Effects of subcutaneous immunotherapy in allergic rhinitis children sensitive to dust mites
Main Article Content
Keywords
allergic rhinitis, children, clinical response, dust mite, subcutaneous immunotherapy
Abstract
Background: Subcutaneous immunotherapy (SCIT) is now the only treatment that can modify the natural course of allergic rhinitis (AR). However, not all children with AR benefit from SCIT.
Objective: To evaluate the efficacy of SCIT in dust-mites-induced AR children and explore correlative factors predicting treatment response to SCIT.
Methods: 225 children aged 4–17 years old with AR were recruited from January 2016 to September 2019, and monitored at baseline, 4, 12, and 24 months after the start of SCIT treatment. The visual-analogue-score (VAS) was used to assess the clinical symptoms. Multivariate binary logistic regression analyses and receiver operating characteristic curves were used to explore correlative factors in predicting the efficacy of SCIT.
Results: The significant declines in VAS started after 4 months of SCIT and continued to improve throughout the study compared with baseline. An increase in children’s age (OR=0.688, 95%CI: 0.479–0.988) and those with allergic history (OR=0.097, 95%CI: 0.009–1.095) were negatively associated with the risk of poor efficacy. Polysensitized children were more likely to suffer poor efficacy (OR=15.511 95%CI: 1.319–182.355). The clinical response at month 4 (r=0.707) and month 12 (r=0.925) was related to that at month 24. The area under the curve (AUC) for improvement at month 4 and month 12 was 0.746 and 0.860, respectively.
Conclusion: Our study confirmed the clinical efficacy of SCIT in AR children. Children with younger age, negative allergic history, and multiple allergens may predict a worse efficacy. The onset of action and the clinical response to SCIT in the second year can be predicted as early as by month 4.
References
1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 Suppl 86:8–160. 10.1111/j.1398-9995.2007.01620.x
2. Zhang Y, Zhang L. Increasing prevalence of allergic rhinitis in China. Allergy Asthma Immunol Res. 2019;11(2):156–69. 10.4168/aair.2019.11.2.156
3. Meltzer EO. Allergic rhinitis: Burden of illness, quality of life, comorbidities, and control. Immunol Allergy Clin North Am. 2016;36(2):235–48. 10.1016/j.iac.2015.12.002
4. Mir E, Panjabi C, Shah A. Impact of allergic rhinitis in school--going children. Asia Pac Allergy. 2012;2(2):93–100. 10.5415/apallergy.2012.2.2.93
5. Romano M, James S, Farrington E, Perry R, Elliott L. The impact of perennial allergic rhinitis with/without allergic asthma on sleep, work and activity level. Allergy Asthma Clin Immunol. 2019;15:81. 10.1186/s13223-019-0391-9
6. Tu Y, Zhang H, Zhao L, Jin P, Zi X, Li T, et al. The changes in different symptom scores during subcutaneous immunotherapy in Chinese house dust mite allergic patients: A two-year, observational study. J Laryngol Otol. 2019;133(3):213–19. 10.1017/s0022215119000094
7. Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, et al. International consensus statement on allergy and rhinology: Allergic rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108–352. 10.1002/alr.22073
