Talk:Allergen immunotherapy

message: As there was no mention as to WHAT it was that was being disputed (May 2011), my best guess was the use of links to Grazax.
Looking at the links and their date, given that the product was new it would be expected that there would be a number of articles using it specifically. While the article only mentions the product once, it claims the product is recommended as a matter of fact; the link however points out that Grazax was the first LICENSED sub-lingual product available. As such, that section has been edited to reflect the abstract of the article.
BayaniMillsτ 06:44, 19 August 2011 (UTC)
thread_title: Neutrality Removed

message: An observation by Moises Claderon who has authored immunotherapy meta-analyses is that there are few injection therapy studies which makes meta-analysis difficult. By contrast, there were more than 45 placebo controlled studies on sublingual, which is greater than the number of injection immunotherapy studies  since the 1970s. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001936. The outcomes of sublingual and injection therapy are similar so why not combine them?  —Preceding unsigned comment added by Jimthompson md (talk • contribs) 17:32, 11 October 2008 (UTC)
thread_title: Analysis

message: The sentences:
"Immunotherapy administered through cutaneous injections or sublingually has substantial empirical support. Numerous research articles and several meta-analytic studies support its clinical effectiveness. " seem to suggest that both sublingual and injection imunotherapy are equally well tried and tested. 
As far as I can see this is not the case.
 
The Cochrane reviews of "Allergen immunotherapy for asthma"
http://www.cochrane.org/reviews/en/ab001186.html
"Allergen injection immunotherapy for seasonal allergic rhinitis" (2007)
http://www.cochrane.org/reviews/en/ab001936.html
and Grazax (sublingual imunothereapy) http://www.npc.co.uk/MeReC_Extra/2007/no27_2007_suppl.htm (2007)
Sublingual immunotherapy for allergic rhinitis
http://www.cochrane.org/reviews/en/ab002893.html  (2003)
imply to my reading that the sublingual is far newer and less tried & tested and (though results are encouraging) is less well established as effective, but the dates of these studies differ by four years making a proper comparison is difficult.
I am no expert but this article could do with someone who is expert to clarify this point.
--Sam 15:56, 15 April 2008 (UTC)
replies: text: I'm no expert, however I've broken them both up; and included new methods of treatment.
BayaniMillsτ 06:25, 19 August 2011 (UTC)
thread_title: Lumping of sublingual and injection imunotherapy together - Needs help

message: This article is a good start, but it needs the help of experts to flesh out and make appropriate citations. For example, in the "Mechanism of Therapeutic Action" section, the mechanism of the hypersensitivity itself is described adequately, but therapeutic action is described thus: "the individual's immune system is essentially 'retrained' to tolerate exposure." This suggests that the immune system learns to recognize the allergen as something innocuous. Current study does not support that idea. Instead, it is believed that repeated (controlled) exposure to increasing doses of the allergen causes 'increasing' immune response from plasma- and memory-type B-Cells, which leads to widespread circulation of IgG (and memory cells to augment immune response on future exposures). When the immune system later encounters uncontrolled or large doses of the antigen, the "invader" becomes coated with IgG molecules, which proliferate in the bloodstream and extracellular matrix. This makes the antigen's binding sites unavailable (invisible) to the IgE molecules on granular leukocytes. The immune system doesn't learn to "tolerate" the antigen; instead, it becomes hypersensitive to it and clobbers the substance with IgG. The antigen/IgG complex is then consumed and broken down by phagocytes like neutrophils and macrophages. This keeps any significant amount of antigen from getting to the IgE on (and degranulating) mast cells, which accumulate in tissues like the endothelium, rather than circulating in the blood. 151.151.73.166 (talk) 22:04, 16 December 2007 (UTC)
thread_title: Needs help

