Allergy Immunotherapy as an Early Intervention in Patients With Child-Onset Atopic Asthma

Abstract

Listen

Translate article

Nagaya H, Maren S, Nagaya N. Int Arch Allergy Immunol. 2006;139:9–15 PURPOSE OF THE STUDY. In patients with bronchial asthma, an effective treatment is required at early stages of the disease to prevent irreversible structural changes of the airways. The objective of this study was to evaluate the beneficial effects of routine immunotherapy as an early intervention on forced expiratory volume in 1 second (FEV1) in patients with childhood-onset atopic asthma. STUDY POPULATION. Forty-three patients with child-onset atopic asthma who had received regular immunotherapy injections and periodic FEV1 measurements. METHODS. Beneficial effects of successful immunotherapy on FEV1 were analyzed retrospectively in 43 unselected patients who received standard subcutaneous immunotherapy with periodic FEV1 measurements and became asymptomatic. RESULTS. Although there was no significant correlation between the duration of asthma symptoms before immunotherapy and the changes in FEV1 before and after immunotherapy in the 43 unselected patients, there was a significant inverse correlation between these 2 parameters in 23 patients whose asthma duration was <20 years. Because the FEV1 increased after immunotherapy in all 14 patients whose asthma duration was <5 years, the 43 patients were divided into group, 1 including these 14 patients, and group 2, including 29 patients whose asthma duration was >5 years. The FEV1 decreased in 7 of the 29 asymptomatic patients in group 2. There was no difference in the initial FEV1 between the 2 groups, but the final FEV1 and the mean of the average increase in FEV1 per year during immunotherapy were significantly higher in group 1 than in group 2. CONCLUSIONS. Immunotherapy should be started as early as possible at the youngest age to increase a beneficial effect of successful immunotherapy on FEV1. REVIEWER COMMENTS. Specific immunotherapy has demonstrated clinical benefits for allergic asthma in double-blind, placebo-controlled trials. The results from this study indicate that immunotherapy can modify the natural progression of asthma by improving lung function. Furthermore, early intervention leads to a greater improvement in FEV1, which suggests that early use of immunotherapy should be considered in allergic asthmatic patients. Additional studies will be needed to assess whether this improvement in lung function persists after the discontinuation of immunotherapy.