***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND The safety and efficacy of specific immunotherapy for mold allergy are not known in children and adolescents . OBJECTIVE We evaluated the efficacy and safety of specific immunotherapy with a st and ardized allergen extract in a r and omized , double-blind , placebo-controlled , 3-year prospect i ve study of patients who were allergic to only Alternaria alternata . METHODS Fifty children and adolescents ( 25 girls ; 5 - 18 years of age ) with A alternata-induced seasonal allergic rhinoconjunctivitis and /or bronchial asthma were r and omly assigned to groups given treatment ( Novo-Helisen Depot , A alternata 100 % ) or placebo . The primary end point was the combined symptom medication score . Secondary end points included safety , quality of life , and sensitivity to allergen-specific nasal challenge . RESULTS Forty-five children completed the 3-year study . Although there was no significant change in year 1 , the combined symptom medication score decreased in years 2 and 3 of the study ( by 38.7 % and 63.5 % , respectively ; P < .001 for each ) . The reduction in symptoms was associated with a significant improvement in quality of life ( P < .05 ) and decrease in sensitivity after allergen-specific nasal challenge . Side effects were observed in 7 patients ; the most common ( edema at the site of injection ) occurred after 11 injections . CONCLUSIONS Allergen-specific immunotherapy with st and ardized A alternata extract reduces symptoms of asthma and rhinoconjunctivitis in children and adolescents without serious side effects In this prospect i ve controlled study , 39 children with Alternaria-induced asthma and /or rhinitis were followed-up over a 3-year period . Skin tests and RAST were positive to Alternaria tenuis only . All children were treated with specific Alternaria immunotherapy . The long-term results have shown that immunotherapy was successful in 80 % of the children given more than 80.000 PNU . By contrast , the outcome of 40 selected controls also followed during the same period who did not receive immunotherapy was almost exactly the opposite . In addition to demonstrating the clinical effectivity of specific Alternaria immunotherapy , the authors stress the relationship between successful results , highest tolerated doses , and larger cumulative dosage , which is irrespective of the duration of the therapy Little knowledge is available on molds either from the environmental or clinical points of view . The latter is mainly due to the lack , until recent times , of purified and st and ardized extracts . Injective immunotherapy , largely used for patients allergic to mites and pollens , is regarded with some concern for molds . On the other h and , mold-related allergic symptoms ( i.e.,from Alternaria tenuis ) have in Italy an incidence of about 5 percent , mainly in young patients . We have therefore run a pilot study comparing the efficacy and safety of injective ( SIT ) and sublingual ( SLIT ) immunotherapy by administering the same purified and st and ardized extract of Alternaria tenuis to a total of 23 patients for two years , according to an open experimental plan . Excellent tolerance was shown to SLIT while four ( two medium- grade ) side effects appeared with SIT . Clinical improvement , subjectively stated comparing symptoms ( mainly rhinitis ) and drug consumption before and after the therapy , confirmed by an increase in the Specific Nasal Provocation threshold , was obtained with both therapies , but with a statistically significant difference in favour of SLIT . Skin reactivity and blood Alternaria tenuis specific IgE , total IgG and IgG changed in the SIT-treated group , while no statistically significant change was shown in the SLIT-treated group . These results are in good agreement with previous reports on SIT and SLIT with other inhalant allergens ( mites , grasses ) , and suggest the potential use of SLIT for Alternaria allergy , mainly in young patients , when there are concerns about the safety of and compliance with the traditional injective therapy A placebo‐controlled , double‐blind study of immunotherapy with the mould species Cladosporium was performed in 22 adult asthmatics . The diagnosis of Cladosporium allergy was based on a combination of bronchial provocation test and daily symptom score in the Cladosporium season . An aqueous preparation of a potent , biologically st and ardized and purified extract was used in a clustered dose‐increase regimen . The clinical efficacy was evaluated by a combination of symptoms ( asthma score + peak flow ) and consumption of antiasthmatic medication . The mean changes in symptoms and medication consumption over a 10–week registration period ( peak Cladosporium season ) in 1982 after 