Allergen immunotherapy for allergic asthma: The future seems bright - 15/03/23

Doi : 10.1016/j.rmed.2023.107125

Zuzana Diamant, MD PhD ^a,^b,^c,^d,^⁎ , Maurits van Maaren, MD ^e, Antonella Muraro, MD PhD ^f, Milos Jesenak, MD PhD ^g, Ilja Striz, MD PhD ^h,^⁎
^a Dept of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Belgium
^b Dept of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
^c Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
^d Dept Clin Pharm & Pharmacol, Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands
^e Department of Internal Medicine, Allergy and Clinical Immunology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
^f Food Allergy Referral Centre, Padua University Hospital, Padua, Italy
^g Department of Pediatrics, Department of Pulmonology and Phthisiology, Department of Allergology and Clinical Immunology, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
^h Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

^∗Corresponding author. Department of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium.Department of Microbiology Immunology & TransplantationKU LeuvenCatholic University of LeuvenLeuvenBelgium^∗∗Corresponding author.

Abstract

Allergen specific immunotherapy (AIT) is the only causal therapeutic option for allergic airway diseases including asthma and allergic rhinitis. AIT has been shown to restore the allergen immune tolerance, can modify both the early and late-onset allergen-specific airway hyperreactivity, helps to achieve disease control/remission and prevents new sensitisations. Recent real life data on long-term effectiveness of house dust mite (HDM) AIT in a large group of patients with HDM-driven asthma further underscored its unique therapeutic potential as well as confirmed previous data with pollen AIT. More widespread use of this causal treatment in select patient populations should further move this promising therapeutic field. In this mini-review, we discuss updates on new insights based on real world patient data.

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Highlights

•	Allergen immunotherapy (AIT) is the only causal treatment of allergic diseases including asthma which also has a proven cost-effectiveness.
•	The key benefits of AIT consist of disease modifying effects and protective (preventive) properties against the allergic march.
•	Real-life data show long-term effectiveness (disease remission/modification) of HDM-AIT in HDM-driven asthma across 10 years follow-up.
•	Clinical benefits have also been achieved with pollen allergen extracts (both SCIT and SLIT), but more long-term real-life data in larger cohorts should confirm the persistence of clinical effectiveness in asthma.
•	Predictive biomarkers identifying responders to AIT represent an unmet need while research is ongoing.