Advances in Allergen Immunotherapy for Asthma

Ioana Agache; Alexandru Laculiceanu; Catalina Cojanu; Daniela Spanu; Liliana Rogoze


Curr Opin Allergy Clin Immunol. 2020;20(6):602-608. 

In This Article

Abstract and Introduction


Purpose of Review: Allergen immunotherapy (AIT) is a well-known disease-modifying intervention for allergic diseases. Its benefit in allergic asthma, ranging from prevention to facilitating asthma control, is yet to be clarified.

Recent Findings: In 2017, following several well-designed randomised controlled trials (RCTs) with house-dust mites (HDM) sublingual (SLIT) tablets in asthma, global initiative for asthma (GINA) guidelines highlighted the need to treat the allergic component of asthma. In 2019, the European Academy of Allergy and Clinical Immunology published the first comprehensive guidelines for HDM AIT in allergic asthma, formulating separate recommendations for subcutaneous, SLIT drops, and SLIT tablets. Significant steps were undertaken in understanding the mechanisms of allergic asthma, facilitating the stratified approach for selecting responders and in translating the immune-modulation effect in achieving long-term control of the chronic inflammation in asthma.

Summary: Currently existing guidelines recommend AIT as a therapeutic option in controlled or partially controlled HDM allergic asthma. Limited data are available for pollen, molds and pets, as well as for the severe allergic asthma population. The challenge for the future research will be to clarify the subendotypes of allergic asthma responding to AIT, the mechanisms facilitating its' preventive and disease-modifying effect, the optimal duration of the treatment, and route of administration.


Allergic asthma is a high-prevalence chronic disease, especially in the pediatric population where it can account for up to 90% of cases with asthma.[1–3] It is often persistent although there is a wide variation in disease severity.

Targeted immune modulation of a specific sensitization with allergen immunotherapy (AIT) is the only disease-modifying intervention in allergic diseases, with proven efficacy in allergic rhinitis where it prevents the occurrence of asthma and/or of new sensitizations (primary prevention) and decreases the need for antiinflammatory and rescue medication.[4–6]

The last years brought a specific focus on asthma primary and secondary prevention and on the potential role of immune modulation as a disease-modifying treatment approach.[7–9] The introduction of high-quality standardized extracts for AIT together with clinical trials with a specific focus on AIT in asthma has renewed the interest for this immune-modulatory approach in asthma.[10,11] Newer approaches to AIT are currently being tested including modified allergens, second-generation adjuvants/carriers, and routes of administration, all aiming to increased efficacy with no compromise on safety.[12–15]