Allergic asthma treatment
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Allergic Asthma Treatment: Current Strategies and Innovations
Allergen Immunotherapy (AIT) for Allergic Asthma
Mechanisms and Efficacy of AIT
Allergen immunotherapy (AIT) is a unique treatment for allergic asthma that modifies the immune system to induce long-term tolerance to allergens. Unlike pharmacotherapy, which only controls symptoms, AIT can lead to lasting physiological changes, reducing the severity of allergic reactions even years after treatment ends. The primary mechanisms of AIT include changes in immunoglobulin classes (IgA, IgE, and IgG), induction of immunosuppressive regulatory T cells, and shifts in T-helper cell profiles from Th2 to Th1. Additionally, AIT decreases early-phase reaction activity and increases the production of cytokines such as IL-10, IL-35, TGF-β, and IFN-γ1.
Administration Routes and Safety
AIT is typically administered via subcutaneous injections or sublingual drops/tablets over several years. While effective, AIT carries risks, including severe and sometimes fatal anaphylaxis. Therefore, patient selection and the use of proven allergen extracts and desensitization protocols are crucial for successful treatment1 5 7.
Monoclonal Antibodies in Allergic Asthma Treatment
Anti-IgE Therapy
Monoclonal antibodies targeting IgE, such as omalizumab, have shown efficacy in treating moderate-to-severe allergic asthma. These antibodies form complexes with free IgE, preventing its interaction with mast cells and basophils, thereby reducing allergic responses. Clinical trials have demonstrated that omalizumab significantly reduces the incidence of clinically significant exacerbations and improves other asthma-related outcomes3 10.
Economic and Clinical Considerations
Despite its clinical benefits, omalizumab is associated with high costs, leading to incremental cost-effectiveness ratios (ICERs) that exceed conventional thresholds. The key drivers of cost-effectiveness include asthma-related mortality risk, quality of life improvements, and reductions in oral corticosteroid (OCS) use10.
Probiotics and Herbal Interventions
Probiotics
The use of probiotics in treating allergic asthma has been explored, but the results are inconclusive. While some studies suggest benefits in reducing symptoms of allergic rhinitis, there is no significant evidence supporting the efficacy of probiotics in treating asthma4.
Herbal Medicines
Herbal-based treatments have shown promise in managing asthma and allergic rhinitis. Various medicinal plants have been identified to have bronchodilatory effects, improve pulmonary function, and antagonize asthma mediators like histamine. However, the quality and quantity control of these herbal remedies remain a challenge, and more research is needed to validate their efficacy and safety6.
Conclusion
The treatment landscape for allergic asthma includes a variety of strategies, from allergen immunotherapy and monoclonal antibodies to probiotics and herbal medicines. AIT remains a cornerstone for long-term modification of allergic responses, while monoclonal antibodies like omalizumab offer targeted relief for severe cases. Probiotics and herbal interventions provide alternative options, though their efficacy requires further validation. As research continues, these treatments hold the potential to improve the quality of life for individuals with allergic asthma.
Sources and full results
Most relevant research papers on this topic
Clinical and Experimental Treatment of Allergic Asthma with an Emphasis on Allergen Immunotherapy and its Mechanisms.
Allergen immunotherapy (AIT) effectively treats allergic asthma by modifying the immune system, enabling individuals to live improved lives for years after treatment ends.
Systematic ReviewTreatment strategies for allergy and asthma
Understanding allergen-induced inflammation can lead to new treatment targets and improved allergy treatments.
Highly CitedTreatment of allergic asthma with monoclonal anti-IgE antibody.
RhuMAb-E25 is an effective treatment for moderate-to-severe allergic asthma, providing relief without requiring corticosteroids.
RCT
Large Human TrialHighly CitedProbiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials.
Probiotics may have a beneficial effect in allergic rhinitis by reducing symptom severity and medication use, but more high-quality studies are needed to confirm this.
Systematic ReviewHighly CitedInjection allergen immunotherapy for asthma.
Allergen specific immunotherapy significantly reduces asthma symptoms and medication use, and improves bronchial hyper-reactivity, but risks of local or systemic adverse effects must be considered.
Systematic Review
Very Rigorous JournalHighly CitedHerbal interventions in asthma and allergy.
Herbal medicines show potential in treating asthma and allergic rhinitis symptoms, with potential benefits similar to allopathic medicines and fewer side effects.
Systematic ReviewHighly CitedEAACI Guidelines on Allergen Immunotherapy: House dust mite‐driven allergic asthma
House dust mite allergen immunotherapy (SLIT-tablet) is recommended as an add-on treatment for adults with controlled or partially controlled house dust mite-driven allergic asthma, and SCIT and SLIT drops are recommended for children with controlled house dust mite-driven allergic asthma.
Rigorous JournalHighly CitedAllergen-Specific Immunotherapy in the Treatment of Pediatric Asthma: A Systematic Review
SCIT may reduce long-term asthma medication use in children, but its impact on asthma-related quality of life and health care use remains inconclusive.
Systematic ReviewBCG for the prevention and treatment of allergic asthma.
BCG treatment shows potential in preventing and treating allergic asthma by redirecting pathogenic Th2 towards protective Th1 and regulatory T cell responses in animal models.
Rigorous JournalOmalizumab for the treatment of severe persistent allergic asthma: a systematic review and economic evaluation.
Omalizumab significantly reduces the incidence of clinically significant asthma exacerbations in both adults and children, making it a cost-effective treatment option for severe persistent allergic asthma.
Systematic ReviewHighly Cited