Large Real-World Study Confirms Long-Term Benefits of Allergen Immunotherapy in Pediatric Allergic Rhinitis

A comprehensive real-world analysis involving over 11,000 children has provided robust evidence for the long-term effectiveness of allergen immunotherapy (搜索)搜索该药品 (AIT) in treating pediatric allergic rhinitis (搜索)搜索该疾病, with benefits persisting for up to 9 years following treatment initiation. The study, representing one of the largest real-world evaluations of AIT in pediatric patients, demonstrates sustained reductions in medication use and improved disease control compared to standard symptomatic treatment.

Study Design and Population

The noninterventional study analyzed administrative health care claims data from Germany's largest health insurance company, examining records from 2008 to 2017. Conducted as a subgroup analysis of the larger REACT study, the investigation included 11,036 children under 18 years of age (mean age 11.4 years, 62.1% male) with physician-diagnosed allergic rhinitis (搜索)搜索该疾病, with or without concurrent asthma (搜索)搜索该疾病.

Participants were randomized 1:1 to receive either allergen immunotherapy (搜索)搜索该药品 or standard care, with treatment effectiveness evaluated over a 9-year follow-up period. The study population was further stratified into younger (0-11 years) and older (12-17 years) cohorts to assess age-related treatment responses.

Sustained Medication Reductions

Children receiving allergen immunotherapy (搜索)搜索该药品 demonstrated consistently greater reductions in allergic rhinitis (搜索)搜索该疾病 medication use compared to controls throughout the study period. The AIT group achieved a 70% reduction in medication use versus 61% in the control group, representing a 9% greater improvement with immunotherapy.

The benefits became increasingly pronounced over time. By year 3, participants receiving AIT showed a 12% greater reduction in medication use than controls, with an absolute difference of -0.08 (95% CI: -0.13 to -0.02; P = 0.0114). This advantage expanded to a 13% greater reduction by year 5 (absolute difference -0.15; -0.22 to -0.08; P < 0.0001) and reached a 16% greater reduction by year 9 (absolute difference -0.12; -0.23 to -0.01; P = 0.0344).

Steroid-Sparing Effects

Investigators highlighted a "marking and consistent steroid-sparing effect" among children treated with allergen immunotherapy (搜索)搜索该药品. Compared to controls, AIT was associated with a 28% greater reduction in inhaled corticosteroid (INCS) prescriptions. The treatment also demonstrated significant effects on other medication classes, with AIT patients showing a 28% further reduction in short-acting β₂-agonist prescriptions beyond the 45% reduction observed in controls.

Across years 2 to 9, both antihistamine and intranasal corticosteroid prescriptions per subject were significantly decreased with AIT use. The immunotherapy group achieved an additional 12% reduction in antihistamine prescriptions beyond the 64% reduction seen in controls.

Enhanced Benefits in Asthmatic Children

Children with concurrent asthma (搜索)搜索该疾病 experienced particularly pronounced benefits from allergen immunotherapy (搜索)搜索该药品. These patients demonstrated a 21% greater reduction in asthma medication use (69% vs 48% in controls), along with significant improvements in disease control markers. Severe exacerbations were reduced by 57% versus 36% in controls, while new oral corticosteroid prescriptions decreased by 74% compared to 41% in the control group.

The AIT group showed a remarkable 65% greater reduction in combination inhaled corticosteroid plus long-acting β₂-agonist (ICS + LABA) prescriptions compared to controls. Between-group differences for asthma (搜索)搜索该疾病 medication reductions remained significant during years 2-8, with absolute differences reaching -0.51 (-0.72 to -0.30; P < 0.0001) in year 8, representing a 22% greater reduction.

Age-Related Treatment Responses

The analysis revealed differential responses based on patient age at treatment initiation. Younger children (0-11 years) demonstrated stronger allergic rhinitis (搜索)搜索该疾病 medication reductions than adolescents (12-17 years). During follow-up, younger children experienced an additional 9% reduction compared with controls, building upon a 57% reduction from baseline.

Adolescents showed more modest improvements, with a 3% additional reduction beyond their 63% baseline improvement. However, investigators noted that adolescents did not show significant reductions in antihistamine prescriptions with allergen immunotherapy (搜索)搜索该药品, with benefits limited to inhaled corticosteroid use reductions during specific time periods (years 2-3 and 5-6).

Clinical Implications

"This subgroup analysis provides robust evidence for the long-term effectiveness of AIT in children with AR, including those with pre-existing asthma (搜索)搜索该疾病," the investigators concluded. "AIT was associated with significant, sustained reductions in AR and asthma medication use and asthma exacerbations for up to 9 years following initiation."

The findings support the disease-modifying potential of allergen immunotherapy (搜索)搜索该药品 and suggest that early intervention may help prevent disease progression. As study investigator Christian Woehlk, MD, PhD, from the Respiratory Research Unit at Bispebjerg Copenhagen University Hospital (搜索)搜索该词条 in Denmark, and colleagues noted, "The reduction in the use of symptom-relieving medications not only supports the findings of the REACT study but also broadens the scope of the long-term evidence supporting [allergen immunotherapy]."

The study addresses a significant gap in pediatric real-world data, as previous evidence for allergen immunotherapy (搜索)搜索该药品 effectiveness had primarily come from randomized controlled trials with limited long-term follow-up in children.