Open Access 01-12-2015 | Review
Allergen immunotherapy in pregnancy
Published in: Allergy, Asthma & Clinical Immunology | Issue 1/2015
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Background
Allergic diseases such as asthma and allergic rhinitis constitute a
significant burden of disease among women of childbearing age and those who are
pregnant. Adequately managing these conditions is paramount in reducing negative
fetal outcomes as well as maternal complications during pregnancy. However, the
potential for harm to both the mother and fetus demands carefully balancing efficacy
and safety of treatment. Allergen immunotherapy (AIT) has emerged as a relatively
safe and efficacious mode of therapy in both children and adults. AIT has also been
considered for use during pregnancy.
Methods
A review of the literature was
conducted for data regarding the safety of initiation and continuation of AIT during
pregnancy as well as the effect of AIT on the development of atopy in offspring. MEDLINE and the Cochrane Library were searched for clinical trials, randomized
control trials, observational studies and journal articles in English using the terms
"Pregnancy" and "Immunotherapy" from 1900 to present. This yielded 4 studies
(totaling 422 pregnancies receiving AIT) investigating the continuation of AIT in
pregnancy, 2 (totaling 31 pregnancies receiving AIT) evaluating AIT initiation during
pregnancy and 5 observing the effect of AIT on atopy in offspring.
Results
No significant difference was found in the incidence of prematurity,
hypertension (HTN)/proteinuria, congenital malformations or perinatal deaths between
the women continued on AIT (both subcutaneous (SC) IT and sublingual (SL) IT to
inhalant allergens as well as venom IT) during pregnancy and controls. Similarly, there
was no significant difference in maternal or fetal complications between pregnant
women initiated on AIT and controls. Among the few pregnant women (10/453
pregnancies) who experienced generalized reactions while receiving AIT, none were
found to have fetal complications. Neither SCIT nor SLIT during pregnancy altered the
risk of developing atopic disease in offspring.
Conclusions
Based on these data, the continuation of AIT during pregnancy
appears safe. Furthermore, the few data available suggest that the initiation of AIT
during pregnancy might also be safe, however, more data is required for a definitive
conclusion. Lastly, available studies do not show a convincing reduction in the
development of atopy in offspring from the administration of AIT during pregnancy.