8. Wheatley LM, Togias A. Clinical practice. Allergic rhinitis. N Engl J Med. 2015;372(5):456–63. 10.1056/NEJMcp1412282
9. Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol. 2013;131(5):1288–96.e3. 10.1016/j.jaci.2013.01.049
10. Liu Z, Lu H, Feng X, Hu L, Wang J, Yu H. Predictive methods for efficacy of house dust mite subcutaneous immunotherapy in allergic rhinitis patients: A prospective study in a Chinese population. Int Forum Allergy Rhinol. 2020;10(3):314–19. 10.1002/alr.22508
11. Li Q, Li M, Yue W, Zhou J, Li R, Lin J, et al. Predictive factors for clinical response to allergy immunotherapy in children with asthma and rhinitis. Int Arch Allergy Immunol. 2014;164(3):210–17. 10.1159/000365630
12. Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines–2016 revision. J Allergy Clin Immunol. 2017;140(4):950–8. 10.1016/j.jaci.2017.03.050
13. Reddel HK, Bacharier LB. Global Initiative for Asthma Strategy 2021: Executive summary and rationale for key changes. Eur Respir J. 2022;59(1):2102730. 10.1183/13993003.02730-2021
14. Alvarez-Cuesta E, Bousquet J, Canonica GW, Durham SR, Malling HJ, Valovirta E. Standards for practical allergen--specific immunotherapy. Allergy. 2006;61 Suppl 82:1–20. 10.1111/j.1398-9995.2006.01219_1.x
15. Demoly P, Bousquet PJ, Mesbah K, Bousquet J, Devillier P. Visual analogue scale in patients treated for allergic rhinitis: aAn observational prospective study in primary care–Asthma and rhinitis. Clin Exp Allergy. 2013;43(8):881–8. 10.1111/cea.12121
16. Liu J-L, Ning W-X, Li S-X, Xu Y-C, Wu L, Wang Y-S, et al. The safety profile of subcutaneous allergen immunotherapy in children with asthma in Hangzhou, East China. Allergol Immunopathol (Madr). 2017;45(6):541–8. 10.1016/j.aller.2017.04.002
17. Klimek L, Bergmann KC, Biedermann T, Bousquet J, Hellings P, Jung K, et al. Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC). Allergo J Int. 2017;26(1):16–24. 10.1007/s40629-016-0006-7
18. Huang Y, Wang C. Comparison of long-term efficacy of subcutaneous immunotherapy in pediatric and adult patients with allergic rhinitis. Allergy Asthma Immunol Res. 2019;11(1): 68–78. 10.4168/aair.2019.11.1.68
19. Lee JH, Kim SC, Choi H, Jung CG, Ban GY, Shin YS, et al. A retrospective study of clinical response predictors in subcutaneous allergen immunotherapy with house dust mites for allergic rhinitis. Allergy Asthma Immunol Res. 2018;10(1): 18–24. 10.4168/aair.2018.10.1.18
20. Drazdauskaitė G, Layhadi JA, Shamji MH. Mechanisms of allergen immunotherapy in allergic rhinitis. Curr Allergy Asthma Rep. 2020;21(1):2. 10.1007/s11882-020-00977-7
21. Meiler F, Zumkehr J, Klunker S, Rückert B, Akdis CA, Akdis M. In vivo switch to IL-10-secreting T regulatory cells in high dose allergen exposure. J Exp Med. 2008;205(12):2887–98. 10.1084/jem.20080193
22. Nouri-Aria KT, Wachholz PA, Francis JN, Jacobson MR, Walker SM, Wilcock LK, et al. Grass pollen immunotherapy induces mucosal and peripheral IL-10 responses and blocking IgG activity. J Immunol. 2004;172(5):3252–9. 10.4049/jimmunol.172.5.3252
23. Kappen JH, Durham SR, Veen HI, Shamji MH. Applications and mechanisms of immunotherapy in allergic rhinitis and asthma. Ther Adv Respir Dis. 2017;11(1):73–86. 10.1177/1753465816669662
