The
Allergic Rhinitis and its Impact on
Asthma document was first published in 2001. Since then, new data on specific
immunotherapy have appeared. This review is intended as an update to the original document. MedLine (2001 to June 2006) was searched with appropriate key words, and panelists were asked to identify further relevant articles. Randomized controlled trials were considered for the evaluation of efficacy. For the evaluation of safety and additional effects, studies with lower grades of evidence were included. The clinical efficacy of injection
immunotherapy in
rhinitis and
asthma was confirmed, as well as the safety, provided that recommendations are followed. Studies have demonstrated the long-term efficacy and the preventive effect of
immunotherapy in reducing the onset of new sensitizations. One randomized open trial demonstrated that in children with
allergic rhinitis, injection
immunotherapy may reduce the risk of developing
asthma. There is strong evidence that sublingual immunotherapy is effective in
allergic rhinitis in adults. Recent meta-analyses demonstrated its efficacy in
allergic rhinitis in children and in
asthma, although more definitive trials are required. Current data indicate that sublingual immunotherapy is safe and the rate of adverse reactions is not greater below 5 years of age. One randomized open trial showed that in children with
allergic rhinitis, sublingual immunotherapy reduced the onset of
asthma. Further studies are needed to identify the optimal maintenance dose and to elucidate the mechanism of action. Novel approaches for
immunotherapy are currently under evaluation, including the use of adjuvants,
peptides, and
DNA-conjugated and recombinant
allergens.