What is the role of immunotherapy in the treatment of asthma?

Updated: Oct 07, 2019
  • Author: John J Oppenheimer, MD; Chief Editor: Michael A Kaliner, MD  more...
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Answer

The use of repeated injections of escalating doses of allergen is effective in treating allergic rhinitis, and positive effects may persist even years after treatment has been stopped. This treatment is also considered mandatory for life-threatening bee and wasp sting (hymenoptera venom) reactions. [36]

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.

Supporters of this treatment for asthma 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). The acquisition of new sensitivities can be reduced or eliminated with the use of immunotherapy in monosensitized or oligosensitized children.

In a 2003 meta-analysis of 75 randomized, controlled trials, Abramson et al reported that immunotherapy decreased asthma symptoms and the need for medication. [37] Another study showed improved PEFR and decreased use of medications in a highly selected group of children, but only for the first year of therapy.

Despite the fact that the cost may be $800 for the first year and $170 per year thereafter (1996 estimate), a study designed to evaluate the cost-effectiveness of subcutaneous immunotherapy (SCIT) in addition to symptomatic therapy (ST) compared with ST alone found that all patients receiving SCIT demonstrated improved medical outcomes and cost savings. [38]

Allergen immunotherapy should be considered if specific allergens have a proven relationship to symptoms; the individual is sensitized (ie, positive skin test or allergin-specific IgE findings); the allergen cannot be avoided and is present year-round (eg, industrial); or symptoms are poorly controlled with medical therapy, and a vaccine to the allergen is available. This treatment is especially useful if the asthma is associated with allergic rhinitis.

Referral to an allergist is required. The patient must commit to a course of 3–5 years of therapy (a trial of several months can be considered, although generally effect takes approximately a year to plateau).


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