ABSTRACT
Asthma is frequently associated with atopy, characterized by the production of specific immunoglobulin E in response to environmental allergens. Currently, two types of allergen immunotherapy (AIT) are used in clinical practice: subcutaneous and sublingual immunotherapy, both accepted as key components of the therapeutic repertoire for allergic rhinitis and conjunctivitis. However, their role in asthma remains controversial. The present document is aimed at providing the clinicians with a review of the evidence on the use of AIT in asthma, focusing on the most relevant aspects of its mechanism of action, its efficacy, and existing data on safety, tolerability, and cost-effectivity, both in pediatric and adult populations. A systematic search of MEDLINE, Cochrane, and Clinical Trials databases from 2000 to April of 2016 was carried out by a panel of experts from the Spanish Allergy and Clinical Immunology Scientific Society. Relevant studies prior to the year 2000 included in ulterior systematic reviews were also considered. More than 4000 articles were identified during the search and 241 were selected to retrieve available evidence on AIT, which was graded according to the Oxford classification. All the group members reviewed the resulting text until the final version reached the consensual agreement. A summary of recommendations on the more relevant topics are proposed. The role of AIT as a valuable therapeutic strategy for prevention of exacerbation and progressive decline in lung function is highlighted. Future research should include specific tools for asthma evaluation when assessing AIT effectiveness in asthmatic patients.
Subject(s)
Asthma/therapy , Desensitization, Immunologic/methods , Hypersensitivity/therapy , Adult , Allergens/immunology , Asthma/etiology , Child , Female , Humans , Hypersensitivity/complications , MaleABSTRACT
Asthma is frequently associated with atopy, characterized by the production of specific immunoglobulin E in response to environmental allergens. Currently, two types of allergen immunotherapy (AIT) are used in clinical practice: subcutaneous and sublingual immunotherapy, both accepted as key components of the therapeutic repertoire for allergic rhinitis and conjunctivitis. However, their role in asthma remains controversial. The present document is aimed at providing the clinicians with a review of the evidence on the use of AIT in asthma, focusing on the most relevant aspects of its mechanism of action, its efficacy, and existing data on safety, tolerability, and cost-effectivity, both in pediatric and adult populations. A systematic search of MEDLINE, Cochrane, and Clinical Trials databases from 2000 to April of 2016 was carried out by a panel of experts from the Spanish Allergy and Clinical Immunology Scientific Society. Relevant studies prior to the year 2000 included in ulterior systematic reviews were also considered. More than 4000 articles were identified during the search and 241 were selected to retrieve available evidence on AIT, which was graded according to the Oxford classification. All the group members reviewed the resulting text until the final version reached the consensual agreement. A summary of recommendations on the more relevant topics are proposed. The role of AIT as a valuable therapeutic strategy for prevention of exacerbation and progressive decline in lung function is highlighted. Future research should include specific tools for asthma evaluation when assessing AIT effectiveness in asthmatic patients (AU)
El asma se asocia frecuentemente con alergia, entendida ésta como la producción de IgE específica frente a alérgenos ambientales. Actualmente, existen dos tipos de inmunoterapia específica con alérgenos (ITE) para la práctica clínica habitual: subcutánea y sublingual, ambas indicadas en el tratamiento de la rinitis y la conjuntivitis alérgicas. Sin embargo, su papel en el asma resulta todavía controvertido. Este documento pretende ofrecer al clínico una revisión de la evidencia del uso de ITE en asma, centrándose en aspectos más relevantes como su mecanismo de acción, eficacia, seguridad, tolerabilidad y coste-eficacia, tanto en población adulta como pediátrica. Un panel de expertos de la Sociedad Española de Alergología e Inmunología Clínica, llevó a cabo una búsqueda sistemática en las bases de datos MEDLINE, Cochrane y Clinica Trials, desde 2000 a abril de 2016. También se revisaron algunos estudios anteriores al 2000, incluidos en revisiones sistemáticas posteriores. Se identificaron más de 4000 artículos en la búsqueda y se seleccionaron 241 para documentar la evidencia disponible y graduarla según la clasificación Oxford. Todos los miembros del panel revisaron el texto resultante hasta la versión final, alcanzando un acuerdo de consenso y se propusieron recomendaciones para los aspectos más relevantes. Se señala específicamente que la ITE resulta potencialmente valorable en la prevención de las exacerbaciones y el declive progresivo de la función pulmonar, aunque se necesitan nuevos estudios que incluyan variables específicas de evaluación de asma para verificar la eficacia de la ITE en esta patología (AU)
Subject(s)
Humans , Child , Adult , Asthma/therapy , Desensitization, Immunologic/methods , Consensus Development Conferences as Topic , Immunologic Techniques/methods , Allergens/immunology , Hypersensitivity/immunology , Treatment Outcome , Cost-Benefit Analysis/methods , Immunotherapy/classification , Allergy and Immunology , Allergy and Immunology/standards , Biomarkers/analysis , Administration, Sublingual , Infusions, Subcutaneous , Allergens/administration & dosage , Asthma/economicsABSTRACT
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