A national audit of pollen immunotherapy for children in the United Kingdom: patient selection and programme safety

Vance, G.H.S., Goldring, S., Warner, J.O., Cox, H., Sihra, B., Hughes, S., Gardner, J., North, J., Roberts, Graham, Proudfoot, C.A., Clarke, A., Luyt, D.K., Gillies, D. and Fox, A.T. (2011) A national audit of pollen immunotherapy for children in the United Kingdom: patient selection and programme safety. [in special issue: Special Centenary Issue on Immunotherapy] Clinical & Experimental Allergy, 41 (9), 1313-1323. (doi:10.1111/j.1365-2222.2011.03803.x). (PMID:21762222)

Abstract

BACKGROUND: Specific immunotherapy (SIT) is an effective treatment for grass and/or tree pollen-induced severe allergic rhinoconjunctivitis. However, there are limited detailed data on the use of immunotherapy in children in the United Kingdom.

OBJECTIVES: We audited NHS paediatric practice against current national guidelines to evaluate patient selection, SIT modalities and adverse events (AEs).

METHODS: Paediatricians offering pollen SIT were identified through the British Society of Allergy and Clinical Immunology Paediatric Allergy Group (BSACI-PAG) and the database of SIT providers compiled for the Royal College of Physicians and Royal College of Pathologists 2010 joint working group. Standardized proformas were returned by 12 of 20 centres (60%), including 12 of 14 centres offering subcutaneous immunotherapy (SCIT) (85%).

RESULTS: Three hundred and twenty-three children, with mean age 11 years at initiation (69% boys), had undergone 528 SIT cycles (SCIT 31%) over 10 years. Fifty-five percent of all patients had asthma. Among SCIT programmes 24.5% patients had perennial (± seasonal) asthma; 75.6% of asthmatics undertaking SCIT had treatments at BTS/SIGN step 2 or above. AEs occurred frequently (50.4% of all SIT cycles) but were mild. In sublingual immunotherapy (SLIT) treatment, local intraoral immediate reactions were most common (44.9% SLIT cycles), as compared with delayed reactions around the injection site in SCIT (28.3% SCIT cycles). An asthma diagnosis had no impact on the number of cycles with AEs, or the severity reported. Few cycles (2.9%) were discontinued as a result of AE(s).

CONCLUSIONS AND CLINICAL RELEVANCE: Pollen SIT is available across England, though small numbers of children are being treated. Current national guidelines to exclude asthmatic children in SIT programmes are not being adhered to by most specialist paediatric allergy centres. SCIT and SLIT has been well tolerated. Review of patient selection criteria is needed and may allow greater use of this therapeutic option in appropriate clinical settings.

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Contributors

Author: Graham Roberts

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