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Specific immunotherapy in asthma: a comprehensive review.

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Allergen immunotherapy (SIT), including subcutaneous (SCIT) and sublingual (SLIT) forms, can improve asthma symptoms, especially when co-occurring with rhinitis. However, it is not recommended as a standalone treatment for asthma alone.

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Area of Science:

  • Allergy and Immunology
  • Respiratory Medicine
  • Clinical Therapeutics

Background:

  • Allergen immunotherapy (SIT) for asthma lacks clear guideline recommendations, making its prescription a subject of ongoing debate.
  • Existing guidelines often do not provide definitive guidance on the use of SIT in asthma management.

Purpose of the Study:

  • To evaluate the efficacy and safety of allergen immunotherapy (SIT) in patients with asthma.
  • To determine the role of SIT in asthma management, particularly when associated with allergic rhinitis.

Main Methods:

  • An extensive review of the scientific literature was conducted.
  • Analysis included studies on both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT).

Main Results:

  • Robust studies demonstrate that SCIT and SLIT improve asthma symptoms, particularly when asthma is linked with rhinitis.
  • Favorable meta-analyses exist, though trial heterogeneity limits their definitive conclusions.
  • Fatalities associated with SIT are rare, with no reported deaths in Europe in two decades or the US in four years. Uncontrolled asthma is a risk factor for adverse events, but SIT has not been shown to worsen or induce asthma.

Conclusions:

  • Sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) are viable options for asthma coexisting with rhinitis, provided asthma is well-controlled with medication.
  • A measurable clinical benefit in asthma symptoms can be anticipated in such cases.
  • SIT is not currently recommended as monotherapy for respiratory allergy presenting solely as asthma.