Local side effects during sublingual allergen-specific immunotherapy and pathogenetically based methods for their correction (Review)
https://doi.org/10.53529/2500-1175-2024-2-9-17
Abstract
Introduction. The study of the effectiveness and safety of allergen-specific immunotherapy remains relevant due to the emergence of a personalized approach in allergology and new dosage forms. Adverse reactions during sublingual allergen-specific immunotherapy are the leading reason of treatment discontinuation. Understanding the mechanisms of side effects and knowing how to overcome them allows us to achieve better tolerability of allergen-specific immunotherapy and maintain patient compliance.
The aim of the review is to combine the available literature data on the frequency, nature, and pathogenetic basis of adverse events during sublingual allergen-specific immunotherapy and to consider options for their prevention and treatment.
About the Author
V. Ya. Zakurskaya
Rostov State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Vita Ya. Zakurskaya — assistant of the Clinical Immunology and Allergology Chair, Rostov State Medical University of Russia.
344022, Rostov-on-Don, 29, Nakhichevansky lane
References
1. Jutel M, Brüggenjürgen B, Richter H, Vogelberg C. Real-world evidence of subcutaneous allergoid immunotherapy in house dust mite-induced allergic rhinitis and asthma. Allergy. 2020; 75 (8): 2050–2058. https://doi.org/10.1111/all.14240.
2. Balabolkin II. Pollinoz u detei i podrostkov: sovremennye aspekty patogeneza i tendentsii v terapii. Allergologiya i immunologiya v pediatrii. 2020; 62 (3): 6–14. (In Russ.) https://doi.org/10.24411/2500-1175-2020-00001.
3. Schmitt J, Schwarz K, Stadler E, Wüstenberg EG. Allergy immunotherapy for allergic rhinitis effectively prevents asthma: Results from a large retrospective cohort study. J Allergy Clin Immunol. 2015 Dec; 136 (6): 1511–1516. https://doi.org/0.1016/j.jaci.2015.07.038.
4. Van der Borght K, Brimnes J, Haspeslagh E, et al. Sublingual allergen immunotherapy prevents house dust mite inhalant type 2 immunity through dendritic cell-mediated induction of Foxp3+ regulatory T cells. Mucosal Immunology. 2024 Apr. https://doi.org/10.1016/j.mucimm.2024.03.012.
5. Incorvaia C, Ridolo E, Bagnasco D, Scurati S, Canonica GW. Personalized medicine and allergen immunotherapy: the beginning of a new era. Clin Mol Allergy. 2021 Jul 7; 19 (1): 10. https://doi.org/10.1186/s12948-021-00150-z.
6. Yamamoto T, Ohashi-Doi K, Matsuhara H, Verhoog L, Lindholm M, Lawton S, et al. Allergen Release Profiles of Fast-Dissolving Freeze-Dried Orodispersible Sublingual Allergy Immunotherapy Tablets. Curr Ther Res Clin Exp. 2022; 96: 100678. https://doi.org/10.1016/j.curtheres.2022.100678.
7. Badgujar BP, Mundada AS. The technologies used for developing orally disintegrating tablets: a review. Acta Pharm. 2011 Jun;61 (2): 117–139. https://doi.org/10.2478/v10007-011-0020-8.
8. Blynskaya EV, Tishkov SV, Alekseev KV, Minaev SV, Marakhova AI. Features of the design of freeze-dried orally disintegrating tablets. Farmatsiya (Pharmacy). 2019; 68 (2): 17–23. (In Russ.) https://doi.org/10/29296/25419218-2019-02-03.
9. Litovkina AO. Sto desyat’ let ASIT: nastoyashchee i budushchee. Vestnik allergologa-immunologa. 2021; 01 (01): 4–5. (In Russ.)
10. Casale TB, Cox LS, Wahn U, Golden DBK, Bons B, Didier A. Safety Review of 5-Grass Pollen Tablet from Pooled Data of Clinical Trials. J Allergy Clin Immunol Pract. 2017; 5: 1717–1727 e1711.
11. Canonica GW, Cox L, Pawankar R, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J. 2014; 7 (1): 6. https://doi.org/10.1186/1939-4551-7-6.
