Allergen Immunotherapy Shows Long-Term Benefits in Children with Allergic Rhinitis

A real-world study involving over 11,000 children supports the long-term effectiveness of allergen immunotherapy in treating allergic rhinitis.1 Children with and without asthma experienced symptom relief with this treatment.

“The reduction in the use of symptom-relieving medications (AH and INCS) not only supports the findings of the REACT study but also broadens the scope of the long-term evidence supporting [allergen immunotherapy],” study investigator Christian Woehlk, MD, PhD, from the Respiratory Research Unit at Bispebjerg Copenhagen University Hospital in Denmark, and colleagues wrote.1

Several randomized controlled trials support the efficacy of allergen immunotherapy for allergic rhinitis and asthma; however, investigators have recognized the lack of real-world pediatric data. Investigators conducted a study within the pre-defined framework of the REACT study, a large, retrospective cohort study examining the effectiveness of allergen immunotherapy over 9 years in more than 45,000 participants with allergic rhinitis.2

This real-world study included 11,036 children aged < 18 years (mean age, 11.4 years; 62.1% male) who had physician-diagnosed allergic rhinitis with or without asthma.1 Investigators randomized children 1:1 to the allergen immunotherapy or standard care (controls), and treatment effectiveness was evaluated over a 9-year follow-up period.

Participants were divided into younger (0–11 years) and older (12–17 years) cohorts. Short-acting β₂-agonist and inhaled corticosteroid prescriptions were more frequent among younger children, whereas long-acting β₂-agonist and inhaled corticosteroid use was comparable across age groups.1

Investigators highlighted a “marking and consistent steroid-sparing effect” among children with allergen immunotherapy. Children receiving allergen immunotherapy displayed 9% greater reduction in allergic rhinitis medication use than controls (70% vs 61%). Compared to controls, allergen immunotherapy was associated with a 28% greater reduction in INCS prescriptions.1

By year 3, participants receiving allergen immunotherapy had a 12% greater reduction in medication use than controls, with an absolute difference between arms of -0.08 (-0.13 to -0.02; P =.0114). By year 5, those on allergen immunotherapy had a 13% greater reduction in medication use than controls (absolute difference, -0.15; -0.22 to -0.08; P <.0001). By year 9, participants receiving allergen immunotherapy had a 16% greater reduction in medication use (absolute difference, -0.12; -0.23 to -0.01; P =.0344).1

Similarly, children with asthma receiving allergen immunotherapy had a 21% greater reduction in asthma medication use (69% vs 48%), severe exacerbations (57% vs 36%), and new oral corticosteroid prescriptions (74% vs 41%). The team found those on allergen immunotherapy had a 65% greater reduction in ICS + LABA prescriptions for asthma compared to controls. Between-group differences for asthma medication reductions were significant during years 2 – 8, with absolute differences of -0.24 (−0.34, −0.14; P <.0001) in year 3 (16% greater reduction), −0.41 (−0.53, −0.29; P < .0001) in year 5 (23% greater reduction), and −0.51 (−0.72, −0.30; P <.0001) in year 8 (22% greater reduction).1

The analysis showed that younger children, between the ages of 0 – 11 years, had stronger allergic rhinitis medication reductions than adolescents aged 12 – 17 years. During follow-up, younger children experienced an additional 9% reduction compared with controls, on top of a 57% reduction from baseline. Adolescents showed a further 3% reduction beyond their 63% baseline improvement, driven by greater decreases in both antihistamines and inhaled corticosteroid use. However, investigators did not observe a significant reduction in antihistamine prescriptions for adolescents treated with allergen immunotherapy—only reductions for inhaled corticosteroid use during years 2 – 3 and 5 – 6.12

“This subgroup analysis provides robust evidence for the long-term effectiveness of AIT in children with AR, including those with pre-existing asthma,” investigators concluded.1 “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. Importantly, they suggest that early intervention may help prevent disease progression.”

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. Published 2021 Nov 30. doi:10.1016/j.lanepe.2021.100275