Early sublingual immunotherapy for allergic rhinitis reduces risks for allergic asthma
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Key takeaways:
- Early sublingual immunotherapy reduces patient-years compared with patients who start it later.
- Early initiation also can save 1,950 euro over 20 years compared with later initiation.
Children who begin sublingual immunotherapy for allergic rhinitis at age 5 years have less risk for developing allergic asthma than children who begin this treatment later, according to a study published in Allergy.
Early initiation also improves quality of life and reduces health care costs, Eckard Hamelmann, MD, PhD, chief physician, Clinic for Pediatric and Adolescent Medicine, Bethel Children’s Center, Evangelical Hospital, Bielefeld, Germany, and colleagues wrote.
“It has been shown in multiple clinical studies that allergy immunotherapy (AIT), not surprisingly, works well and is efficacious in the pediatric population with allergic rhinitis,” Hamelmann told Healio.
Also, Hamelmann said, clinical trials have shown that AIT potentially has an even greater effect for children compared with adults in terms of reducing the risk for developing asthma.
“We wanted to explore the hypothesis that early vs. later initiation of AIT in children with allergic rhinitis has a positive impact on reducing disease progression and risk of asthma development by developing a statistical model,” Hamelmann said.
Study design, results
The study comprised 812 children (63% boys; mean age, 8.6 years) diagnosed with moderate to severe grass pollen allergic rhinitis (AR) but no allergic asthma, including 305 diagnosed with AR when they were aged younger than 5 years, 253 diagnosed between ages 5 and 7 years and 254 diagnosed when they were aged older than 7 years.
Also, 398 of these children received sublingual immunotherapy (SLIT) tablets in the 3 years following diagnosis in addition to medication for relieving symptoms. The other 414 children only used symptom-relieving medication in the following 3 years.
During the next 20 years, 19% of the children who began SLIT at age 5 years, 24% of those who began SLIT at age 7 years and 29% of those who began at age 12 years developed allergic asthma.
The children who began SLIT at age 5 years also had 294 fewer patient-years than those who began at age 7 years and 578 fewer patient-years than those who began at age 12 years, in addition to increases in quality of life compared with those who began treatment later.
Based on modeling, the researchers also predicted that 27% of the children who were diagnosed with moderate to severe AR at age 5 years but who did not receive SLIT tablets would develop asthma within the following decade.
In comparison, the researchers continued, 16% of the children who were diagnosed with AR and began SLIT at age 5 years would develop allergic asthma, for a risk reduction of 41%.
Total costs per patient in the 20 years following the AR diagnosis included 20,429 euro (95% CI, 19,116 to 21,776) for children who began SLIT at age 5 years, 21,050 euro (95% CI, 19,904 to 22,182 euro) for those with initiation at age 7 years and 22,379 euro (95% CI, 21,273 to 23,487 euro) for those beginning at age 12 years.
The researchers further predicted that the children who began SLIT at age 5 years would experience a 1,950 euro reduction in health care costs 20 years after AR diagnosis and a 2,097 euro reduction in health care costs 50 years after AR diagnosis compared with those who began SLIT at age 12.
Conclusions, next steps
Based on these findings, the researchers called the reduction in new onset allergic asthma cases among children with AR with initiation of SLIT clinically meaningful and permanent, with the greatest benefits including costs savings and improved quality of life with early initiation.
“Our working assumption was that time to initiation of AIT matters in children,” Hamelmann said. “It was surprising that our study showed a difference in effect sizes by delaying initiation of AIT by ‘only’ 1 year/one pollen season with a negative impact on developing new onset of asthma.
Also, Hamelmann expressed surprise that early initiation of AIT had the largest reduction on the risk for developing asthma without increasing the overall treatment cost.
“For pollen allergy, a delay of 1 year translates into just one pollen season,” he said.
“In other words, if continuously optimizing symptomatic medication season after season, instead of treating the underlaying cause of the disease with allergy immunotherapy, the expected population-based outcome and disease progression will be negatively affected.”
Hamelmann called the time to AIT initiation “essential” for children with allergic rhinitis.
“The ‘wait and see’ strategy with continuous use of symptom-relieving medications is not an optimal solution for all children suffering from allergic rhinitis,” he said.
Furthermore, he said, the findings reassure physicians that early initiation of AIT in children with allergic rhinitis not only improves clinical outcomes, but also does not add to the overall treatment costs.
“It would be great if the same results could be confirmed for perennial allergy such as house dust mite allergy, where we know that the risk of developing asthma is even larger than for seasonal allergies such as grass or birch,” Hamelmann said.
So, he continued, he would like to see more data from interventional studies about asthma prevention including house dust mite AIT.
“Also, more solid real-world evidence studies using bigger databases may be an opportunity for generating more real-life data of the clinical benefits of AIT in children,” he said.
For more information:
Eckard Hamelmann, MD, PhD, can be reached at eckard.hamelmann@uni-bielefeld.de.