12. Cox LS, Larenas Linnemann D, Nolte H, Weldon D, Finegold I, Nelson HS. Sublingual immunotherapy: a comprehensive review. J Allergy Clin Immunol. 2006 May; 117 (5): 1021–1035. https://doi.org/10.1016/j.jaci.2006.02.040.
13. Belsito DV. The diagnostic evaluation, treatment, and prevention of allergic contact dermatitis in the new millennium. J Allergy Clin Immunol. 2000; 105 (3): 409–420. https://doi.org/10.1067/mai.2000.104937.
14. Bakula A, Lugović-Mihić L, Situm M, Turcin J, Sinković A. Contact allergy in the mouth: diversity of clinical presentations and diagnosis of common allergens relevant to dental practice. Acta Clin Croat. 2011; 50 (4): 553–561.
15. Pitsios C, Rossi CM, Terreehorst I, et al. Eosinophilic esophagitis as a side-effect of allergen immunotherapy: protocol for a systematic review and meta-analysis. Eur Ann Allergy Clin Immunol. 2024; 56 (1): 4–8. https://doi.org/10.23822/EurAnnA-CI.1764-1489.311.
16. Miehlke S, Alpan O, Schröder S, Straumann A. Induction of eosinophilic esophagitis by sublingual pollen immunotherapy. Case Rep Gastroenterol. 2013; 7 (3): 363–368. https://doi.org/10.1159/000355161.
17. Kawashima K, Ishihara S, Masuhara M, et al. Development of eosinophilic esophagitis following sublingual immunotherapy with cedar pollen extract: A case report. Allergol Int. 2018; 67 (4): 515–517. https://doi.org/10.1016/j.alit.2018.03.003.
18. Petroni D, Spergel JM. Eosinophilic esophagitis and symptoms possibly related to eosinophilic esophagitis in oral immunotherapy. Ann Allergy Asthma Immunol. 2018; 120 (3): 237–240.e4. https://doi.org/10.1016/j.anai.2017.11.016.
19. Bokov DO, Smirnov VV. Sovershenstvovanie metodov standartizatsii ekstraktov lechebnykh allergenov: ot PNU do LC-MS. Immunopatologiya, allergologiya, infektologiya. 2013; 4:31–41. (In Russ.) https://doi.org/10.14427/jipai.2013.4.31.
20. Nevskaya LV, Lavrenchik EI, Zhdanova MYU, Fadeikina OV, Kapitanova VK. Mezhdunarodnyi opyt standartizatsii preparatov-allergenov. BIO-preparaty. Profilaktika, diagnostika, lechenie. 2017; 4 (64): 222–229. (In Russ.)
21. Asllani J, Mitsias D, Konstantinou G, et al. The Allergen Immunotherapy Adverse Events Registry: Setup & methodology of a European Academy of Allergy and Clinical Immunology taskforce project. Clin Transl Allergy. 2023; 13 (6): e12266. https://doi.org/10.1002/clt2.12266.
22. Nolte H, Calderon MA, Bernstein DI, et al. Anaphylaxis in Clinical Trials of Sublingual Immunotherapy Tablets. J Allergy Clin Immunol Pract. 2024; 12 (1): 85–95.e4. https://doi.org/10.1016/j.jaip.2023.11.011.
23. Calderón MA, Simons FE, Malling HJ, Lockey RF, Moingeon P, Demoly P. Sublingual allergen immunotherapy: mode of action and its relationship with the safety profile. Allergy. 2012; 67 (3): 302–311. https://doi.org/10.1111/j.1398-9995.2011.02761.x.
24. Lin SY, Azar A, Suarez-Cuervo C, et al. Role of sublingual immunotherapy in the treatment of asthma: An updated systematic review. Int Forum Allergy Rhinol. 2018; 8 (9): 982–992. https://doi.org/10.1002/alr.22152.
25. Radulovic S, Calderon MA, Wilson D, Durham S. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2010; 2010 (12): CD002893. doi:10.1002/14651858.CD002893.pub2.