message: The following are references that are yet to be added/used.
They are from the references list at http://www.allergy.org.au/content/view/148/128/
Comparison
Malling HJ. Comparison of the clinical efficacy and safety of subcutaneous and sublingual immunotherapy: methodological approaches and experimental results.  Curr Opin Allergy Clin Immunol.  2004; 4(6): 539-42
Mechanism
Akdis M, Akdis CA.  Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol. 2007 Feb 23; [Epub ahead of print]  
Sublingual
Pajno GB. Sublingual immunotherapy: The optimism and the issues. J Allergy Clin Immunol. 2007 Feb 13;  
Berto P, Bassi M, Incorvaia C, Frati F, Puccinelli P, Giaquinto C, Cantarutti L, Ortolani C.   Cost effectiveness of sublingual immunotherapy in children with allergic rhinitis and asthma. Allerg Immunol (Paris). 2005 Oct;37(8):303-8.
Novembre E, Galli E, Landi F, Caffarelli C, Pifferi M, De Marco E, Burastero SE, Calori G, Benetti L, Bonazza P, Puccinelli P, Parmiani S, Bernardini R, Vierucci A. Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2004 Oct;114(4):851-7.
Wilson DR, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis. Allergy. 2005 Jan;60(1):4-12. Review.
Wilson DR, Torres LI, Durham SR. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2003;(2):CD002893. Review.
Lima MT, Wilson D, Pitkin L, Roberts A, Nouri-Aria K, Jacobson M, Walker S, Durham S. Grass pollen sublingual immunotherapy for seasonal rhinoconjunctivitis: a randomized controlled trial. Clin Exp Allergy. 2002 Apr;32(4):507-14.
Other
Bousquet PJ et. Sub-Lingual Immunotherapy - World Allergy Organisation Position Paper 2009. WAO Journal Nov 2009: 233-281 
Bussmann C, Bockenhoff A, Henke H, Werfel T, Novak N.  Does allergen-specific immunotherapy represent a therapeutic option for patients with atopic dermatitis? J Allergy Clin Immunol. 2006 Dec;118(6):1292-8.  
Enrique E, Cistero-Bahima A. Specific immunotherapy for food allergy: basic principles and clinical aspects. Curr Opin Allergy Clin Immunol. 2006 Dec;6(6):466-9.  
"'Specific Conditions'"
Abramson MJ, Puy RM, Weiner JM. Allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2003;(4):CD001186. Review.  
Golden DB, Kagey-Sobotka A, Norman PS, Hamilton RG, Lichtenstein LM. Outcomes of allergy to insect stings in children, with and without venom immunotherapy. N Engl J Med. 2004 Aug 12; 351(7):668-74.
Brown SG, Wiese MD, Blackman KE, Heddle RJ. Ant venom immunotherapy:  a double-blind, placebo-controlled, crossover trial. Lancet. 2003 Mar 22;361(9362):1001-6.
Hopefully they help
BayaniMillsτ 06:23, 19 August 2011 (UTC)
thread_title:  References For Use 

message: removing silly image
there is an image of a girl in "anaphylactic shock". she is resting with her eyes closed and wearing an o2 mask. while she might be in mild anaphylactic shock, it must not be severe shock as she not even intubated. alternatively, she may just be sleeping with an oxygen mask on for any myriad of reasons. this image is not illustrative of a patient in true "shock" and adds nothing to the article overall. (shellac.) —Preceding unsigned comment added by Shellac (talk • contribs) 
:Actually, she is in the ER being treated for anaphylactic shock as a result of allergy shots. This image is even used in a biology book in a section about hyposensitization (allergy shots). I wouldn't say that it is "silly" by any means. There are different levels of anaphylactic shock. This patient's throat closed up, she was unable to breath, & she passed out. Please ask the author of the image before making broad assumptions. Thanks, нмŵוτнτ 02:06, 20 February 2008 (UTC)
thread_title:  Other Issues 

