Contoli, Marco; Porsbjerg, Celeste; Fritzsching, Benedikt; Buchs, Sarah; Rask Larsen, Julie; Freemantle, Nick; (2023) Long-term, real-world effects of allergy immunotherapy in children with allergic rhinitis and pre-existing asthma - a subgroup analysis of the REACT study. Allergologie , 46 (10)

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Abstract

Background: Randomised controlled trials (RCTs) have demonstrated the efficacy of allergy immunotherapy (AIT) in allergic rhinitis (AR) and the disease-modifying effects of the SQ grass sublingual immunotherapy (SLIT)-tablet.// Objective: To assess real-world, long-term effectiveness and safety across AIT subgroups: route of administration, therapeutic allergen, persistence to AIT, and SQ grass SLIT-tablet.// Methods: The primary outcome of AR prescriptions from a retrospective cohort study (REACT; 2007–2017) was assessed across pre-specified AIT subgroups in AR subjects with, and without AIT prescriptions (controls). Safety was assessed as anaphylaxis ≤2 days of the first AIT prescription. Subgroup follow-up continued until samples were <200 subjects.// Results: Subcutaneous immunotherapy (SCIT) and SLIT-tablets showed similarly greater reductions in AR prescriptions than controls (SCIT versus SLIT-tablets: Year 3, p=0.15; Year 5, p=0.43). Comparably greater reductions in AR prescriptions were observed for grass- and house dust mite (HDM)-specific AIT than controls, but significantly smaller reductions were observed for tree-specific AIT (tree versus HDM, and versus grass: Years 3 and 5, p<0.0001). Persistence to AIT was associated with greater reductions in AR prescriptions versus non-persistence (persistence versus nonpersistence: Year 3, p=0.09; Year 5, p=0.006). SQ grass SLIT-tablet showed sustained reductions versus controls for up to 7 years (Year 3, p=0.002; Year 5, p=0.03). Rates of anaphylactic shock were low (0.000–0.092%), with no events for SQ SLIT-tablets.// Conclusion: These results demonstrate real-world, long-term effectiveness of AIT, complement disease-modifying effects observed in SQ grass SLIT-tablet RCTs, and highlight the importance of using newer evidence-based AIT products for tree pollen AR.

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