Pearls of Wisdom: Immunotherapy For Antigen-Stimulated Asthma
Answer: Immunotherapy may improve his asthma symptoms and reduce his medication burden.
Immunotherapy is underused in patients with asthma, partly because of concerns about cost and partly because of limited efficacy data. In fact, guidelines from major societies on the use of immunotherapy for asthma do not readily settle the issue since, in the words of one publication, authorities' opinions have ranged "from absolute rejection to guarded recommendation."1
Study: Treat Allergies Before Pollen Season Begins
To provide further insight into the effectiveness of immunotherapy for the treatment of asthma, the researchers conducted a meta-analysis of 54 studies from the Cochrane Database of Systematic Reviews examining various antigens, including dust, pollen, animal dander, and mold.
Overall, the researchers concluded that immunotherapy was "strongly correlated with significant reduction in asthma symptoms and asthma medications use."
Immunotherapy is generally very safe; however, the rare serious or life-threatening reactions that have been observed during immunotherapy were disproportionately seen during treatment of asthma. Because provision of immunotherapy requires specially trained staff and management tools, and carries a risk, enthusiasm from some experts is tepid.
Certainly, for patients whose symptoms are clearly linked to antigens or whose asthma is difficult to control, consideration of immunotherapy is appropriate. Recent evolution of sublingual immunotherapy, which has not been associated with severe systemic reactions (but also appears to be somewhat less efficacious), offers still another path for consideration.
What’s the “Take-Home?”
Some patients have asthma for which antigen stimulation (eg, grasses, weeds, mold, house dust) is a primary culprit. When antigen provocation appears likely, or when asthma responds poorly to standard treatment, immunotherapy merits consideration.
1. Dunagan DP, Bowton DL. When to consider allergen immunotherapy for asthma. J Respir Dis. 2001;22(5):280-288.