24. Lao-Araya M, Steveling E, Scadding GW, Durham SR, Shamji MH. Seasonal increases in peripheral innate lymphoid type 2 cells are inhibited by subcutaneous grass pollen immunotherapy. J Allergy Clin Immunol. 2014;134(5):1193–5.e4. 10.1016/j.jaci.2014.07.029
25. Berings M, Karaaslan C, Altunbulakli C, Gevaert P, Akdis M, Bachert C, et al. Advances and highlights in allergen immunotherapy: On the way to sustained clinical and immunologic tolerance. J Allergy Clin Immunol. 2017;140(5):1250–67. 10.1016/j.jaci.2017.08.025
26. Kouzegaran S, Zamani MA, Faridhosseini R, Rafatpanah H, Rezaee A, Yousefzadeh H, et al. Immunotherapy in allergic rhinitis: Its effect on the immune system and clinical symptoms. Open Access Maced J Med Sci. 2018;6(7):1248–52. 10.3889/oamjms.2018.264
27. Calderón MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: Looking at the published evidence. J Allergy Clin Immunol. 2012;129(4):929–34. 10.1016/j.jaci.2011.11.019
28. Soyyigit S, Guloglu D, Ikinciogullari A, Secil D, Oztuna D, Mungan D, et al. Immunologic alterations and efficacy of subcutaneous immunotherapy with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients. Ann Allergy Asthma Immunol. 2016;116(3):244–51.e2. 10.1016/j.anai.2016.01.002
29. Kim SH, Shin SY, Lee KH, Kim SW, Cho JS. Long-term effects of specific allergen immunotherapy against house dust mites in polysensitized patients with allergic rhinitis. Allergy Asthma Immunol Res. 2014;6(6):535–40. 10.4168/aair.2014.6.6.535
30. Frew AJ, Powell RJ, Corrigan CJ, Durham SR. Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117(2):319–25. 10.1016/j.jaci.2005.11.014
31. Zeng D, Li W, Zhou J, Wen X, Chen S, Xie X, et al. Analysis of the immunoglobin E molecular sensitization profile in children with allergic asthma and predictive factors for the efficacy of allergy immunotherapy. Ann Transl Med. 2020;8(21):1459. 10.21037/atm-20-7314
32. Di Lorenzo G, Mansueto P, Pacor ML, Rizzo M, Castello F, Martinelli N, et al. Evaluation of serum s-IgE/total IgE ratio in predicting clinical response to allergen-specific immunotherapy. J Allergy Clin Immunol. 2009;123(5):1103–10, 10.e1-4. 10.1016/j.jaci.2009.02.012
33. Lai X, Li J, Xiao X, Liu E, Zhang C, Wang H, et al. Specific IgG4 production during house dust mite immunotherapy among age, gender and allergic disease populations. Int Arch Allergy Immunol. 2013;160(1):37–46. 10.1159/000339239
34. Pelaia C, Vatrella A, Lombardo N, Terracciano R, Navalesi P, Savino R, et al. Biological mechanisms underlying the clinical effects of allergen-specific immunotherapy in asthmatic children. Expert Opin Biol Ther. 2018;18(2):197–204. 10.1080/14712598.2018.1402003
35. Cui L, Wang ZN, Xu ZQ, Xia ZF. Efficacy and safety of sublingual immunotherapy of allergic rhinitis in children between 4 and 5 years age group and 11 and 12 years age group. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;48(1):17–21.
36. Hamizan AW, Rimmer J, Husain S, Alvarado R, Tatersall J, Sewell W, et al. Local specific Immunoglobulin E among patients with nonallergic rhinitis: A systematic review. Rhinology. 2019;57(1):10–20. 10.4193/Rhin18.074
37. Pevec B, Pevec MR, Markovic AS, Batista I. House dust mite subcutaneous immunotherapy does not induce new sensitization to tropomyosin: Does it do the opposite? J Investig Allergol Clin Immunol. 2014;24(1):29–34.
