[New administration routes for immunotherapy].
Specific immunotherapy represents the turning point of the treatment of allergic illnesses and this, together with avoiding the allergen, currently constitutes the only etiologic treatment available. When conditions are optimum, which include showing the etiologic importance of the allergen, the availability of quality allergenic extracts and the correct monitoring of the patient, immunotherapy with subcutaneous injections is a safe and efficient treatment. As in any other treatment, subcutaneous immunotherapy is not exempt from possible adverse reactions related to its administration, although when the recommended guidelines are followed, these reactions tend to be predominantly local, of little intensity and easy to control. Over the last 15 years, especially in Europe, there has been an increased interest in the use of local applications, not injections, in immunotherapy and we are looking, above all, to increase the safety and the patients acceptance. The alternative applications to injected immunotherapy that have been studied and used to date are: oral, sublingual, nasal and bronchial. In the World Health Organisation position papers (WHO), from the European Academy of Allergies and Clinical Immunology (EAACI) and the European Society of Paediatric Allergy and Clinical Immunology (ESPACI), bronchial immunotherapy is not recommended, due to the fact that its efficiency is not sufficiently documented and the there is a risk involved with severe side effects of an asthmatic nature. Nasal immunotherapy is not considered to be suitable for clinical use on children and oral immunotherapy is not considered to be suitable for clinical use on children and oral immunotherapy is not recommended, except as part of controlled studies, due to the risk of side effects and insufficient documentation that guarantees the efficiency. Currently, in clinical practice, it apears that a progressive interest has been detected in sublingual immunotherapy and in our country this is being used more and more, which means that the current level of our knowledge on this terapeutical method should be reviewed. In order to consider sublingual immunotherapy as a valid alternative, taking the bassis of its action mechanisms as a starting point, a greater safety in its administration should be checked, its clinical efficiency demonstrated and this efficiency should at least be comparable to that obtained using subcutaneous immunotherapy. The action mechanism of sublingual immunotherapy is unknown. Experiments using allergenic extracts marked with radioactive isotopes administered sublingually do not indicate any absorption through the oral mucous, which is reassuring in the sense that no systematic adverse reactions are feared, but on the other hand we are faced with serious doubts concerning the basis for this type of immunotherapy administration. Sublingual immunotherapy, especially when the treatment is exclusively sublingual (where the dose is subsequently spat out), is a safe treatment according to what can be deduced from the clinical tests and the pharmacovigilance studies published, although the sublingual means of administration with a subsequent ingestion of the dose can give rise to adverse systematic reactions, such as urticaria and asthma. From the experience gained since this method has been used, to date there have been no reported serious systematic reactions that are life threatening. The analysis of the results of the double-blind control clinical tests published to date, lead us to the same conclusion as the WHO, the EAACI and the ESPACI position papers, in the sense that there is not sufficient evidence available to recommend the use of sublingual immunotherapy on children, except when it is part of a controlled study. (ABSTRACT TRUNCATED)
Martorell Aragonés
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A
Sección de Alergia, Servicio de Pediatria, Hospital General Universitario, Valencia, España.
D000281:Administration, Intranasal; D000284:Administration, Oral; D000286:Administration, Sublingual; D000328:Adult; D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D001249:Asthma / Q000209:etiology / Q000628:therapy; D001980:Bronchi; D002648:Child; D002986:Clinical Trials as Topic; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D004333:Drug Administration Routes; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007279:Injections, Subcutaneous; D007322:Instillation, Drug; D016032:Randomized Controlled Trials as Topic; D012449:Safety; D017211:Treatment Failure; D016896:Treatment Outcome; D014944:World Health Organization
D000485:Allergens; D007074:Immunoglobulin G
Nuevas vías de administración de inmunoterapia.