What evidence exists to support the use of immunotherapy in the treatment of asthma?

Updated: Jan 07, 2019
  • Author: Michael J Morris, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Repeated injections of small doses of allergen have been used for more than almost 100 years to treat allergic rhinitis. This treatment is clearly effective, and positive effects may persist even years after treatment is stopped. This treatment is also considered mandatory for life-threatening bee and wasp sting (hymenoptera venom) reactions. The role of repeated allergen injections in patients with asthma has been more controversial, ranging from a relative indication to no indication. Benefit has been shown in individuals with allergy-induced asthma. [79]

Supporters argue that compliance can be ensured, and evidence shows that the underlying disease process can be modified or even prevented (eg, preventing asthma in children with allergic rhinitis). Acquisition of new sensitivities can be reduced or eliminated with immunotherapy of monosensitized or oligosensitized children.

Immunotherapy decreased asthma symptoms and the need for medication in a 2003 meta-analysis of 75 randomized controlled trials by Abramson et al. [80] Another study showed improved peak expiratory flow rate (PEFR) and decreased use of medications in a highly selected group of children, but only for the first year of therapy.

Patients receiving subcutaneous immunotherapy (SCIT) demonstrated improved medical outcomes and cost savings in one study designed to evaluate the cost-effectiveness of SCIT in addition to symptomatic therapy (ST), compared with ST alone. [78]


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