Subcutaneous specific immunotherapy for seasonal allergic rhinitis: a review of treatment practices in the US and Europe

Abstract

Background:

Subcutaneous specific immunotherapy (SCIT) is claimed to be successful both in the US and Europe, yet treatment methodology differs.

Methods:

The authors review current literature surrounding guidelines and clinical trials in Europe and the US and contrast the treatment approach to SCIT for allergic rhinitis. Search methodology employs MEDLINE and PubMed, selecting articles on SCIT and allergic rhinitis, limited between 1990–2009. They focus on the safety and efficacy of vaccines, and the differences in formulations. Also mentioned are: standardization, new approaches in SCIT and sublingual immunotherapy (SLIT).

Results:

SCIT treatment differs in many respects regarding availability of SCIT products, regulatory controls, guidelines (e.g. multiple allergen vaccines in US, single allergen vaccines in Europe) and in location of formulation (US, clinician’s office; Europe, manufacturers).

Conclusions:

SCIT is an effective and safe therapy, but major evidence for efficacy is provided from European studies of single allergen extract vaccines; these vaccines may gain more acceptance because of increasing regulatory approval and lower numbers of injections. The potential impact upon public health (e.g. arrest of the ‘allergic march’) should not be overlooked.

Key words:

• Allergic rhinitis
• Europe
• Practice
• Subcutaneous specific immunotherapy
• United States

Transparency

Declaration of funding

We thank Allergy Therapeutics (UK) Ltd for funding this article.

Declaration of financial/other relationships

L.C. has disclosed that she has acted as a consultant for Hollister-Stier, Stallergenes and Schering-Plough. M.C. has acted as a consultant for ALK-Abello and Schering-Plough, and a speaker for ALK-Abello, Allergy Therapeutics (UK) Ltd, MSD and GSK. He has appeared on advisory boards for Allergy Therapeutics (UK) Ltd and ActoGeniX, received honoraria from ALK-Abello, Allergy Therapeutics (UK) Ltd, Schering-Plough and MSD and research grants from ALK-Abello and GSK.

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she has received grant funding from, and acted as a consultant to, Dynova Labs, Dyax, and Flint Hills Resources; and that he/she is on the speakers bureau for AstraZeneca and Alcon. Peer Reviewer 2 has disclosed no relevant financial relationships.

Acknowledgements

The authors would like to thank Dr Martin Quinn of Prism Ideas for providing editorial support, funded by Allergy Therapeutics (UK) Ltd.