title: Effectiveness of immunotherapy in children depends on place of living - A pilot study.
abstract: BACKGROUND
  It is considered that farm areas protect young patients from allergy and asthma due to high exposure to endotoxins. Allergen immunotherapy (AIT) is the only treatment of allergy modifying the immune response with the potential to change the natural history of allergic diseases. It seems that studies evaluating the efficacy of immunotherapy in large cohorts of allergic patients living in farm areas are needed to understand the influence of environment on immune response during AIT.
  
  
  OBJECTIVE
  To compare the clinical effectiveness of immunotherapy between children living in farm versus urban areas.
  
  
  METHODS
  This was a retrospective analysis of 87 children living in farm area (n=42) and city area (n=45), aged 8-16, who completed three years of subcutaneous immunotherapy due to allergic rhinitis/asthma. An AIT efficacy questionnaire has been designed to be filled in by the allergy specialist during a regular immunotherapy visit before and after AIT.
  
  
  RESULTS
  We observed significantly higher improvement in total score among children from farm area compared to children from city area (p<0.001). Between-group differences in symptoms and drug scores did not reached the level of significance. Multivariate logistic regression analysis (adjustment for the effect of gender and type of allergy) showed that living in farm areas was independently associated with significant improvement in total score after immunotherapy (OR: 10.9; 95%CI: 3.7-32.2).
  
  
  CONCLUSIONS
  The current analysis of the better AIT effectiveness in the farm population has shown the protective influence of environmental exposures on asthma and allergic rhinitis in our children.
authors.affiliation: Department of Allergology and Internal Medicine in Children, Copernicus Hospital, al. Pilsudskiego 71, 90-329 Lodz, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Pawlowski
authors.affiliation: Department of Allergology and Internal Medicine in Children, Copernicus Hospital, al. Pilsudskiego 71, 90-329 Lodz, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Jerzynska
authors.affiliation: Department of Allergology and Internal Medicine in Children, Copernicus Hospital, al. Pilsudskiego 71, 90-329 Lodz, Poland.
authors.forename: D
authors.initials: D
authors.lastname: Podlecka
authors.affiliation: Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Stelmach
authors.affiliation: Clinical Department of Internal Medicine, Asthma and Alergology, Barlicki Hospital, ul. Kopcinskiego 22, Lodz, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Majak
authors.affiliation: Department of Allergology and Internal Medicine in Children, Copernicus Hospital, al. Pilsudskiego 71, 90-329 Lodz, Poland. Electronic address: alergol@kopernik.lodz.pl.
authors.forename: I
authors.initials: I
authors.lastname: Stelmach
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D003888:Desensitization, Immunologic; D000072480:Farms; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D065631:Rhinitis, Allergic / Q000628:therapy*; D012424:Rural Population; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Children; City; Farm; Immunotherapy; Improvement