D1.189 - Does Allergen Immunotherapy Add Clinically Meaningful Benefit in Paediatric Asthma and Allergic Rhinitis? A 36-Month Real-World Comparison

Real-world evidence on allergen immunotherapy (AIT) effects on quality of life (QoL) in paediatric asthma and allergic rhinitis (AR), including atopic comorbidities, remains limited.

We analysed routine-care data (2020–2025) from children/adolescents <18 years (n=1,908; mean age 9.2 years; 62.9% female). Month 2 was baseline with follow-up at months 12, 24 and 36. Strategies were sublingual AIT (SLIT; n=969), allergoid immunotherapy (n=423) or no AIT (n=516). Primary outcomes were change from baseline in the Pediatric Asthma Quality of Life Questionnaire (PAQLQ; higher=better) and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ; lower=better). Secondary outcomes included the Asthma Control Test (ACT) and minimal clinically important difference (MCID; PAQLQ increase ≥0.5 points; RQLQ decrease ≥0.5 points). Between-strategy differences were estimated using multivariable regression adjusted for age, sex, baseline severity (mild/moderate/severe), phenotype (including atopic dermatitis), and baseline score. Data were analysed in anonymised/aggregated form; no identifiable patient information is reported.

Asthma was present in 1,604 patients (PAQLQ in n=972; ACT in n=1,604) and AR in 1,233 (RQLQ in n=1,233). Mean ΔPAQLQ improved by +1.63 to +1.69 at 12 months and +1.73 to +1.81 at 36 months across strategies; 100% achieved PAQLQ MCID at each timepoint. Mean ΔRQLQ improved by −0.99 to −1.02 at 12 months and −1.42 to −1.53 at 36 months; 77–78% achieved RQLQ MCID at 12 months and 93–95% at 36 months. ACT increased by +3.98 to +4.27 at 12 months and +4.21 to +4.54 at 36 months; ACT≥20 increased from 71–74% at baseline to 93–95% at 12 months and 96–97% at 36 months. Adjusted differences were small (36 months: allergoid vs no AIT ΔPAQLQ β=−0.073; SLIT vs no AIT ΔRQLQ β=+0.066) and ACT differences were not significant.

In routine care, paediatric QoL and asthma control improved substantially over 36 months. Compared with no AIT, SLIT or allergoid AIT was not associated with clinically meaningful additional improvement in PAQLQ/RQLQ or ACT.