[Immunotherapy of asthma: pro and contra]

Area of Science:

• Allergy and Immunology
• Respiratory Medicine

Context:

• Specific immunotherapy (IT) for asthma, introduced in 1911, remains debated due to empirical protocols, undefined extracts, unclear mechanisms, and potential side effects.
• Despite controversies, clinical efficacy of allergen-specific IT is well-documented for hay fever with seasonal asthma and selected perennial asthma patients.

Purpose:

• To evaluate the role and effectiveness of specific immunotherapy in managing allergic respiratory diseases.
• To emphasize the importance of patient selection and the multifactorial nature of allergic disease management.

Summary:

• Allergen-specific IT is most effective in patients with proven IgE-mediated disease, particularly for seasonal allergic asthma and hay fever.
• IT can lead to considerable reduction in symptoms and medication needs, though it is rarely curative.
• Optimal IT requires careful patient selection and should be viewed as an integral component of a broader strategy targeting allergic disease pathophysiology.

Impact:

• Provides a basis for optimizing patient selection and treatment protocols for allergen-specific immunotherapy.
• Highlights the benefit of IT in reducing symptom burden and drug consumption in allergic respiratory conditions.
• Supports the integration of IT into a comprehensive management plan for allergic diseases beyond symptomatic treatment.