Allergy Immunotherapy Halts Asthma Progression

Patients with allergic asthma could benefit from allergy immunotherapy (AIT) to prevent the condition from progressing.

A team of investigators, led by Jochen Schmitt, MD, MPH, TU Dresden, Medizinische Fakultät Carl Gustav Carus, Center for Evidence‐Based Healthcare, recently completed a population-based cohort study involving 1,739,440 patients using healthcare data derived between 2005-2014 from statutory health insurance in Germany.

In the study, the severity of asthma was classified in accordance to the treatment steps recommended by the global initiative for asthma (GINA), while the effect of allergy immunotherapy on the transition between the GINA steps was analyzed using multivariable Cox regression models adjusted for age and sex.

A total of 39,167 individuals older than 14 were classified as having incident asthma during the observation period and were included in the study. Of the 39,167 patients, 4111 received allergy immunotherapy.

“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, .80‐.95) and GINA step 3 to GINA step 4 (HR, .66; 95% CI, .60‐.74),” the authors wrote. “GINA medication for step 2 and step 5 were rarely prescribed.”

Allergic asthma is a deadly condition, often causing substantial morbidity, while increasing the severity of asthma.

In the past, investigators found evidence pointing to allergy immunotherapy as a measure preventing the progression from allergic rhinitis to asthma, but did not find evidence on the potential of allergy immunotherapy to prevent the progression from mild to more severe asthma.

“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,” the authors wrote.

A 2018 study showed that rhinitis and asthma appear to be symptoms of a single disease in different parts of the airway, after evaluating asthma and rhinitis in children and adolescents with the goal of identifying potential phenotypes to help improve patient-specific management.

In an interview with MD Magazine® while at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting in San Francisco, Brian Vickery, MD, explained how a poor, unevidenced dosing regimen has burdened recent phase 3 food allergy immunotherapy trials.

Rhinitis was diagnosed by questionnaire inquiring about specific symptoms (sneezing, stuffy nose, runny nose, post-nasal drip, and sinus pressure or sinus headache) and doctor diagnosis of hay fever, allergic rhinitis, and allergies in the nose or sinus disease.

Results showed a high prevalence of rhinitis, at 94%. Perennial allergic rhinitis with seasonal exacerbations (PARSE) was the most common and most severe (34.2%), while non-allergic rhinitis was least common and least severe (11.2%).

Rhinitis was also shown to be difficult to control. A majority of the children did not get full relief even when taking a combination of antihistamines and nasal corticosteroids. Of those with PARSE, 84% required continuous treatment. Of those requiring continuous treatment, 67% remained symptomatic throughout the year.

The American Academy of Allergy, Asthma and Immunology (AAAAI) has previously stated there are 2 types of rhinitis: allergic and non-allergic. Allergic rhinitis involves the immune system, which responds to allergens by releasing histamine, causing inflammatory symptoms in the nose, throat, and eyes. Smoke, strong odors, changes in temperature or humidity can also cause symptoms. Allergic rhinitis can worsen asthma.

The study, “The moderating role of allergy immunotherapy in asthma progression. Results of a population‐based cohort study,” was published online in the European Journal of Allergy and Clinical Immunology.