Is immunotherapy safe for treatment of severe asthma

Abstract

Purpose of reviewThe benefits of allergen immunotherapy (AIT), including subcutaneous allergen immunotherapy (SCIT) and sublingual allergen immunotherapy (SLIT), for IgE-mediated asthma are well established, especially for dust mite. This review will explore whether the benefits of AIT outweigh the risks in severe asthmatic patients.Recent findingsStudies have mostly included mild and moderate asthmatic patients, but at least a few studies do show improvements in asthma symptoms and medication use in severe asthmatic patients. Asthma, and especially uncontrolled asthma, is a major risk factor for severe and fatal systemic reactions from SCIT. Uncontrolled asthma is an absolute contraindication for SCIT. It is less clear whether the benefits of SCIT and SLIT may outweigh the risks in well controlled, severe asthmatic patients, and further study is needed in this area. Asthma biologics, especially Omalizumab, may improve outcomes in severe, controlled asthmatic patients on SCIT, but further data are needed regarding timing of initiation and duration of treatment.SummaryAlthough severe asthmatic patients may benefit from AIT, significant risks exist, especially in those with uncontrolled asthma. Further study is needed regarding optimal strategies to minimize risks.

Safety of subcutaneous immunotherapy with Novo-Helisen-Depot in the children: a retrospective analysis from a single center in Northern China

“…Asthma biologics, especially Omalizumab, had been reported that it could improve outcomes in severe, controlled asthmatic patients with SCIT ( 20 ). In our study the application of Omazumab before treatment was associated with a decreased risk of immediate LRs in maintenance phase.…”

Management of comorbidities in difficult and severe asthma

“…Where sensitisation to certain allergens is proven, subcutaneous or sublingual immunotherapy has been shown to be efficacious in children and adults for both allergic rhinitis and asthma [40][41][42][43], although safety and efficacy evidence is less clear in severe asthma [44]. Biologic therapies such as anti-IgE, anti-IL-5/5R and anti-IL-4/13R are not indicated in allergic rhinitis but can provide benefit when administered for treatment of severe asthma.…”