Is Immunotherapy Safe for Treatment of Severe Asthma

Tolly E.G. Epstein; Christopher W. Calabria

Disclosures

Curr Opin Allergy Clin Immunol. 2022;22(6):396-401. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: The benefits of allergen immunotherapy (AIT), including subcutaneous allergen immunotherapy (SCIT) and sublingual allergen immunotherapy (SLIT), for IgE-mediated asthma are well established, especially for dust mite. This review will explore whether the benefits of AIT outweigh the risks in severe asthmatic patients.

Recent Findings: Studies have mostly included mild and moderate asthmatic patients, but at least a few studies do show improvements in asthma symptoms and medication use in severe asthmatic patients. Asthma, and especially uncontrolled asthma, is a major risk factor for severe and fatal systemic reactions from SCIT. Uncontrolled asthma is an absolute contraindication for SCIT. It is less clear whether the benefits of SCIT and SLIT may outweigh the risks in well controlled, severe asthmatic patients, and further study is needed in this area. Asthma biologics, especially Omalizumab, may improve outcomes in severe, controlled asthmatic patients on SCIT, but further data are needed regarding timing of initiation and duration of treatment.

Summary: Although severe asthmatic patients may benefit from AIT, significant risks exist, especially in those with uncontrolled asthma. Further study is needed regarding optimal strategies to minimize risks.

Introduction

Allergen immunotherapy (AIT) has been shown to significantly improve outcomes for multiple atopic conditions, including asthma.[1] These benefits have been tempered; however, by the risk of life-threatening systemic allergic reactions associated with AIT, especially subcutaneous allergen immunotherapy (SCIT). Asthma has consistently been found to be a significant risk factor for severe and fatal SCIT reactions.[2–4] Patients with severe asthma may be at greater risk for such events, but they may also derive significant benefits from SCIT. This review is a summary of arguments for and against the use of SCIT in severe asthmatic patients, as well as strategies to minimize risks.

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