The moderating role of allergy immunotherapy in asthma progression: Results of a population‐based cohort study

Abstract

Background Allergic asthma causes substantial morbidity and constitutes a public health burden, which increases with asthma severity. There is evidence that allergy immunotherapy (AIT) prevents the progression of allergic rhinitis (AR) to asthma. However, evidence is missing on the potential of AIT to prevent progression from milder to more severe asthma. Methods This population‐based cohort study utilized healthcare data (2005 to 2014) from a statutory health insurance in Germany. The severity of asthma was classified according to the treatment steps recommended by the global initiative for asthma (GINA). The effect of AIT on the transition between the GINA steps was analyzed using multivariable Cox regression models adjusted for age and sex. Results From the total cohort of 1,739,440 patients, 39,167 individuals aged 14 years or older were classified as having incident asthma during the observation period and were included in the study. From these, 4111 patients (10.5%) received AIT. AIT exposure was associated with a significantly decreased likelihood of asthma progression from GINA step 1 to GINA step 3 (HR 0.87; 95% CI 0.80‐0.95) and GINA step 3 to GINA step 4 (HR 0.66; 95% CI 0.60‐0.74). GINA medication for step 2 and step 5 was rarely prescribed. Conclusions This observational study in a real‐world setting indicates that patients with allergic asthma who receive AIT are less likely to experience progression of asthma severity than asthma patients not receiving AIT.

Biomarkers for diagnosis and prediction of therapy responses in allergic diseases and asthma

“…255,256 Licensed products are available for therapy of AR, allergic asthma, stinging insect hypersensitivity, AD. [257][258][259][260][261][262] AIT for food allergy is currently investigational; however, phase 3 trials are promising. 263 Current evidence indicates that immunological changes associated with AIT differ from permanent tolerance as in healthy nonallergic individuals.…”

Allergen Immunotherapy in Children User’s Guide

“…AIT decreases allergic inflammation and in turn the symptoms of allergy, disease severity, and medication requirements. AIT also has protective effects on new sensitizations, progression of AR into asthma, and also on asthma severity . There is still room for improvement of AIT within the perspectives of safety, efficacy, and adherence in daily practice and by development and utilization of modified allergens and/or by application of AIT via novel routes.…”

Cost-effectiveness of subcutaneous house dust mite allergen immunotherapy plus pharmacotherapy for allergic asthma

“…In a similar way, a previous population-based retrospective cohort study by Schmitt et al evaluated the protective effect of AIT in asthma progression using the GINA treatment steps as a subrogate of disease severity in a real-world setting. Authors suggest that exposure to AIT is associated with a decreased risk of asthma progression from GINA Step 1 to Step 3 (HR 0.87 95% CI 0.80-0.95) and from GINA Step 3 to GINA Step 4 (HR 0.66 95% CI 0.60-0.74) (40). Although authors adopted a different definition of clinical effectiveness than that used in our study, their results highlight the protective effect of the SCIT in a realworld setting.…”