Allergen immunotherapy in asthma; what is new?

Area of Science:

• Allergy and Immunology
• Respiratory Medicine
• Pharmacology

Background:

• Allergen immunotherapy (AIT) for asthma remains debated, lacking definitive guideline recommendations for subcutaneous and sublingual routes.
• Existing clinical trials often lack asthma-specific designs and objective pulmonary function measures, complicating AIT's role.
• Despite methodological limitations in meta-analyses, consistent positive outcomes in asthma symptoms, medication use, and bronchial reactivity are reported.

Approach:

• Reviewing existing controlled randomized trials and meta-analyses on AIT in asthma.
• Evaluating clinical efficacy, including symptom reduction, medication needs, and bronchial hyperresponsiveness.
• Assessing the safety profile and disease-modifying potential of AIT, including prevention of asthma onset and long-term effects.

Key Points:

• Favorable results in asthma symptom control, reduced medication requirements, and improved bronchial reactivity are consistently observed in AIT trials.
• AIT demonstrates potential disease-modifying actions, including preventing asthma onset and providing long-lasting effects.
• Fatalities associated with AIT are rare, with uncontrolled asthma identified as the primary risk factor for severe adverse events.

Conclusions:

• Allergen immunotherapy (AIT) can be safely integrated as an add-on therapy for asthma patients with co-existing rhinitis, provided asthma is well-controlled.
• AIT is not recommended as a sole treatment for asthma.
• For respiratory allergy solely manifesting as asthma, AIT's use requires individual case evaluation.