1
|
Escarrer-Jaume M, Juliá-Benito JC, Quevedo-Teruel S, Del Prado AP, Sandoval-Ruballos M, Quesada-Sequeira F, Álvaro-Lozano M. Changes in epidemiology and clinical practice in IgE-mediated Allergy in children. An Pediatr (Barc) 2021; 95:56.e1-56.e8. [PMID: 34183295 DOI: 10.1016/j.anpede.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, it is estimated around 10% in Spain. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a significant public health problem. Taking into account epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of the European population will suffer from some type of allergic disorder. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain possible cross reactivity, anticipate potential risk of food trangressions, and prescribe correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in quality of life.
Collapse
Affiliation(s)
- Mercedes Escarrer-Jaume
- Unidad de Alergología y Neumología Pediátrica Clínica Juaneda, Palma de Mallorca, Spain; Centro de Salud San Agustín, Palma de Mallorca, Spain.
| | - Juan Carlos Juliá-Benito
- Centro de Salud República Argentina, Valencia, Spain; Unidad de Alergología y Neumología Pediátrica, Hospital IMED, Valencia, Spain
| | - Sergio Quevedo-Teruel
- Unidad de Alergia y Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Spain; Universidad Alfonso X el Sabio, Villanueva de la Cañada, Spain
| | - Ana Prieto Del Prado
- Unidad de Alergia Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA, Málaga, Spain
| | - Mónica Sandoval-Ruballos
- Servicio de Alergia y Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Montserrat Álvaro-Lozano
- Servicio de Alergia y Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Escarrer-Jaume M, Juliá-Benito JC, Quevedo-Teruel S, Prieto Del-Prado A, Sandoval-Ruballos M, Quesada-Sequeira F, Álvaro-Lozano M. [Changes in epidemiology and clinical practice in IgE-mediated allergy in children]. An Pediatr (Barc) 2021. [PMID: 34119433 DOI: 10.1016/j.anpedi.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, in Spain is estimated around 10%. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a public health problem of the first magnitude. Considering epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of European population will suffer from some type of allergy. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain the possible cross reactivity, anticipate potential risk of food transgressions, and prescribe the correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in patients quality of life.
Collapse
Affiliation(s)
- Mercedes Escarrer-Jaume
- Unidad de Alergología y Neumología pediátrica Clínica Juaneda, Palma de Mallorca, España; Centro de salud San Agustín, Palma de Mallorca, España.
| | - Juan Carlos Juliá-Benito
- Centro de salud República Argentina, Valencia, España; Unidad de alergología y neumología pediátrica, Hospital IMED, Valencia, España
| | - Sergio Quevedo-Teruel
- Unidad de Alergia y Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, España; Universidad Alfonso X el Sabio, Villanueva de la Cañada, España
| | - Ana Prieto Del-Prado
- Unidad de Alergia Pediátrica, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga. IBIMA, Málaga, España
| | - Mónica Sandoval-Ruballos
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | | | - Montserrat Álvaro-Lozano
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, España; Institut de Recerca Sant Joan de Déu, Barcelona, España; Universitat de Barcelona, Barcelona, España
| |
Collapse
|
3
|
Arasi S, Pajno GB, Panasiti I, Sandoval M, Alvaro-Lozano M. Allergen Immunotherapy in children with respiratory allergic diseases. Minerva Pediatr 2020; 72:343-357. [PMID: 32731732 DOI: 10.23736/s0026-4946.20.05959-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Allergen immunotherapy (AIT) is a well-established treatment for allergic respiratory diseases. It represents a cornerstone in the clinical management of allergic children since it is the only curative option to date able to modify the natural history of Ig-E mediated allergic diseases. Through a well-defined immunologic mechanism, AIT promotes regulatory T cells and cuts down the immune response induced by allergens. According to current guidelines based on up-to-date evidence, AIT should be offered to children with moderate-severe allergic rhinitis and/or controlled asthma starting from 5 years of age, further to an adequate risk-benefit assessment which includes patient's adherence to the treatment and a proper selection of the right product. Younger age and mild disease could be considered based on an individual evaluation. Both subcutaneous (SCIT) and sublingual (SLIT) routes of administration have a good efficacy and safety profile with safer outcomes for SLIT compared to SCIT. Only standardized products with documented evidence of clinical efficacy should be used. Although AIT is used worldwide, there are still gaps and limitations, including the lack of reliable biomarkers predictive of the clinical outcome. Novel adjuvants are currently under investigations to boost the strength and efficiency of the immune response, as well as new formulations with better efficacy and better patient's adherence to the treatment. Herein, we aim to provide an overview of current key evidence with major regard to clinical practice as well as knowledge gaps and future research needs in the context of AIT in children with respiratory allergic diseases.
Collapse
Affiliation(s)
- Stefania Arasi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy -
| | - Giovanni B Pajno
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Ilenia Panasiti
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Mónica Sandoval
- Department of Allergy and Clinical Immunology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Montserrat Alvaro-Lozano
- Department of Allergy and Clinical Immunology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| |
Collapse
|
4
|
Sublingual immunotherapy in children. Allergol Immunopathol (Madr) 2018; 46:105-106. [PMID: 29458988 DOI: 10.1016/j.aller.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/25/2018] [Indexed: 11/24/2022]
|
5
|
Alvaro M, Escarrer M. Food allergy in childhood: Are we close to having an effective treatment? Allergol Immunopathol (Madr) 2017; 45:313-315. [PMID: 28688477 DOI: 10.1016/j.aller.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 12/22/2022]
|
6
|
Allergen-Specific Immunotherapy for Respiratory Allergy in Children: Unmet Needs and Future Goals. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:946-950. [PMID: 28389302 DOI: 10.1016/j.jaip.2017.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/15/2016] [Accepted: 01/19/2017] [Indexed: 12/20/2022]
Abstract
Allergen-specific immunotherapy for the treatment of respiratory allergy is currently supported, at least for selected products, by evidence of efficacy and effectiveness in the pediatric age. However, unmet needs remain in terms of administration regimens, duration of treatment, biomarkers, and preventive effects. These knowledge gaps need to be urgently addressed to provide pediatricians and pediatric allergists with more definite recommendations for the use of this treatment in children. This article critically appraises the most relevant debated issues on allergen-specific immunotherapy in children, focusing on allergen standardization procedures, heterogeneity of clinical studies, and regulatory and pharmacoeconomic aspects.
Collapse
|