Can immunotherapy prevent the progression of airway disease?

The potential of allergen immunotherapy (AIT) to prevent allergic airway disease progression are demonstrated. Though not all patients benefit equally, there is limited research on which patients may benefit most.In this article, we focus on factors that may influence the risk of progression and their influence on the preventive effects of AIT, and whether some patients may benefit more than others may.

Various factors including age, genetic predisposition, number of sensitizations and co-morbidities, can influence the risk of progression, especially from allergic rhinitis/rhinoconjunctivitis (ARC) to asthma. Early age and severity are associated with a higher risk of progression. Younger children with ARC may benefit most from AIT with respect to prevent development of asthma. The number of sensitizations may not influence the effect. Since early allergic multisensitization and multimorbidity is associated with a low chance of remission and high risk of progression of allergic airway disease this group would be an obvious target for preventive AIT, which remains to be investigated.

AIT might be considered at an earlier age than hitherto. Most AIT studies have not stratified the results based on sensitizations and comorbidities. We recommend existing randomized controlled trial data to be reevaluated for this purpose.