A review of allergen immunotherapy in asthma

Abstract

Asthma is one of the most common chronic diseases worldwide. Besides symptomatic treatments, allergen immunotherapy (AIT) is a possible add-on treatment for asthmatic patients. In case of an immunologically proven allergen-driven mechanism of asthma, AIT represents the only etiologic treatment for allergic symptoms. AIT has proven both its efficacy and effectiveness in reducing asthma symptoms and asthma medications. It is still debated whether its prescription in severe asthmatic patients is allowed and safe. As for uncontrolled asthma, such a condition should be considered temporary, and AIT may be started as asthma becomes at least partially controlled after treatment adjustment. Finally, randomized trials and real-life studies in recent years have proven that AIT could be administered as a preventive strategy to reduce the risk of developing asthma in patients suffering from allergic rhinitis. More studies are needed to provide more precise indications on the role in clinical practice of AIT in asthmatic patients. Nevertheless, present data are already strong enough to highlight its role as a therapeutic option for allergic asthma and as a preventive strategy to stop or at least decelerate the allergic march.

Allergen immunotherapy in patients with severe asthma: A need for prospective trials

“…AIT remains the only disease-modifying intervention for children with asthma and allergic rhinitis. 7 …”

“…2,3 While on monthly immunotherapy injections, patients have significant reductions in asthma symptoms, medication use, and improvement in bronchial hyperreactivity. [4][5][6][7][8] After completion of 3 years of AIT, most patients achieve sustained effects of treatment despite discontinuation of AIT. AIT remains the only disease-modifying intervention for children with asthma and allergic rhinitis.…”

“…AIT remains the only disease-modifying intervention for children with asthma and allergic rhinitis. 7 Current National Heart, Lung, and Blood Institute (NHLBI) asthma treatment guidelines recommend consideration of subcutaneous AIT in treatment steps 2, 3, and 4. 9 Patients with severe asthma on NHLBI treatment steps 5 and 6 are typically excluded from AIT because uncontrolled asthma is a risk factor for allergic reactions during AIT.…”

Alergenska imunoterapija u liječenju astme

“…Brojne kontrolirane kliničke studije dokazale su učinkovitost i sigurnost AIT-a u liječenju alergijske astme u odraslih i djece, što je potvrđeno i metaanalizama. 34,14 Vrlo opsežna metaanaliza objavljena 2017. godine procjenjivala je učinkovitost AIT-a u astmi prema nekoliko parametara: učinku na simptome (engl. symptom score), učinku na korištenje lijekova (engl.…”

“…Metaanalize pokazuju usporedivu učinkovitost SCIT-a i SLIT-a, no SLIT ima bolji sigurnosni profil. 34,14,46 Situacije u kojima treba razmotriti primjenu AIT-a navedene su u tablici 1.…”