Efficacy of allergen-specific immunotherapy as a steroid-sparing agent in children with allergic asthma.The aim of this study was to investigate the efficacy of an allergen-specific immunotherapy with a high-dose hypoallergenic mite preparation (allergoid) as a steroid-sparing agent in children with allergic asthma. Sixty-five children with asthma (Global Initiative for Asthma treatment levels II and III; 6-17 years old), after reaching asthma control with inhaled steroids during a 5-month baseline period, were randomized to receive subcutaneous mite allergoid immunotherapy (SCIT) plus fluticasone propionate (FP), or FP therapy alone for 2 years. During 2 subsequent 5-month winter periods, steroid therapy was adjusted according to predefined dose steps, determining and comparing the changes in FP dosages and the lowest FP dose sufficient to maintain asthma control. Immunologic and functional investigations were also carried out. Children treated with house dust mite SCIT plus FP were able to significantly reduce the FP dose by more steps (P < .05), compared to the group on FP alone. The mean daily dose in the immunotherapy group decreased from 330.3 µg in the baseline period to 151.5 µg after 2 treatment years, whereas in the control group the dose decreased from 290.6 µg to 206.3 µg. Compared with the control group, significant improvement was also observed in morning peak expiratory flow (P = .0315). Significantly increased levels of specific IgG(1) (P = .0001) and IgG(4) (P < .0001) were also observed. The authors concluded that adding mite allergoid SCIT to pharmacologic treatment is an effective and safe strategy to reduce corticosteroid doses while maintaining disease control in children with mite-induced allergic asthma.
Editor’s comment: Specific immunotherapy in allergy induced asthma should not be an alternative but a complementary treatment to drug treatment.
Zielen S, Kardos P, and Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: A randomized controlled trial. Journal of Allergy and Clinical Immunology 2010; in press [published online ahead of print 12 July 2010]
source : Medical Journal Reviews WAO Provided by dr Widodo judarwanto SpA, pediatrician
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