5–7 months of immunotherapy were compared with the corresponding 1981 pretreatment 10‐week period A significant ( P= 0.03 ) difference in terms of “ improved ” , “ unchanged ” and “ deteriorated ” patients in favour of Cladosporium treatment was found . Approximately 80 % in the Cladosporium group showed improved/unchanged symptoms contrary to 30 % of the placebo treated . Side effects were observed frequently but only in the Cladosporium‐treated . About 70 % experienced a large local reaction and 100 % had episodes of asthma during dose‐increase phase . Only a few severe systemic reactions occurred . Based on the clinical efficacy of the treatment we consider immunotherapy with Cladosporium feasible for highly specialized clinics A double‐blind histamine placebo controlled immunotherapy trial was performed to investigate the clinical effect of a purified and st and ardized Cladosporium herbarum allergen preparation .  Thirty children with a clinical history suggesting mould‐induced asthma and /or rhinoconjuctivitis were included . The diagnosis was confirmed by positive skin prick test and Phadebas RAST ® as well as positive bronchial and /or conjunctival provocation test to Cladosporium herbarum . Immunotherapy was given for 10 months in a double‐blind manner to r and omized groups with either Pharmalgen ® /Cladosporium herbarum preparation or histamine placebo .  Allergic side effects to injections were common , especially during the peak of the mould season ( July‐September in Sc and inavia ) . In the active group , 13/16 patients experienced general reactions during the first 10 months of treatment . After 6 months of treatment , eye , nose and bronchial symptom scores and peak expiratory flow rates were similar for the groups , maybe because most of the children were also sensitive to many other allergens , including Alternaria alternala . However , medication scores were significantly lower in the treated group ( P < 0.01 ) . Bronchial ( P < 0.01 ) and conjunctival sensitivity ( P= 0.01 ) were significantly reduced in the Cladosporium‐treated group but not in the placebo group after 10 mouths of treatment . This is the first double‐blind clinical trial showing the clinical efficacy of immunotherapy in children with mould‐induced asthma Studies of immunotherapy with oral Alternaria extracts are scarce . We decided to perform a clinical trial of the clinical safety and efficacy of this extract as well as of its effects on in vivo and in vitro parameters in 39 patients with Alternaria allergy , aged between 7 and 17 years , who are also sensitized extract was used . Allergic activity was determined through RAST inhibition and skin prick test . Quantification of the principal allerten ( Alt a 1 ) was performed through the 2-site binding assay , with a mean content of 34.2 ng Alt a 1/micro g protein . The parameters analyzed were the symptom-medication score , skin prick using the end-point technique , specific bronchial challenge test , peak flow , total and specific IgE and IgG4 .  Nineteen patiens received active treatment with oral immunotherapy and another 19 received symptomatic treatment . The initial phase of immunotherapy lasted 3 months until the maximum dose was reached . This was maintained for 12 months ; the mean accumulated dos was 280,000 PNU . Significant differences were found in reduction in the symptom-medication score in the treated group after 12 months of immunotherapy . No differences were found in the control group . Immunotherapy was well tolerated with 0.42 adverse reactions per 100 doses administered . All adverse reactions were mild-to-moderate . In the treated group , papule size was significantly reduced . Values for the specific bronchial challenge test , expressed through PD20 , were significantly higher in the immunotherapy group . Peak flow showed no changes in either group . Values of IgG4 were significantly higher in the immunotherapy group . Total and specific IgE levels showed no significant changes in either group . In conclusion , oral immunotherapy with Alternaria extract is clinical ly effective in pediatric patients . In general , the therapy was well tolerated . It modified specific cutaneous and bronchial reactivity in our sample and increased levels of specific IgG4 , wich are implicated in humoral response INTRODUCTION Sensitisation to Alternaria is a cause of respiratory disease in Spain , particularly in childhood , but it is also a significant marker of the severity of this disease . Therefore , the use of an aetiological treatment ( allergen specific immunotherapy ) is essential , and both subjective and objective clinical parameters should be used to follow up this treatment . OBJECTIVE This open-label , uncontrolled , observational , prospect i ve study was design ed in