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Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence

Dominguez-Ortega J1, Delgado J2, Blanco C3, Prieto L4, Arroabarren E5, Cimarra M6, Henriquez-Santana A7, Iglesias-Souto J8, Vega-Chicote JM9, Tabar AI5,10

1Servicio de Alergología, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
2Unidad de Gestión Clínica de Alergología, Hospital Virgen Macarena, Sevilla, Spain
3Servicio de Alergia, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
4Sección de Alergología and Universidad de Valencia, Valencia, Spain
5Servicio de Alergología, Complejo Hospitalario de Navarra, Pamplona, Spain
6Servicio de Alergología, Hospital Clínico Universitario San Carlos, Madrid, Spain
7Servicio de Alergología, Hospital Universitario Infanta Elena (Valdemoro), Madrid, Spain
8Servicio de Alergología, Hospiten Sur, Tenerife, Spain
9Unidad de Gestión Clínica de Alergología, Hospital Regional Universitario de Málaga, Spain
10Instituto de Investigación Sanitaria de Navarra (IdiSNA), RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Pamplona, Spain

J Investig Allergol Clin Immunol 2017; Vol 27(Suppl. 1) : 1-35
doi: 10.18176/jiaci.0149

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. 

Key words: Asthma treatment, Allergen immunotherapy, SLIT, SCIT, Efficacy, Safety, Children, Adults, Severe asthma, Cost-effectiveness.