Allergen Immunotherapy for asthma in a public healthcare setting: The Cuban experience

Abstract

RATIONALE: Allergen immunotherapy (AIT) is a cost-effective approach and is particularly attractive for a social-security-based healthcare system. Nevertheless, AIT is underdeveloped and hardly available in most Latin American countries. The aim of this work was to review the 20years Cuban experience developing House Dust Mite AIT for asthma METHODS: Standardized allergen extracts were developed for the wellknown species Dermatophagoides pteronyssinus and for the tropical species D.siboney and Blomia tropicalis. The system based on Biological Units using Histamine as standard was used. In addition to IgE activity, Group 1 allergen content was measured. RESULTS: AIT with D. pteronyssinus, as well as, with the relevant tropical species D.siboney and B.tropicalis proved to be highly effective in 9 DBPC clinical trials (3 for each product) in 355 patients. Asthma symptoms decreased down to 56% and 53% after 1-year treatment, by subcutaneous or sublingual routes, respectively. Medication decreased to 58 and 60%. Overall, 76% patients showed clinical improvement, independently of the administration route (OR: 22-40). Products have been progressively introduced country-wide in Cuba, achieving an overall consumption (2008-2016) of roughly 100 000 patient-year treatments. A Phase IV country-wide study performed on 2018 patients has confirmed the efficacy shown in controlled trials. QoL index, medication and asthma symptoms showed highly significant improvements. Sublingual route has shown similar efficacy as compared to injection, with less systemic side-effects and no life-threatening reactions CONCLUSIONS: AIT with standardized HDM allergens has shown to be, not only a clinically advantageous treatment, but also an approach able to be extended into a public healthcare system.