[Specific immunotherapy in allergic asthma]

Asthma is a chronic inflammatory disease of the airways considered as the result of a deregulated immune response, with a pivotal role played the TH2 cytokine phenotype. The treatment of allergic asthma is based on allergen avoidance, pharmacotherapy, allergen-specific immunotherapy, and patient education. Specific immunotherapy is able to normalize the upraised TH2 cytokine phenotype and indicated for patients who have demonstrable evidence of IgE-mediated clinically relevant sensitisation to pollens, house-dust mites and cat or dog allergens. The exposure to the allergens must be related to the appearance of symptoms. Randomised controlled trials in asthma have found that immunotherapy was effective (evidence 1a, strength of recommendation A) in reducing specific and non-specific bronchial hyperreactivity, asthmatic symptoms, and medication requirements. Patient selection is important and efficacy must be balanced against the risk of side effects. Immunotherapy should be used by pneumologists with a training in allergology in patients with mild asthma.