Pollen subcutaneous immunotherapy("allergy shots") improved health-related quality of life (HRQoL), decreased symptom scores with 1 year of treatment, and maintained improvements for the next 2 years (total observation was 3 years) among children and adolescents with allergic rhinoconjunctivitis, according to study findings published in Allergy, Asthma & Clinical Immunology. Researchers sought to assess the effect of pollen subcutaneous immunotherapy (SCIT) on HRQoL and to characterize the association between HRQoL and symptoms of allergic rhinoconjunctivitis among children and adolescents.
The researchers conducted a longitudinal prospective cohort study at a pediatric clinic in Stockholm, Sweden, from 2012 to 2016 that included 158 children (mean age 11 years, range 5-16 years; 52 girls) on SCIT (birch and/or grass). This allergen-specific immunotherapy was offered if allergic rhinoconjunctivitis symptoms were poorly controlled with standard treatment. At index and after 1, 2, and 3 years of treatment, researchers measured HRQoL (via DISABKIDS questionnaires), symptoms (using unvalidated scoring questions) and allergen-specific IgE and IgG4 antibodies (via blood test or skin prick test). Among the study population, 77% received allergen treatment for birch, 8% for grass, and 15% for birch and grass. At index, 26% of participants had rhinoconjuncitivitis, and 74% had asthma and rhinoconjunctivitis.
Researchers found overall HRQoL mean scores improved from 79.5 (index) to 85.1 after 1 year of pollen SCIT (P <.001). These improvements were maintained after year 2 (mean 84.8) and year 3 (mean 87.2). Also with respect to HRQoL, investigators found statistically significant improvements in participants’ scores after 1 year of pollen SCIT for independence (from 80.3 to 86.3; P ≤.001), inner strength (from 81.7 to 89.0; P ≤.001), equality (from 87.0 to 91.7; P ≤.001), and physical ability (from 67.0 to 74.7, P ≤.001), with these improvements maintained during the study period. Boys reported significantly greater improvement in physical ability than girls after both 2 and 3 years of SCIT, and younger children (age 5 to 10 years) reported significantly greater improvement in physical ability than older children (age 11 to 16 years) after 1 year of treatment. No other significant improvement in HRQoL results were noted between participant subgroups.
Mean symptom scores decreased from 19.9 (index) to 11.5 after 1 year (P <.001); this was maintained for year 2 (mean 11.9) and year 3 (mean 10.3). Subgroup analysis of girls, boys, and younger and older children showed similar results. Overall, researchers noted a decrease in the proportion of children with severe or very severe symptoms, from 35.6% to 4.5%, after 1 year of SCIT. Allergen-specific IgE antibodies showed a statistically significant decrease for birch (from 151.0 to 76.8kU/L), and IgG4 antibodies showed a statistically significant increase for grass (from 0.5 to 14.3g/L) and birch (from 2.2 to 17.6g/L) during the study period (all P <.001). Study limitations include lack of placebo control, the use of subjective and objective circumstances inherent in measuring HRQoL, parental bias in questionnaire responses (especially among younger children), use of unvalidated instruments for measuring symptom scores, and lack of data on medication use during immunotherapy.
“In children and adolescents with allergic rhinoconjunctivitis, pollen SCIT improved HRQoL and decreased symptom scores after 1 year of treatment, and the improvements were maintained during the study years,” researchers concluded. “The proportion of severe and very severe symptoms significantly decreased after 1 year of pollen SCIT,” they added. “Further there was a decrease in IgE levels and an increase in IgG4 levels after 3 years’ SCIT.”
From: Agenäs H, Brorsson AL, Kull I, Lindholm-Olinder A. Treatment with pollen allergen immunotherapy improves health-related quality of life in children and adolescents: A 3-year follow-up-study. Allergy Asthma Clin Immunol. Published online January 17, 2023. doi:10.1186/s13223-023-00756-9
Dr. Kenneth Backman of Allergy & Asthma Care of Fairfield County comments: "We've long known that subcutaneous allergen immunotherapy is highly effective for pollen allergy, as well as dust mites, molds, and pet allergies. This study confirms that children not only see symptom improvement, but see significant quality of life benefits from allergy injections. Allergy injections remain the most effective natural, nonmedication treatment for airborne allergies, buidling the body's tolerance of allergens rather than just suppressing symptoms."
