The Global Initiative for Asthma Report updated in 2019 stated that potential benefits of allergen immunotherapy (AIT), compared to pharmacological and avoidance options, must be weighed against the risk of adverse effects and the inconvenience and cost of the prolonged course of therapy in asthma. Thus, with the aim of clarifying some aspects with regard to the possible use of AIT in allergic asthma treatment armamentarium, a group of expert allergists from the Spanish Allergy and Clinical Immunology Scientific Society (SEAIC), particularly from the Immunotherapy and Asthma Interest Groups developed a frequently asked questions in clinical practice. This document updates relevant topics on the use of AIT in asthma and could facilitate physician clinical decisions and improve health outcomes for individual patients.

Background. Chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by partial (hyposmia) or total (anosmia) loss of smell, is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), worsens disease severity and quality of life. The objective of this study was to determine whether, in real-life conditions, biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare smell improvement in N-ERD and non-N-ERD subgroups. Methods. A multicenter, non-interventional, retrospective, observational study was performed, including 206 patients with severe asthma undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab) with CRSwNP. Results. Improved olfaction was found after treatment with all monoclonal antibodies: omalizumab (35.8%), mepolizumab (35.4%), reslizumab (35.7%), and benralizumab (39.1%), with no differences between groups. Patients with atopy, greater use of short course systemic corticosteroids, and larger polyp size were more likely to experience improvement in smell. The proportion of patients experiencing smell improvement was similar between the N-ERD (37%) and non-N-ERD (35.7%) groups. Conclusions. This is the first study to compare real-life improvement in sense of smell among patients undergoing long-term treatment with omalizumab, mepolizumab, reslizumab, or benralizumab for severe asthma and associated CRSwNP. Approximately 4 out of 10 patients reported a subjective improvement in sense of smell (with non-significant differences between biologic drugs). No differences were found in smell improvement between the N-ERD and non-N-ERD group.

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In ihrem 2019 aktualisierten Bericht schreibt die Global Initiative for Asthma, die möglichen Vorteile der Allergen-Immuntherapie (AIT) gegenüber medikamentösen und Karenzmaßnahmen müssten gegen das Nebenwirkungsrisiko sowie den Aufwand und die Kosten dieser langfristigen Form der Asthmatherapie abgewogen werden. Mit dem Ziel, diesbezüglich bei einigen Aspekten des möglichen Einsatzes der AIT als Teil des therapeutischen Arsenals bei allergischem Asthma mehr Klarheit zu schaffen, hat ein allergologisches Expertengremium aus der Mitgliedschaft der spanischen Fachgesellschaft für Allergologie und klinische Immunologie (SEAIC), genauer gesagt aus deren Arbeitsgruppen für Immuntherapie und Asthma, eine Aufstellung häufiger Fragen für die klinische Praxis zusammengetragen. Dieses Dokument soll den aktuellen Stand wichtiger Aspekte der Anwendung der AIT bei Asthma darstellen, Ärztinnen und Ärzten als klinische Entscheidungshilfe dienen und zu besseren Behandlungsergebnissen für die Patienten beitragen.