Allergen Immunotherapy Shows Long-Term Efficacy in Pediatric Allergic Rhinitis

Allergen immunotherapy (AIT) showed long-term efficacy in a large, real-world cohort of children and adolescents with allergic rhinitis (AR) with or without asthma.1

The findings, published in Allergy, suggest that AIT can lead to sustained, clinically meaningful reductions in prescription medication use and health care resource utilization (HCRU) for up to 9 years.

Allergen immunotherapy for children and adolescents with allergic rhinitis showed long-term efficacy in a large, real-world cohort. | Image credit: Volha Zaitsava stock - adobe.com

“To our knowledge, this pre-specified, per-protocol analysis of 11,036 children with physician-diagnosed AR, with or without pre-existing asthma, represents one of the largest real-world evaluations of AIT in pediatric patients—demonstrating sustained, long-term (up to 9 years) reductions in AR and asthma medication use, improved asthma control, and fewer asthma exacerbations compared to controls,” the study authors wrote.

The noninterventional, real-world study used administrative health care claims data from the largest German health insurance company, analyzing data from 2008 to 2017. The study, which is a subgroup analysis of the REACT study (NCT04125888), included children and adolescents aged 6 to 17 years who had received a new diagnosis of allergic rhinitis and/or asthma. Participants were stratified into 2 groups: those who initiated AIT and a matched control group who did not receive AIT but were treated with standard symptomatic pharmacotherapy.

The primary measure of effectiveness was the reduction in daily consumption of relevant prescription medications—specifically, antiallergic/antiasthmatic drugs, oral corticosteroids, and antibiotics—comparing outcomes from the 12-month baseline period with up to 9 years of follow-up.

There was a significantly greater reduction in AR medication use in the AIT group compared with the control group—a benefit that persisted throughout the follow-up period. For patients with AR, the AIT group showed a 9% greater reduction in the use of AR medication than the 61% reduction seen in the control group.

The authors highlighted that the improvement was sustained over time. The absolute difference between the groups at year 3 was −0.08 (95% CI, −0.13 to −0.02; P = .0114), indicating a 12% greater reduction for the AIT group compared with controls. By year 8, there was a −0.51 absolute difference (95% CI, −0.72 to −0.30; P < .0001), demonstrating a 22% greater reduction for the AIT group vs controls.

Across years 2 to 9, antihistamine and intranasal corticosteroid (INCS) prescriptions per subject were also significantly decreased with AIT use, which was associated with an additional 12% reduction in antihistamine prescriptions beyond the 64% reduction seen in the control group. INCS prescriptions decreased by an additional 28% beyond the 42% reduction in the control group. Those receiving AIT also showed a 28% further reduction in short-acting β2 agonist prescriptions in addition to the 45% reduction seen in controls. Additionally, inhaled corticosteroid prescriptions decreased by a further 10% beyond the 62% reduction in the control group.

“In children with AR and pre-existing asthma who are treated with AIT, the data suggest improved asthma control (16%-23% greater reduction in asthma prescriptions) and a stepdown in pharmacological management of asthma (65% greater reduction in [inhaled corticosteroids] + [long-acting β2 agonists], compared with controls, which support the disease-modifying effect of AIT,” the authors explained. The results are in line with other studies, including REACT, which showed long-term and sustained efficacy with AIT in the real-world setting.2

The study was limited due to uncertainty regarding over-the-counter medication use, including antihistamine use.1 The authors noted that parents of adolescents may be more inclined to purchase over-the-counter antihistamine medications because they do not require a prescription. Another limitation was that the overall changes seen in medication use could also be influenced by factors such as regression to the mean, the authors explained. However, the strength and consistency of the results support AIT use in children, especially those who are younger and have preexisting asthma.

“This subgroup analysis provides robust evidence for the long-term effectiveness of AIT in children with AR, including those with pre-existing asthma,” the authors concluded. “AIT was associated with significant, sustained reductions in AR and asthma medication use and asthma exacerbations for up to 9 years following initiation. These findings indicate improved disease control and support the disease-modifying potential of AIT.“

References

1. Woehlk C, Stranzl T, Contoli M, et al. Long-term, real-world effectiveness of allergen immunotherapy in children and adolescents with allergic rhinitis and asthma. Allergy. Published online October 1, 2025. doi:10.1111/all.70085

2. Fritzsching B, Contoli M, Porsbjerg C, et al. Long-term real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma: results from the REACT study, a retrospective cohort study. Lancet Reg Health Eur. 2021;13:100275. doi:10.1016/j.lanepe.2021.100275