conclusions No increase in AEs of concern was observed with SCIT or SLIT CSI; however, additional data with standardized regimens and doses are needed.
AB - Background It is unclear whether allergen immunotherapy (AIT) can be safely initiated during the pollen season (coseasonal initiation [CSI]) because of a potential increased risk of systemic allergic reactions. Objective To systematically review publications reporting the safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) CSI to validate or invalidate the perception of increased safety risk. Methods PubMed, EMBASE, Ovid, Literatura Latino Americana em Ciências da Saúde (LILACS), and Cochrane Library databases were searched without limits for studies of any design reporting SCIT or SLIT CSI for pollen allergen. Congress abstracts were included. Results Nineteen eligible studies were identified: 8 SCIT (n = 947 subjects total; n = 340 double-blind placebo-controlled [DBPC]) and 11 SLIT (n = 2668 subjects total; n = 565 DBPC). Study characteristics and safety reporting were heterogeneous. No epinephrine administrations were reported. Discontinuation frequencies were 6% or less and 10% or less with SCIT and SLIT CSI, respectively. In SCIT studies, systemic allergic reaction frequency was 0% to 7% with “up to peak season” or CSI, 0% to 6% with “after peak season” or out-of-season initiation, and 0% to 7% with placebo. In SCIT studies, serious treatment-related adverse event (AE) frequency with CSI ranged from 0% to 2%; few severe AEs were reported. In SLIT studies, systemic allergic reaction frequency ranged from 0% to 4% with CSI, 0% with out-of-season initiation, and 0% to 2% with placebo. Overall, 2 serious treatment-related AEs with SLIT CSI were reported. Severe AE frequency in SLIT studies ranged from 0% to 8% with CSI, 0% to 12% with out-of-season initiation, and 0% to 8% with placebo. Conclusions No increase in AEs of concern was observed with SCIT or SLIT CSI; however, additional data with standardized regimens and doses are needed.
KW - Allergen immunotherapy
KW - Allergic rhinoconjunctivitis
KW - Co-seasonal
KW - In-season
KW - Initiation
KW - Intra-seasonal
KW - Safety
UR - http://www.scopus.com/inward/record.url?scp=84977521834&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84977521834&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2016.05.014
DO - 10.1016/j.jaip.2016.05.014
M3 - Article
C2 - 27349175
AN - SCOPUS:84977521834
SN - 2213-2198
VL - 4
SP - 1194-1204.e4
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 6
ER -