Long-term Efficacy of Allergen Immunotherapy

What Do We Expect?

Franco Frati; Ilaria Dell'Albani; Cristoforo Incorvaia

Disclosures

Immunotherapy. 2013;5(2):131-133. 

In This Article

Summary of Methods & Results

In the current paper, Stelmach et al. studied the effect over time of a 3- or 5-year course of SIT with a house dust mite extract administered by the subcutaneous route in children with allergic asthma caused by exclusive sensitization to dust mites.[8] An observation period 3 years after stopping SIT was chosen. A total of 90 children entered the study and formed three groups of 30 subjects who either received a 3- or 5-year course of SIT or did not undergo SIT because their parents refused this treatment and so served as controls. The effectiveness of SIT was assessed by asthma remission, defined by the absence of any symptom requiring asthma medication for at least 12 months, by a negative result to bronchial provocation test, changes in lung function as measured by the forced expiratory volume in 1 s (FEV1) and decrease in using inhaled corticosteroids, namely budesonide. The results showed that asthma remission occurred in 50 and 54% of children treated with SIT for 3 and 5 years, respectively, and in 3.3% of control subjects; a higher increase of FEV1 was found in children treated for 5 years (from 91.8 to 98% of predicted value) compared with those treated for 3 years (from 90.9 to 92.5% of predicted value) and with control subjects (from 89.6 to 91% of predicted value); the median reduction of the budesonide dose was significantly higher in children treated for 5 years (75%) compared with 3 years (50%) at SIT stopping, but no differences were found at 3 years from stopping (100 and 94%, respectively), while the dose remained unchanged in control subjects. Some results seem to show a higher efficacy of the 5-year duration, however, from the clinical point of view, these are of limited importance. For example, this is true for the FEV1 improvement, the magnitude of which was below the level of clinical perception. Consequently, the authors concluded that a SIT duration of 3 years is adequate to treat children with mite-induced allergic asthma, but that longer observation periods are likely to improve our knowledge on this issue.

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