message: I have been keen to have this treatment for some time, but have not had it.
However, two UK General Practisioners (Dr's) who I respect, have each recommended against because they say sometimes it kills the patient. I am unsure what the true risk is and whether their view is based on anecdote or out of date information.  It would be good to have a section covering the frequency of fatalaties from this treatment, both in the past and (if things have improved in the last 20 years then) as compared to nowadays.
Also this article need backing up with reference to double blind controlled studies and scientific articles.
--Sam 17:49, 7 April 2008
I have found further information on this.  It seems fatalaties can occur but the most common cause is breathing difficulty in Asthmatics and fatalaty is relatively rare - many articles on the web say 1 in 2 million injections.  fatalaties can be reduced by various medical procedures and precautions.  Desensitisation injections are applied repeatedly so that increases the odds a bit but it is still relatively safe eg 1 person might have 150 or more injections.  Non-fatal adverse reactions are more common.
The reticence to desensitisation treatment seems to be local to the UK.
More on this here:
Select Committee on Science and Technology Sixth Report 
http://www.parliament.the-stationery-office.co.uk/pa/ld200607/ldselect/ldsctech/166/16611.htm
"witnesses forcefully told us that immunotherapy was not used to its full potential in the United Kingdom. The reason for this was partly historical; when early types of immunotherapy were administered by general practitioners, a number of patients had suffered anaphylactic shock. Professor Anthony Frew, President of the EAACI, told us that "between 1952 and 1986 there were about 27" associated fatalities (Q 195) and the EAACI felt that the limited use of immunotherapy in the United Kingdom "reflects concerns about safety""
The Cochrane review has useful information on "Allergen immunotherapy for asthma"
http://www.cochrane.org/reviews/en/ab001186.html
and regards it as relatively safe.
"Deaths due to allergen immunotherapy were extremely rare, with estimates ranging from one per one million to one per two million injections.
"
Could do with a higher resolution version of the picture, if possible.  —Preceding unsigned comment added by 89.243.2.37 (talk) 14:02, 16 November 2008 (UTC)
thread_title: Fatalaties from desensitization treatment

message: I think that this article should be moved/renamed to allergy immunotherapy or allergen specific immunotherapy. I prefer allergen specific immunotherapy. The term hyposensitization is not in common usage.--Literaturegeek | T@1k? 19:41, 5 April 2009 (UTC)
thread_title: Rename of article

message: In the 2nd last sentence of the start section, the word 'efficious' should probably be 'efficacious'. But it could also be that something else was meant (e.g. 'efficient'). Who could check / decide? (I don't see a quotation mark there.) Jacosi (talk) 11:33, 24 September 2009 (UTC)
thread_title:  Non-existing word: efficious 

message: ImVision Therapuetics AG are currently testing the direct injection of small quantities of allergens directly into the lymphatic nodes (Phase 1 complete for Cat allergy) http://www.imvision-therapeutics.com/page2.asp?PageID=657. This method reportedly achieves allergy blocking within several weeks rather than 1 to 5 years needed with SCIT. Intralymphatic Immunotherapy isn't mentioned in the article. Spinstorm (talk) 09:16, 6 September 2010 (UTC)
replies: text: Why don't you add it then? :) It certainly sounds interesting, but be cautious in the wording of the content as it is phase 1 and preliminary results.--Literaturegeek | T@1k? 16:07, 8 September 2010 (UTC)

text: Treatment Added. -- BayaniMillsτ 06:27, 19 August 2011 (UTC)
thread_title:  No mention of Intralymphatic Immunotherapy 