26. Gushchin IS. Ustranenie neizbezhnosti allergicheskogo otveta. Pul’monologiya. 2010; (4): 23–33. (In Russ.) https://doi.org/10.18093/0869-0189-2010-4-23-33.
27. Novak N, Allam JP. Mucosal dendritic cells in allergy and immunotherapy. Allergy. 2011 Jul; 66 Suppl 95: 22–24. https://doi.org/10.1111/j.1398-9995.2011.02626.x. PMID: 21668846.
28. Allam JP, Stojanovski G, Friedrichs N, Peng W, Bieber T, Wenzel J, Novak N. Distribution of Langerhans cells and mast cells within the human oral mucosa: new application sites of allergens in sublingual immunotherapy? Allergy. 2008 Jun; 63 (6): 720–727. https://doi.org/10.1111/j.1398-9995.2007.01611.x. PMID: 18445186.
29. Ricca V, Landi M, Ferrero P, et al. Minimal persistent inflammation is also present in patients with seasonal allergic rhinitis. J Allergy Clin Immunol. 2000; 105 (1 Pt 1): 54–57. https://doi.org/10.1016/s0091-6749(00)90177-5.
30. Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter third update [published correction appears in J Allergy Clin Immunol. 2011 Mar; 127 (3): 840]. J Allergy Clin Immunol. 2011; 127 (1 Suppl): S1–S55. https://doi.org/10.1016/j.jaci.2010.09.034.
31. Passalacqua G, Villa G, Altrinetti V, Falagiani P, Canonica GW, Mariani G, Bagnasco M. Sublingual swallow or spit? Allergy. 2001 Jun; 56 (6): 578. https://doi.org/10.1034/j.1398-9995.2001.056006578.x. PMID: 11421908.
32. Federal’nye klinicheskie rekomendatsii po provedeniyu allergen-spetsificheskoy immunoterapii. Moscow, Rossiyskaya assotsiatsiya allergologov i klinicheskikh immunologov, 2013. 14 p. (In Russ.)
33. Kareva EN. Vybor antigistaminnogo preparata: vzglyad farmakologa. RMZH. 2016; 12: 811–816. (In Russ.)
34. Tarzi M, Klunker S, Texier C, et al. Induction of interleukin-10 and suppressor of cytokine signalling-3 gene expression following peptide immunotherapy. Clin Exp Allergy. 2006; (36): 465–474. https://doi.org/10.1111/j.13652222.2006.02469.x.
35. Alexander C, Ying S, Kay A, Larche M. Fel d 1-derived T-cell peptide therapy induces recruitment of CD4+CD25+; CD4+ interferon-gamma + T-helper type 1 cells to sites of allergen-induced late-phase skin reactions in cat-allergic subjects. Clin Exp Allergy. 2005; (35): 52–58. https://doi.org/10.1111/j.13652222.2005.02143.x.
36. Turchina MS, Karaseva ZV. Sindrom nizkoi rezistentnosti k gistaminu: prichina ili sledstvie patologii ZHKT? Ehksperimental’naya i klinicheskaya gastroehnterologiya. 2020; (7):152–157. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-179-7-152-157.
37. Federal’nye klinicheskie rekomendatsii po diagnostike I lecheniyu krapivnitsy. Moscow, Rossiyskaya assotsiatsiya allergologov i klinicheskikh immunologov, 2023. (In Russ.)
38. Kakhkharova DZH, Daminova NR, Nurullaeva IR, Ganiev FZ, Makhkambaev AM. Allergicheskii kontaktnyi stomatit, maskiruyushchiisya pod aftoznyi stomatit. Universum: meditsina i farmakologiya. 2024; 1 (106): 13–16. (In Russ.)
39. Canonica GW, Compalati E. Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies. Clin Exp Immunol. 2009; 158 (3): 260–271. https://doi.org/10.1111/j.1365-2249.2009.04017.x.
Review
For citations:
Zakurskaya V.Ya. Local side effects during sublingual allergen-specific immunotherapy and pathogenetically based methods for their correction (Review). Allergology and Immunology in Paediatrics. 2024;(2):9-17. (In Russ.) https://doi.org/10.53529/2500-1175-2024-2-9-17
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