The efficacy and safety of preventive allergen immunotherapy (pAIT) in children are currently under investigation. Here, we provide an overview of pAIT with respiratory allergens concerning the prevention of new sensitizations, allergic disease onset and progression as well as further immunomodulatory effects. Three databases were searched for clinical pAIT studies in children. Selected publications were reviewed for preventive outcomes according to prevention level (primary, secondary, and tertiary), allergen type, administration route, dose, and treatment duration. The primary prevention approach appears safe but showed no allergen‐specific effect on new sensitizations. Secondary prevention seems feasible and may induce regulatory T cell‐mediated immunotolerance. The number of studies at these prevention levels is limited. Tertiary prevention with grass and/or tree pollen‐based pAIT has shown efficacy in preventing disease progression from allergic rhinitis/conjunctivitis to asthma. Data on tertiary pAIT with house dust mites and other allergen types are inconclusive. Subcutaneous and sublingual routes appear similarly effective, but head‐to‐head comparative paediatric studies are scarce. Additionally, there are fewer placebo‐controlled studies. Nevertheless, immunomodulatory outcomes of pAIT are encouraging. Currently, limited but favourably suggestive evidence is available for preventing respiratory allergic diseases in children by pAIT. Primary and secondary prevention have potential and warrant further investigation through well‐designed studies.

中文翻译：

---

儿童吸入性过敏原的预防性过敏原免疫治疗

目前正在研究儿童预防性过敏原免疫疗法（pAIT）的有效性和安全性。在这里，我们概述了 pAIT 与呼吸道过敏原有关预防新致敏、过敏性疾病的发作和进展以及进一步的免疫调节作用。检索了三个数据库以了解儿童临床 pAIT 研究。根据预防级别（一级、二级和三级）、过敏原类型、给药途径、剂量和治疗持续时间对选定出版物的预防结果进行了审查。一级预防方法似乎是安全的，但对新的致敏作用没有表现出过敏原特异性作用。二级预防似乎可行，并且可能诱导调节性 T 细胞介导的免疫耐受。这些预防水平的研究数量有限。基于草和/或树花粉的 pAIT 的三级预防已显示出在预防从过敏性鼻炎/结膜炎到哮喘的疾病进展方面的功效。关于屋尘螨和其他过敏原类型的三级 PAIT 的数据尚无定论。皮下和舌下途径似乎同样有效，但头对头的比较儿科研究很少。此外，安慰剂对照研究较少。尽管如此，pAIT 的免疫调节效果还是令人鼓舞的。目前，通过 pAIT 预防儿童呼吸道过敏性疾病的证据有限，但具有积极意义。一级和二级预防具有潜力，值得通过精心设计的研究进行进一步调查。