נזלת אלרגית והטיפול ד"ר יעל לוי לאימונולוגיה ואלרגיה 22 אוקטובר 2014

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Adele Hodges
5 years ago
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1 נזלת אלרגית והטיפול באימונותרפיה תת לשונית( SLIT ( קיפר מכון ד"ר יעל לוי לאימונולוגיה ואלרגיה 1 22 אוקטובר 2014

2 Figure 1 The prevalence of asthma, hay fever, and eczema in two studies 25 years apart. Grey bars, 1964; black bars, Data from Ninan et al.3 Holgate, S T et al. Arch Dis Child 2005;90:

3 Trends in the prevalence of asthma and wheezing in Arabs and Jews [1997 vs 2003]. Romano-Zelekha et al.j Asthma 2007;44:364-9

4 The natural history of allergic rhinitis in childhood Pediatric Allergy and Immunology Volume 21, Issue 6, pages , 9 MAY 2010 DOI: /j x

5 co-morbidities &complications Asthma Otitis media with effusion Sinusitis Mouth breathing and orthodentic malocclusions Impaired sleep Interference with normal childhood activities Quality of life Gentile D et al. Current and Future Directions in Pediatric Allergic Rhinitis. JACI In Practice 2013;1:214-26

6 Impact of rhinitis on asthma severity in school age children Allergy 4 AUG 2014 DOI: /all

quality of life (13% of total population) 19% of allergic rhinitis patients remain uncontrolled 13% have a poor quality of

7 Allergic Rhinitis and unmet therapeutic needs TNS 2009: 623 subjects with AR/ 2003 individuals from general population Control with symptomatic treatments 73% remain uncontrolled (19% of total population) Quality of life 48 % have bad quality of life (13% of total population) 19% of allergic rhinitis patients remain uncontrolled 13% have a poor quality of life despite using symptomatic treatments A.Didier et al. Unmet therapeutic needs in allergic patients. Abstract at XXIX EAACI 2010

8 ALLERGIC RHINITIS:MANAGEMENT

9 IMMUNOTHERAPY (IT)METHODS IN ALLERGIC DISEASES subcutaneous SUBLINGUAL ORAL

13 100 Years of Allergen Immunotherapy SCIT First RCT SCIT First RCT SLIT WHO ARIA First Meta SLIT Large RCT SCIT First Meta SCIT Large RCT SLIT EBM SCIT SLIT (drops) SLIT tablets-fda Approved(2014)

14 עד היום אימונותרפיה ניתנת רק בזריקות הטיפול: חצי שנה חיסון פעם בשבוע, והמשך טיפול פעם בחודש למשך 3-5 שנים צריך להישאר במרפאה 30 דקות לאחר החיסון לא מתאים לילדים קטנים מס' זריקות בכל פעם נעשה במרפאת אלרגיה

15 אופציה חדשה לחיסון אימונותרפי SLIT יעילות מוכחת בטיפול באלרגיה SLIT פרופיל בטיחותי טוב טיפות מתחת ללשון יותר מזריקות כל יום Sub Lingual ImmunoTherapy Solution (Staloral) נוח לשימוש הטיפול בבית

16 STALORAL - Efficacy in mites allergy Significant reduction in the global rhinitis symptom score from the first year through the end of the second year (p<0.02) Significant decrease in nasal obstruction (p=0.01) Significant reduction in nasal pruritus (p=0.01) Tonnel AB et al. Allergic rhinitis due to house dust mites: evaluation of the efficacy of specific sublingual immunotherapy. Allergy 2004; 59:491-7

17 Safety Results Local adverse events more common in immunotherapy treated patients compared to placebo treated The majority of reported adverse events were mild to moderate and did not require any treatment No reports in clinical trials of severe systemic reactions or anaphylaxis No fatalities were reported S. Radulovic, et al Allergy 2011

18 SLIT vs. SCIT SLIT Improvement in rhinitis and conjunctivitis symptoms induced by pollen or mite allergens Improvement in asthma control in adults and Children Decrease in the use of antiallergic medications Optimal safety profile in children and adults Home uptake (storage in the fridge, transport at ambient temp)

19 QUESTIONS Adherence with daily therapy Treatment of patients with multiple allergens sensitization Efficacy compared to SCIT: Even if an advantage in effectiveness is confirmed for SCIT by adequate studies, it must be weighed against the greater safety and convenience of SLIT Nelson H,JACI In Practice 2014;2:144-9

20 Vial (Color cap) Concentration (IR / ml) Blue 10 Violin 300 הטיפול ניתן בהמלצת מומחים לאלרגיה,ונרכש באופן פרטי ע"י המטופל

Immunotherapy. Chris Doyle Consultant Nurse Respiratory & Allergy Alder Hey Childrens NHS FT. October 18 th 2014

Immunotherapy. Chris Doyle Consultant Nurse Respiratory & Allergy Alder Hey Childrens NHS FT. October 18 th 2014 Immunotherapy Chris Doyle Consultant Nurse Respiratory & Allergy Alder Hey Childrens NHS FT Chris.doyle@alderhey.nhs.uk October 18 th 2014 What exactly is Immunotherapy? Medical procedure that uses controlled