message: This page has very little benefit for the average site visitor wishing to source balanced information on allergen injection immunotherapy (AII). The page is very similar to the numerous commercial websites published by allergists who have a financial motive for advocating and promoting and AII. The potential for serious adverse reactions including deaths from AII are glossed over, the fact that almost no long term immunological monitoring is taking place to establish if AII is associated with an increase in the incidence of auto-immune or other immunological conditions is not even mentioned. The ethical prerequisite for exploration of conventional alternative treatment options are not even touched on nor is there any mention of the importance of informed patient consent prior to AII. 
Many allergists are justifying the prescription of AII on the basis of skin prick testing alone, in many instances the skin prick testing is conducted without positive and negative controls and without objective measurements of wheal and flare being taken, in those circumstances the skin prick test results are wholly unreliable. Skin prick reactions to some allergens are also controversial in that a significant percentage of patients who are proven not to be allergic on RAST testing are testing positive on skin prick tests, and the reverse is also true, patients who test positive on RAST can not infrequently test negative on skin prick tests. 
The edit history for the page shows that any content that raises any of these types of issues has been removed or edited including links to articles in the medical literature about serious adverse events from AII. In its current form this page is nothing more than a blatant advertisement for the 'allergy injection industry'. 
In most areas of medicine there is a reasonable arms length separation between the prescriber and the medicine supplier, a patient will visit their doctor be issued a prescription and the patient will attend a pharmacy to be issued the medicine, in that way there is not a direct conflict of interest whereby the doctor profits from the patient receiving a particular type of medicine. However with AII in many instances the doctor is both the prescriber and the supplier of the therapy profiting from both the prescribing and the supply, obviously that situation results in a direct conflict of interest. In such a situation is it possible to determine if AII is being prescribed for the benefit of the patient or for the benefit of the prescriber/supplier?
There are a plethora of publications by allergists on the benefits of AII overwhelmingly those publications are anecdotal uncontrolled studies that lack the scientific credibility of a double blind controlled study with three arms with at least 100 patients in each arm. The US supreme court has already ruled on anecdotal medical evidence and determined it to be treacherous. Given that allergists appear to have a paucity of ammunition in their therapeutic armoury it is unsurprising that almost every paper written by an allergist on AII ends with the predetermined conclusion that AII is a highly beneficial therapy that should be used more often. This is no different to any other product manufacturer/supplier endorsing and marketing their particular brand of kool-aid. 
There is absolutely no incentive for allergen manufacturers or the allergists to conduct any statistically reliable studies to establish if AII (for example) increased the long term incidence of Rheumatoid Arthritis, if it were discovered and accepted that AII did result in a significant long term increase in immunological illness then it would be hard to justify the massive number of injections currently given for relatively minor conditions. If AII was restricted to a small minority of patients in special circumstances then what other services would the allergists offer to be able to remain in practice?
This is a therapy that should not be entered into lightly and this page should reflect a balanced perspective on the pros and cons of this sort of treatment rather than it simply being a marketing page for the allergen injection industry.  — Preceding unsigned comment added by 58.96.98.54 (talk) 05:14, 31 December 2011 (UTC)
thread_title:  Advertisement for Allergen Injection Industry 

message: Potentially useful review article:
Allergen injection immunotherapy for seasonal allergic rhinitis.
http://www.ncbi.nlm.nih.gov/pubmed/17253469
24.218.111.172 (talk) 21:05, 5 March 2012 (UTC)
thread_title:  A couple of relevant review articles that could be used 

message: I have posted information about an article that points to concerns with sub lingual immunotherapy efficacy. (although totally anecdotal, I have experienced both forms of treatment, and lost all of the benefits gained through sub-cutaneous treatment, when I switched to sub lingual.) There are also older studies with rats that showed a lack of treatment effect with sub lingual treatment, unfortunately, I researched this in 1993 and do not have the peer reviewed publication and article information any longer. 
Also, in regards to the edit mentioning the monetary aspect of subcutaneous immunotherapy, it is more common to see board certified allergists use subcutaneous immunotherapy and general practitioners who know the lesser hazards of sub lingual immunotherapy to branch out to increase their practices. There are manufacturers of the sub lingual solutions and if it was just as effective, wouldn't it make more sense for even allergists to increase the size of their practice by having patients who are deterred by injections and the limitations of injection hours to move to sub lingual immunotherapy if money were the deciding factor in choosing which treatment to offer?
There is also no control of sub lingual drops and that the variance of concentrations of allergens are not consistent and that each solution must be tested to pass muster.The subcutaneous solutions are tested and controlled. Sub lingual drops are akin to folk remedies of eating local honey because it contains local pollens.
http://www.medicalnewstoday.com/releases/128492.php
Efficacy, Dosage Concerns Unresolved On Sublingual Immunotherapy
Main Category: Immune System / Vaccines
Also Included In: Allergy
Article Date: 07 Nov 2008 - 0:00 PDT
68.227.231.169 (talk) 23:30, 13 May 2012 (UTC)
replies: text: Agreed, the sections about Sublingual immunotherapy reads like an advertisement without citations 216.10.193.23 (talk) 14:50, 3 May 2013 (UTC)
thread_title:  Sublingual immunotherapy is presented in too positive a light in the article 