38. Gold DR, Wang X, Wypij D, Speizer FE, Ware JH, Dockery DW. Effects of cigarette smoking on lung function in adolescent boys and girls. N Engl J Med. 1996;335(13):931–7. 10.1056/nejm199609263351304
39. Kita H. Eosinophils: Multifunctional and distinctive properties. Int Arch Allergy Immunol. 2013;161 Suppl 2(02):3–9. 10.1159/000350662
40. Keles S, Karakoc-Aydiner E, Ozen A, Izgi AG, Tevetoglu A, Akkoc T, et al. A novel approach in allergen-specific immunotherapy: Combination of sublingual and subcutaneous routes. J Allergy Clin Immunol. 2011;128(4):808–15.e7. 10.1016/j.jaci.2011.04.033
41. Shamji MH, Layhadi JA, Sharif H, Penagos M, Durham SR. Immunological responses and biomarkers for allergen--specific immunotherapy against inhaled allergens. J Allergy Clin Immunol Pract. 2021;9(5):1769–78. 10.1016/j.jaip.2021.03.029
42. Shamji MH, Durham SR. Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers. J Allergy Clin Immunol. 2017;140(6):1485–98. 10.1016/j.jaci.2017.10.010
43. Hankin CS, Cox L, Bronstone A. The health economics of allergen immunotherapy. Immunol Allergy Clin North Am. 2011;31(2):325–41, x. 10.1016/j.iac.2011.03.007
44. Senna G, Ridolo E, Calderon M, Lombardi C, Canonica GW, Passalacqua G. Evidence of adherence to allergen-specific immunotherapy. Curr Opin Allergy Clin Immunol. 2009;9(6): 544–8. 10.1097/ACI.0b013e328332b8df
2. Zhang Y, Zhang L. Increasing prevalence of allergic rhinitis in China. Allergy Asthma Immunol Res. 2019;11(2):156–69. 10.4168/aair.2019.11.2.156
3. Meltzer EO. Allergic rhinitis: Burden of illness, quality of life, comorbidities, and control. Immunol Allergy Clin North Am. 2016;36(2):235–48. 10.1016/j.iac.2015.12.002
4. Mir E, Panjabi C, Shah A. Impact of allergic rhinitis in school--going children. Asia Pac Allergy. 2012;2(2):93–100. 10.5415/apallergy.2012.2.2.93
5. Romano M, James S, Farrington E, Perry R, Elliott L. The impact of perennial allergic rhinitis with/without allergic asthma on sleep, work and activity level. Allergy Asthma Clin Immunol. 2019;15:81. 10.1186/s13223-019-0391-9
6. Tu Y, Zhang H, Zhao L, Jin P, Zi X, Li T, et al. The changes in different symptom scores during subcutaneous immunotherapy in Chinese house dust mite allergic patients: A two-year, observational study. J Laryngol Otol. 2019;133(3):213–19. 10.1017/s0022215119000094
7. Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, et al. International consensus statement on allergy and rhinology: Allergic rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108–352. 10.1002/alr.22073
8. Wheatley LM, Togias A. Clinical practice. Allergic rhinitis. N Engl J Med. 2015;372(5):456–63. 10.1056/NEJMcp1412282
9. Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol. 2013;131(5):1288–96.e3. 10.1016/j.jaci.2013.01.049
10. Liu Z, Lu H, Feng X, Hu L, Wang J, Yu H. Predictive methods for efficacy of house dust mite subcutaneous immunotherapy in allergic rhinitis patients: A prospective study in a Chinese population. Int Forum Allergy Rhinol. 2020;10(3):314–19. 10.1002/alr.22508
11. Li Q, Li M, Yue W, Zhou J, Li R, Lin J, et al. Predictive factors for clinical response to allergy immunotherapy in children with asthma and rhinitis. Int Arch Allergy Immunol. 2014;164(3):210–17. 10.1159/000365630
12. Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines–2016 revision. J Allergy Clin Immunol. 2017;140(4):950–8. 10.1016/j.jaci.2017.03.050
13. Reddel HK, Bacharier LB. Global Initiative for Asthma Strategy 2021: Executive summary and rationale for key changes. Eur Respir J. 2022;59(1):2102730. 10.1183/13993003.02730-2021
