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Allergen immunotherapy and asthma: Efficacy, safety, and other considerations

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The efficacy of allergen immunotherapy (AIT) for allergic asthma is often debated despite multiple controlled trails and three meta-analyses that have established a significant effect on subjective and objective outcomes. Indications for AIT in allergic asthma include suboptimal control with medications, adverse effect of medications, and/or environmental control measures; patient's desire to avoid long-term pharmacotherapy; and presence of comorbid allergic conditions. Symptomatic asthma is a risk factor for AIT systemic reactions (SRs) and asthma should be controlled at the time of the AIT administration. The vast majority of studies in AIT for asthma have used single allergens although the majority of allergic patients in the United States are not monosensitized. There have been conflicting results in the limited number of studies that have investigated the effect of multiallergen AIT or as add-on therapy to asthmatic patients who are optimally controlled with medications and environmental controls. Several studies have suggested that AIT may prevent the development of asthma in subjects with allergic rhinitis and new allergen sensitizations. The recently updated Allergen Immunotherapy Practice Parameters lists possible prevention of asthma in patients with allergic rhinitis as one of the indications for AIT. Currently, subcutaneous immunotherapy is the only route with Federal Drug Administration approved formulations in the United States but sublingual immunotherapy is currently under investigation. This review examines the efficacy, safety, and preventive effects of these two routes of immunotherapy.
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Keywords: Allergen immunotherapy; allergic rhinitis; asthma; monosensitized; multiallergen; subcutaneous immunotherapy; sublingual immunotherapy

Document Type: Review Article

Affiliations: Department of Medicine, Nova Southeastern University Osteopathic College of Medicine, Fort Lauderdale, Florida, USA. [email protected]

Publication date: November 1, 2008

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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