Allergy asthma treatment
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Allergy Asthma Treatment: Insights and Advances
Understanding Allergy and Asthma Treatment Mechanisms
Allergic diseases, including asthma, have become increasingly prevalent worldwide. The treatment of these conditions involves understanding the cellular and soluble mediators involved in allergic inflammatory responses. This knowledge is crucial for identifying new therapeutic targets and improving existing treatments. Recent advancements in systemic and mucosal allergen-specific immunotherapy, identification of key cytokines and their receptors, and new vaccine development approaches have shown promise in tackling the allergy epidemic1.
Allergen Immunotherapy (AIT) for Asthma
Efficacy and Safety of Allergen Immunotherapy
Allergen-specific immunotherapy (AIT) has been a subject of debate due to its potential benefits and risks. Randomized controlled trials have demonstrated that AIT can significantly reduce asthma symptoms, medication use, and bronchial hyper-reactivity. However, it also carries the risk of severe adverse reactions, including anaphylaxis2 4 5. Despite these risks, AIT remains the only treatment that can modify the underlying allergic disease, offering long-term benefits even after the treatment has ended3.
Sublingual vs. Subcutaneous Immunotherapy
Both sublingual (SLIT) and subcutaneous (SCIT) routes of allergen administration have been studied extensively. SLIT has been shown to be a safe and effective alternative to SCIT, particularly in children with allergic rhinitis and asthma. Studies indicate that at least three years of SLIT treatment can significantly reduce symptoms and medication use, improving the quality of life for children with these conditions6. SCIT, on the other hand, has shown efficacy in improving asthma-related quality of life in inner-city children, although it did not significantly impact asthma medication and symptom scores7.
House Dust Mite-Driven Allergic Asthma
The European Academy of Allergy and Clinical Immunology (EAACI) has provided guidelines for the use of house dust mite (HDM) AIT as an add-on treatment for HDM-driven allergic asthma. The guidelines recommend HDM SLIT-tablets for adults with controlled or partially controlled asthma and HDM SCIT for both adults and children to decrease symptoms and medication needs8. These recommendations highlight the importance of selecting patients most likely to respond to AIT and using proven allergen extracts and desensitization protocols.
Preventive Potential of Allergen Immunotherapy
AIT not only treats existing allergic conditions but also has preventive effects. A three-year course of subcutaneous or sublingual AIT can prevent the development of asthma in children and adolescents with moderate-to-severe allergic rhinitis triggered by grass or birch pollen. This preventive effect can last up to two years post-AIT, with some evidence suggesting even longer-lasting benefits9.
Conclusion
Allergen immunotherapy represents a significant advancement in the treatment and prevention of allergic asthma. While it offers substantial benefits in reducing symptoms, medication use, and improving quality of life, it also carries risks that must be carefully managed. The choice between sublingual and subcutaneous routes, patient selection, and adherence to proven protocols are critical for the success of AIT. As research continues, AIT holds promise not only as a treatment but also as a preventive strategy for allergic diseases.
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Most relevant research papers on this topic
Treatment strategies for allergy and asthma
Understanding allergen-induced inflammation can lead to new treatment targets and improved allergy treatments.
Highly 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 CitedClinical 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 ReviewAllergen immunotherapy for asthma.
Allergen specific immunotherapy significantly reduces asthma symptoms and medication use, and improves bronchial hyper-reactivity, but the risk of anaphylaxis must be considered.
Systematic ReviewHighly CitedAllergen immunotherapy for asthma.
Allergen specific immunotherapy significantly reduces asthma symptoms and medication use, improving bronchial hyper-reactivity, but the risk of anaphylaxis must be considered.
Systematic ReviewHighly CitedAllergen specific sublingual immunotherapy in children with asthma and allergic rhinitis
Sublingual allergen specific immunotherapy (SLIT) is a safe and effective treatment for children with asthma and allergic rhinitis, reducing symptoms and improving their quality of life.
Systematic ReviewA randomized trial of subcutaneous allergy immunotherapy in inner-city asthmatic children <4 years of age.
Allergy immunotherapy was ineffective in improving asthma outcomes in inner-city children 4 years of age, except for improving asthma-related quality of life.
RCTEAACI 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 CitedEAACI guidelines on allergen immunotherapy: Prevention of allergy
Allergen immunotherapy (AIT) can prevent asthma in children with grass/birch pollen allergy, but more high-quality clinical trials are needed for other allergic conditions and preventive effects.
Systematic ReviewRigorous JournalHighly CitedAllergen immunotherapy and asthma
Allergen immunotherapy (AIT) effectively reduces symptoms, medication use, and improves quality of life in allergic asthma patients, with long-lasting effects after discontinuing treatment.
Rigorous Journal