14. Alvarez-Cuesta E, Bousquet J, Canonica GW, Durham SR, Malling HJ, Valovirta E. Standards for practical allergen--specific immunotherapy. Allergy. 2006;61 Suppl 82:1–20. 10.1111/j.1398-9995.2006.01219_1.x
15. Demoly P, Bousquet PJ, Mesbah K, Bousquet J, Devillier P. Visual analogue scale in patients treated for allergic rhinitis: aAn observational prospective study in primary care–Asthma and rhinitis. Clin Exp Allergy. 2013;43(8):881–8. 10.1111/cea.12121
16. Liu J-L, Ning W-X, Li S-X, Xu Y-C, Wu L, Wang Y-S, et al. The safety profile of subcutaneous allergen immunotherapy in children with asthma in Hangzhou, East China. Allergol Immunopathol (Madr). 2017;45(6):541–8. 10.1016/j.aller.2017.04.002
17. Klimek L, Bergmann KC, Biedermann T, Bousquet J, Hellings P, Jung K, et al. Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC). Allergo J Int. 2017;26(1):16–24. 10.1007/s40629-016-0006-7
18. Huang Y, Wang C. Comparison of long-term efficacy of subcutaneous immunotherapy in pediatric and adult patients with allergic rhinitis. Allergy Asthma Immunol Res. 2019;11(1): 68–78. 10.4168/aair.2019.11.1.68
19. Lee JH, Kim SC, Choi H, Jung CG, Ban GY, Shin YS, et al. A retrospective study of clinical response predictors in subcutaneous allergen immunotherapy with house dust mites for allergic rhinitis. Allergy Asthma Immunol Res. 2018;10(1): 18–24. 10.4168/aair.2018.10.1.18
20. Drazdauskaitė G, Layhadi JA, Shamji MH. Mechanisms of allergen immunotherapy in allergic rhinitis. Curr Allergy Asthma Rep. 2020;21(1):2. 10.1007/s11882-020-00977-7
21. Meiler F, Zumkehr J, Klunker S, Rückert B, Akdis CA, Akdis M. In vivo switch to IL-10-secreting T regulatory cells in high dose allergen exposure. J Exp Med. 2008;205(12):2887–98. 10.1084/jem.20080193
22. Nouri-Aria KT, Wachholz PA, Francis JN, Jacobson MR, Walker SM, Wilcock LK, et al. Grass pollen immunotherapy induces mucosal and peripheral IL-10 responses and blocking IgG activity. J Immunol. 2004;172(5):3252–9. 10.4049/jimmunol.172.5.3252
23. Kappen JH, Durham SR, Veen HI, Shamji MH. Applications and mechanisms of immunotherapy in allergic rhinitis and asthma. Ther Adv Respir Dis. 2017;11(1):73–86. 10.1177/1753465816669662
24. Lao-Araya M, Steveling E, Scadding GW, Durham SR, Shamji MH. Seasonal increases in peripheral innate lymphoid type 2 cells are inhibited by subcutaneous grass pollen immunotherapy. J Allergy Clin Immunol. 2014;134(5):1193–5.e4. 10.1016/j.jaci.2014.07.029
25. Berings M, Karaaslan C, Altunbulakli C, Gevaert P, Akdis M, Bachert C, et al. Advances and highlights in allergen immunotherapy: On the way to sustained clinical and immunologic tolerance. J Allergy Clin Immunol. 2017;140(5):1250–67. 10.1016/j.jaci.2017.08.025
26. Kouzegaran S, Zamani MA, Faridhosseini R, Rafatpanah H, Rezaee A, Yousefzadeh H, et al. Immunotherapy in allergic rhinitis: Its effect on the immune system and clinical symptoms. Open Access Maced J Med Sci. 2018;6(7):1248–52. 10.3889/oamjms.2018.264
27. Calderón MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: Looking at the published evidence. J Allergy Clin Immunol. 2012;129(4):929–34. 10.1016/j.jaci.2011.11.019
28. Soyyigit S, Guloglu D, Ikinciogullari A, Secil D, Oztuna D, Mungan D, et al. Immunologic alterations and efficacy of subcutaneous immunotherapy with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients. Ann Allergy Asthma Immunol. 2016;116(3):244–51.e2. 10.1016/j.anai.2016.01.002