order to study the evolution of these patients on  allergen specific immunotherapy therapy in daily clinical practice and to assess the use of different monitoring tools . MATERIAL AND METHODS A total of 99 patients were included . They were monosensitised to this perennial allergen and treated with subcutaneous allergen specific immunotherapy . After one year of follow-up , these patients were assessed for the presence of symptoms , use of medication , clinical incidents , quality of life and asthma control . RESULTS After one year of treatment a significant fall was observed in the use of concomitant medication ( β2-agonists : p=0.0278 , inhaled corticosteroids : p=0.0007 , anti-leukotrienes : p=0.0495 ) , nasal symptoms ( p=0.0081 ) , quality of life ( PAQLQ , p<0.0001 ) and asthma control ( ACQ , p<0.0001 ) . Twenty-one patients had to attend emergency department due to exacerbation of their allergic disease , and only one of them had to be admitted to hospital . CONCLUSION respiratory allergic disease due to Alternaria alternata is a disease which is hard to control , and in our daily practice , the use of specific subcutaneous immunotherapy can be of significant benefit in our paediatric patients Allergen-specific immunotherapy ( ASIT ) with fungal extracts has been beset by safety and efficacy problems , which result mainly from qualitative and quantitative variations . Little has been published on the safety and efficacy of these extracts . The objective was to analyze the safety and efficacy of ASIT with an Alternaria alternata extract . A total of 28 patients were selected with rhinitis and /or bronchial asthma because of Alternaria allergy and monosensitization to molds . The patients were r and omized to an active ASIT or placebo group , both groups on a conventional immunotherapy schedule ( increasing weekly doses until maintenance dose and then monthly doses ) . Adverse reactions were classified with the European Academy of Allergology and Clinical Immunology system . Clinical efficacy was analyzed for a year with symptom/medication diary cards , peak expiratory flow ( PEF ) measures , clinical severity score , severity of symptoms ( visual analog scale ) , subjective evaluation of treatment by the patient and the physician , and a quality of life question naire . Twenty-three patients completed the study ; all reached the established maintenance dose with only two mild adverse reactions in the whole sample . Significant improvements were found after 6 months in respiratory symptoms in the active treatment group , and in all symptoms in both groups . PEF increased significantly in the active treatment group but not in the placebo group . The severity of asthma decreased in the active treatment group , and the severity of rhinitis decreased in both groups . Visual analog scale scores for severity of symptoms improved in all phases in the active treatment group , but only after 12 months in the placebo group . Physicians judged the disease course as significantly better in the active treatment group . ASIT with the A. alternata extract was safe , with clinical improvements after one year of treatment BACKGROUND Respiratory allergy due to Alternaria is a relevant clinical problem , and specific immunotherapy may represent a viable treatment option . Sublingual immunotherapy ( SLIT ) is safe and effective , but data for Alternaria are lacking . OBJECTIVE To assess the efficacy of st and ardized SLIT in patients sensitized to Alternaria in a r and omized , prospect i ve , double-blind , placebo-controlled trial . METHODS Patients with rhinitis with or without intermittent asthma and ascertained allergy to Alternaria were enrolled . After a baseline season , SLIT or matched placebo was given for 10 months . Symptoms and rescue medication intake were recorded on diary cards between June and October . Skin prick testing was performed and specific IgE , IgG4 , and precipitin levels were measured at baseline and at the end of the study . RESULTS Twenty-seven patients ( age range , 14 - 42 years ) were r and omized , and 26 completed the study . The baseline characteristics were homogeneous in the 2 groups . After treatment , patients receiving SLIT had a significant improvement in symptoms and a reduction in medication intake vs placebo and vs the run-in season , whereas no change was seen in the placebo group . Skin prick test reactivity significantly decreased only in the SLIT group . No change was seen in specific IgG4 levels in the 2 groups , whereas Alt a 1 specific IgE levels significantly increased in the active group . One patient in the active group reported oral itching and conjunctivitis 
    Output:
    
Low strength evidence suggests that mould AIT is efficacious for the treatment of respiratory allergies .