message: I have gone through vaccination against wasps for 5 years. It is now ca 10 years ago, and I still have itching in my arm at the place where I took the injection every now and then. I looked hard to find any information on this on the net but found nothing, but when I contacted the hospital they urgently explained that it was a known side-effect that they don't tell of, but that it is harmless, even though they didn't know why it happened... I think this should be included in the part about side-effects, both to calm people that wonder what it is, and if there are any explanaitions as to why this happen so many years later and if there are any risks. Some expert here who knows?  — Preceding unsigned comment added by 85.226.37.229 (talk) 21:37, 26 June 2012 (UTC)
thread_title: negative side-effects

message: The section entitled "Procedures" is simply a repeat of the rest of the article. It even contains some of the exact same phrases. Should I delete it? Bfotino (talk) 16:33, 16 February 2013 (UTC)
thread_title: Repetitive Information

message: This article (as pointed out by others) focuses primarily on the benefits of sublingual immunotherapy.  There is no data detailing the studies referenced, or any countervailing data on the topic.  The sublingual section begins by claiming that sublingual administration is "preferred by doctors and patients," but provides no citation.  I added a reference because sublingual administration is not FDA approved and is often used off-label in the U.S., but I do not have the necessary knowledge to edit/update the historical data on immunotherapy.  Subdermal therapy is references as "historical," though it is still the standard for immunotherapy in the United States.  The procedures section is essentially a rehash of the sublingual/subdermal sections.
I compared with historical edits, and it also seems that good data on methods/history of/studies related to subdermal allergen immunotherapy were removed over the last year and replaced with the pro-sublingual data.  I am hesitant to change this without in-depth knowledge of the field, as I may be misunderstanding the reason for their removal. I'm hoping someone else will take a look!
Jrdwiki (talk) 00:29, 23 July 2013 (UTC)
thread_title:  Neutrality of POV 

message: I updated the article in order to complete the missing references.  — Preceding unsigned comment added by 46.218.50.66 (talk) 13:19, 4 October 2013 (UTC)
thread_title:  Update 

message: ... doesn't work very well: doi:10.1001/jamainternmed.2015.2840 JFW | T@lk 11:54, 30 June 2015 (UTC)
thread_title:  Sublingual immunotherapy 

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thread_title:  External links modified 

message: Following this edit by an ip, I have reviewed the related information. 
These are the conclusions of a 2017 systematic review and meta-analysis :
"Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis. CONCLUSIONS: AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE‐mediated food allergy whilst receiving (i.e. desensitization) and post‐discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost‐effectiveness of AIT." 
I am not sure how (and where) to summarize this in the lede to update this sentence of the current version "Its benefit for food allergies is unclear and thus not recommended" and which is the better section of the article to develop it. --BallenaBlanca 🐳 ♂ (Talk) 09:49, 15 April 2018 (UTC)
thread_title:  IgE-mediated food allergies 

message: doi:10.1111/all.13420 JFW | T@lk 09:34, 17 July 2018 (UTC)
thread_title:  EAACI guideline 

message: A few things I'm confused about after reading this article:
* The lead and the "Types" section talk about subcutaneous immunotherapy and sublingual immunotherapy, but the rest of the body mostly talks about oral immunotherapy (which is never defined). Is oral immunotherapy the same thing as sublingual immunotherapy or it is only for food allergies?
* The lead says that subcutaneous immunotherapy has been shown to be effective in children, but nowhere in the article does it address whether subcutaneous immunotherapy has been shown to be effective in adults, or even if it's been studied in adults. That would seem to be an important topic to cover in the article.
* The "Protocol" section lists 3 phases, but doesn't say what the phases are or how long they last. The "Subcutaneous" section, however, talks about just 2 phases. How many phases are there?
Kaldari (talk) 16:45, 12 September 2019 (UTC)
thread_title:  This article is confusing, disjointed, and lacking critical information 

message: * Adding new and improved sources and review articles may help to shed light on new information about allergen immunotherapy and also help to connect it further to science communication. It may also help to add more balance and information to the less common forms of immunotherapy like oral and sublingual. Because most of the sources in this article focus on the effectiveness of subcutaneous therapy, most of the information in the article revolves around subcutaneous therapy. It isn't necessarily overrepresented because it is the most common form of therapy.
Itrauger (talk) 22:03, 11 October 2020 (UTC)
thread_title:  Including new and improved sources