29. Kim SH, Shin SY, Lee KH, Kim SW, Cho JS. Long-term effects of specific allergen immunotherapy against house dust mites in polysensitized patients with allergic rhinitis. Allergy Asthma Immunol Res. 2014;6(6):535–40. 10.4168/aair.2014.6.6.535
30. Frew AJ, Powell RJ, Corrigan CJ, Durham SR. Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117(2):319–25. 10.1016/j.jaci.2005.11.014
31. Zeng D, Li W, Zhou J, Wen X, Chen S, Xie X, et al. Analysis of the immunoglobin E molecular sensitization profile in children with allergic asthma and predictive factors for the efficacy of allergy immunotherapy. Ann Transl Med. 2020;8(21):1459. 10.21037/atm-20-7314
32. Di Lorenzo G, Mansueto P, Pacor ML, Rizzo M, Castello F, Martinelli N, et al. Evaluation of serum s-IgE/total IgE ratio in predicting clinical response to allergen-specific immunotherapy. J Allergy Clin Immunol. 2009;123(5):1103–10, 10.e1-4. 10.1016/j.jaci.2009.02.012
33. Lai X, Li J, Xiao X, Liu E, Zhang C, Wang H, et al. Specific IgG4 production during house dust mite immunotherapy among age, gender and allergic disease populations. Int Arch Allergy Immunol. 2013;160(1):37–46. 10.1159/000339239
34. Pelaia C, Vatrella A, Lombardo N, Terracciano R, Navalesi P, Savino R, et al. Biological mechanisms underlying the clinical effects of allergen-specific immunotherapy in asthmatic children. Expert Opin Biol Ther. 2018;18(2):197–204. 10.1080/14712598.2018.1402003
35. Cui L, Wang ZN, Xu ZQ, Xia ZF. Efficacy and safety of sublingual immunotherapy of allergic rhinitis in children between 4 and 5 years age group and 11 and 12 years age group. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;48(1):17–21.
36. Hamizan AW, Rimmer J, Husain S, Alvarado R, Tatersall J, Sewell W, et al. Local specific Immunoglobulin E among patients with nonallergic rhinitis: A systematic review. Rhinology. 2019;57(1):10–20. 10.4193/Rhin18.074
37. Pevec B, Pevec MR, Markovic AS, Batista I. House dust mite subcutaneous immunotherapy does not induce new sensitization to tropomyosin: Does it do the opposite? J Investig Allergol Clin Immunol. 2014;24(1):29–34.
38. Gold DR, Wang X, Wypij D, Speizer FE, Ware JH, Dockery DW. Effects of cigarette smoking on lung function in adolescent boys and girls. N Engl J Med. 1996;335(13):931–7. 10.1056/nejm199609263351304
39. Kita H. Eosinophils: Multifunctional and distinctive properties. Int Arch Allergy Immunol. 2013;161 Suppl 2(02):3–9. 10.1159/000350662
40. Keles S, Karakoc-Aydiner E, Ozen A, Izgi AG, Tevetoglu A, Akkoc T, et al. A novel approach in allergen-specific immunotherapy: Combination of sublingual and subcutaneous routes. J Allergy Clin Immunol. 2011;128(4):808–15.e7. 10.1016/j.jaci.2011.04.033
41. Shamji MH, Layhadi JA, Sharif H, Penagos M, Durham SR. Immunological responses and biomarkers for allergen--specific immunotherapy against inhaled allergens. J Allergy Clin Immunol Pract. 2021;9(5):1769–78. 10.1016/j.jaip.2021.03.029
42. Shamji MH, Durham SR. Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers. J Allergy Clin Immunol. 2017;140(6):1485–98. 10.1016/j.jaci.2017.10.010
43. Hankin CS, Cox L, Bronstone A. The health economics of allergen immunotherapy. Immunol Allergy Clin North Am. 2011;31(2):325–41, x. 10.1016/j.iac.2011.03.007
44. Senna G, Ridolo E, Calderon M, Lombardi C, Canonica GW, Passalacqua G. Evidence of adherence to allergen-specific immunotherapy. Curr Opin Allergy Clin Immunol. 2009;9(6): 544–8. 10.1097/ACI.0b013e328332b8df
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