title: Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review.
abstract: OBJECTIVE
  Subcutaneous immunotherapy (SCIT) is approved in the United States for the treatment of pediatric asthma and rhinitis; sublingual immunotherapy (SLIT) does not have regulatory approval but is used in clinical practice. The objective of this study was to systematically review the evidence regarding the efficacy and safety of SCIT and SLIT for the treatment of pediatric asthma and allergic rhinoconjunctivitis.
  
  
  METHODS
  Two independent reviewers selected articles for inclusion, extracted data, and graded the strength of evidence for each clinical outcome. All studies were randomized controlled trials of children with allergic asthma or rhinoconjunctivitis treated with SCIT or an aqueous formulation of SLIT. Data sources were Medline, Embase, LILACS, CENTRAL, and the Cochrane Central Register of Controlled Trials through May 2012.
  
  
  RESULTS
  In 13 trials, 920 children received SCIT or usual care; in 18 studies, 1583 children received SLIT or usual care. Three studies compared SCIT with SLIT head-to-head in 135 children. The strength of evidence is moderate that SCIT improves asthma and rhinitis symptoms and low that SCIT improves conjunctivitis symptoms and asthma medication scores. Strength of evidence is high that SLIT improves asthma symptoms and moderate that SLIT improves rhinitis and conjunctivitis symptoms and decreases medication usage. The evidence is low to support SCIT over SLIT for improving asthma or rhinitis symptoms or medication usage. Local reactions were frequent with SCIT and SLIT. There was 1 report of anaphylaxis with SCIT.
  
  
  CONCLUSIONS
  Evidence supports the efficacy of both SCIT and SLIT for the treatment of asthma and rhinitis in children.
authors: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. jkim315@jhmi.edu
authors: Julia M
authors: JM
authors: Kim
authors: Sandra Y
authors: SY
authors: Lin
authors: Catalina
authors: C
authors: Suarez-Cuervo
authors: Yohalakshmi
authors: Y
authors: Chelladurai
authors: Murugappan
authors: M
authors: Ramanathan
authors: Jodi B
authors: JB
authors: Segal
authors: Nkiruka
authors: N
authors: Erekosima
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006255:Rhinitis, Allergic, Seasonal / Q000628:therapy*; D016896:Treatment Outcome
keywords: allergen-specific immunotherapy; asthma; pediatric; rhinitis; rhinoconjunctivitis; subcutaneous immunotherapy; sublingual immunotherapy; systematic review
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