Discussion
redness, dyspnea, itching, hoarseness, allergic rhinoconjunctivitis, ’, local adverse reactions, dysphonia, Allergic Rhinitis, allergic symptoms, obstruction of the airway, systemic adverse reactions, allergic diseases
ADVERSE REACTIONS, LARYNGEAL EDEMA, ALLERGY, ADVERSE EVENTS, AIRWAY OBSTRUCTION, MINOR, ALLERGIC RHINITIS, ALLERGIC RHINOCONJUNCTIVITIS, ADVERSE EFFECTS, ASTHMA, IMMUNE TOLERANCE
In recent years, pediatric allergic rhinoconjunctivitis has become a global health issue and one of the most concerned allergic diseases. As the first-line treatment recommended by Allergic Rhinitis and its Impact on Asthma (ARIA) guideline and European Academy of Allergy and Clinical Immunology (EAACI) guideline (In 2008, Senti et al. (In this study, we observed significant decreases in TNSS and TOSS, less dependence of rescue drugs, and improvements of quality of life at 3, 6 and 12 month after treatments. Also,at 24 and 36 month after treatments, patients in ICLIT and SCIT maintained the improvement of symptoms and quality of life, indicating that ICLIT had sustained and stable efficacy as SCIT.After 1 month of treatments, allergic rhinoconjunctivitis patients in ICLIT group had better improvements than SCIT group in terms of allergic symptoms, dependence on rescue drugs and quality of life, indicating that ICLIT could rapidly mediate immune tolerance. An animal experiment injected an equivalent amount of allergen into one area and found that the dose injected into the lymph nodes was approximately 100-fold higher than that injected subcutaneously into the vein (We compared both short-term and long-term efficacy between ICLIT group and SCIT group.It was found that the two groups had comparable 1-year short-term efficacy and consistent production of immune tolerance. Besides, ICLIT group had poorer 3-year long-term efficacy than SCIT group. After detailed investigation, patients in ICLIT group could be divided into 3 clusters. Cluster 1 referred to symptom improvement, including 14 patients with significant symptom improvement in both short-term and long-term after treatment. Cluster 2 referred to ineffectiveness, including 3 patients without significant symptom improvement in short-term or long-term after treatment. Also, they had no irritation response to ICLIT throughout the treatment period. Considering that these patients were insensitive to immunotherapy, molecular mechanisms could be investigated in this group of children in the future. Cluster 3 referred to poor efficacy, including 6 patients with significant symptom improvement in short-term, but poor symptom control in long-term. The larger proportion of Cluster 3 resulted in the lower long-term symptom control in ICLIT group than that in SCIT group. After analysis of symptom improvement, we found that they actually had a higher sensitivity to ICLIT treatment at the beginning but gradually decreasing sensitivity over the long term, which was similar with the traditional immunotherapy. Tseng et al. (Safety remains a major concern during immunotherapy among pediatric patients with allergic rhinoconjunctivitis. Severe local adverse reactions and systemic adverse reactions may cause laryngeal edema, resulting in partial or complete obstruction of the airway, leading to life-threatening adverse events such as hoarseness, dysphonia, and even dyspnea. Therefore, before treatment, we should carry out emergency plans, the main emergency equipment includes: lathes that can lie flat, bedside breathing, pulse, blood pressure and blood oxygen saturation monitors, syringes, needles, intravenous infusion pumps and other items used to open venous channels, oxygen tanks, suction tubes, stethoscopes, laryngoscopes, tracheal tubes, masks, respiratory air bags, dental pads and other intubation items and instruments to relieve airway obstruction; The main emergency drugs include: antihistamines, rapid-acting β2 agonists, epinephrine solution (1:1000), and other emergency drugs. In this study, 23 patients with ICLIT underwent a total of 69 injections, and only 3 mild local adverse reactions occurred, 1 lymph node swelling/irritation, 1 itching around the puncture site, and 1 redness around the puncture site.All of them relieved within 24 hours without using emergency equipment or medication. There were no moderate to severe local adverse events or systemic adverse events during treatment. This trial is the same as ILIT causing only minor adverse effects in most previously reported studies (The principle of immunotherapy is to reduce the pathogenic antibody IgE, especially the serum specific IgE antibody, and to increase the protective antibody IgG at the same time. Studies have shown that specific IgE competes with IgG4 antibody for binding allergens, and successful SCIT refers to an increase in serum specific IgE at the beginning and a slow decrease for a long time period. In this study, we found that levels of Derp IgE and Derf IgE decreased after treatment of ICLIT and SCIT, and the degree of reduction was similar between the two treatments.There are some limitations in this study. First, this study is open-label study, so patients’ and investigators’ expectation to ICLIT and SCIT (placebo effect) and spontaneous improvement of natural course might affect on the study. Additionally,this was a single-center prospective randomized controlled study with a relatively small sample size. Second, we only investigated changes in IgE levels before and after treatment and did not include the protective antibody IgG4. Therefore, multicenter study with larger sample size is required in the future, as well as that for the molecular mechanisms of ICLIT-induced immune tolerance. ICLIT may become a new option among all AIT treatments.