title: Safety of sublingual-swallow immunotherapy in children aged 3 to 7 years.
abstract: BACKGROUND
  The minimum age to start specific immunotherapy with inhalant allergens in children has not been clearly established, and position papers discourage its use in children younger than 5 years.
  
  
  OBJECTIVE
  To assess the safety of high-dose sublingual-swallow immunotherapy (SLIT) in a group of children younger than 5 years.
  
  
  METHODS
  Sixty-five children (51 boys and 14 girls; age range, 38-80 months; mean +/- SD age, 60 +/- 10 years; median age, 60 months) were included in this observational study. They were treated with SLIT with a build-up phase of 11 days, culminating in a top dose of 300 IR (index of reactivity) and a maintenance phase of 300 IR 3 times a week. The allergens used were house dust mites in 42 patients, grass pollen in 11 patients, olive pollen in 5 patients, Parietaria pollen in 4 patients, and cypress pollen in 3 patients. All adverse reactions and changes in the treatment schedule were compared in 2 subgroups: children 38 to 60 months old and children 61. to 80 months old.
  
  
  RESULTS
  The average cumulative dose of SLIT was 36,900 IR. Adverse reactions were observed in 11 children, none of them severe enough to require discontinuation of immunotherapy. Six reactions occurred in the 60 months or younger age group and 7 in the older than 60 months age group, with no differences between these 2 groups.
  
  
  CONCLUSIONS
  High-dose immunotherapy in children younger than 5 years does not cause more adverse reactions than in children aged 5 to 7 years. There is no reason to forbear studies on safety and efficacy of these preparations in young children.
authors.affiliation: Department of Child and Maternal Medicine, The Fatebenefratelli/Melloni University Hospital, Milan, Italy. allerg@tin.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiocchi
authors.forename: Giovanbattista
authors.initials: G
authors.lastname: Pajno
authors.forename: Stefania
authors.initials: S
authors.lastname: La Grutta
authors.forename: Francesco
authors.initials: F
authors.lastname: Pezzuto
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Incorvaia
authors.forename: Laura
authors.initials: L
authors.lastname: Sensi
authors.forename: Francesco
authors.initials: F
authors.lastname: Marcucci
authors.forename: Franco
authors.initials: F
authors.lastname: Frati
mesh_terms: D000286:Administration, Sublingual; D000367:Age Factors; D000485:Allergens / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000188:drug therapy* / Q000503:physiopathology; D003888:Desensitization, Immunologic; D005260:Female; D006801:Humans; D008297:Male; D012220:Rhinitis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000485:Allergens