CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

ANAPHYLAXIS WITH ALLERGEN IMMUNOTHERAPY

Hülya Köse

Diyarbakır Children’s Diseases Hospital, Department of Pediatric Immunology and Allergic Diseases, Diyarbakır, Türkiye

Köse H. Anaphylaxis with Allergen Immunotherapy. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.177-188.

ABSTRACT

Allergen immunotherapy (AIT) is an effective method for treating allergic diseases and aims to develop long-term tolerance by modulating the allergen-specific immune response. AIT is a clinically proven method for treating IgE-mediated allergic diseases, especially allergic rhinitis, asthma, and anaphylaxis due to bee stings. This therapy is applied by administering increasing doses of specific allergens to patients and promotes immunological adaptation. The mechanism by which allergen immunotherapy (AIT) operates is fundamentally grounded in modulating the immune response specific to allergens. During the treatment process, the activity of Th2 cells decreases, and an increase in regulatory T cells (Treg) is observed. As a result, IgE production against the allergen is suppressed, while IgG4 antibodies, which have a protective effect, increase. At the same time, the activity of mast cells and eosinophils decreases, thus reducing the severity of the inflammatory response. Subcutaneous Immunotherapy (SCIT), sublingual immunotherapy (SLIT), and oral immunotherapy (OIT) are the main application methods. This treatment has demonstrated significant effectiveness in addressing respiratory tract allergies and allergies related to venom. SLIT is administered sublingually in tablet or liquid drops. OIT is generally used in the treatment of food allergies. One of the most significant advantages of AIT is that it can change the natural course of allergic disease rather than just suppressing symptoms. The treatment period is usually 3-5 years, and its effects can continue in the long term. Despite the significant therapeutic benefits AIT provides, it should not be forgotten that it contains some risks. The side effects of AIT are divided into two: local and systemic. Local adverse effects may include redness, itching, and swelling at the injection site, whereas systemic reactions can be more severe. Mild systemic side effects include runny nose, sneezing, and teary eyes, while some patients may also experience symptoms such as headache, nausea, and fatigue. Severe anaphylactic reactions may occur in rare cases, especially in SCIT applications. Systemic side effects are less common in SLIT applications, but mild side effects such as itching in the mouth and throat and stomach irritation may occur. Therefore, patient selection should be made carefully, and the treatment process should be carried out under medical supervision. Allergen immunotherapy is essential in managing allergic diseases and offers patients a treatment opportunity that targets the cause of the disease beyond relieving symptoms.

Keywords: Anaphylaxis; AIT; SCIT; SLIT; OIT

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