Allergen immunotherapy for the treatment of chronic asthma

Abramson MJ, Puy RM, Weiner JM

Published Online:

August 8, 2010

Injecting allergens under the skin (allergen specific immunotherapy) can reduce asthma and use of medication and improve the sensitivity of the lungs, but with a risk of severe reactions. Asthma attacks can be caused by allergies, pollens, cigarette smoke or air pollution and can be fatal. An allergen is a substance that causes an allergic reaction in a person sensitive to it. Allergen specific immunotherapy involves having injections of increasing amounts of the allergen under the skin. It is also called hyposensitisation or desensitisation, and there is a risk of severe allergic reactions. The review of trials found that immunotherapy can reduce asthma symptoms, the need for medications and the risk of severe asthma attacks after future exposure to the allergen. It is possibly as effective as inhaled steroids. However, there is an increased risk of a lump at the injection site, rash, wheezing, breathlessness and very rarely a fatal allergic reaction.

Abstract (click to read)

Background:

Allergen specific immunotherapy has long been a controversial treatment for asthma. Although beneficial effects upon clinically relevant outcomes have been demonstrated in randomised controlled trials, there remains a risk of severe and sometimes fatal anaphylaxis. The recommendations of professional bodies have ranged from cautious acceptance to outright dismissal. With increasing interest in new allergen preparations and methods of delivery, we updated the systematic review of allergen specific immunotherapy for asthma.

Objectives:

The objective of this review was to assess the effects of allergen specific immunotherapy for asthma.

Search strategy:

We searched the Cochrane Airways Group Trials Register up to 2005, Dissertation Abstracts and Current Contents.

Selection criteria:

Randomised controlled trials using various forms of allergen specific immunotherapy to treat asthma and reporting at least one clinical outcome.

Data collection and analysis:

Three authors independently assessed eligibility of studies for inclusion. Two authors independently performed quality assessment of studies.

Main results:

Eighty-eight trials were included (13 new trials). There were 42 trials of immunotherapy for house mite allergy; 27 pollen allergy trials; 10 animal dander allergy trials; two Cladosporium mould allergy, two latex and six trials looking at multiple allergens. Concealment of allocation was assessed as clearly adequate in only 16 of these trials. Significant heterogeneity was present in a number of comparisons. Overall, there was a significant reduction in asthma symptoms and medication, and improvement in bronchial hyper-reactivity following immunotherapy. There was a significant improvement in asthma symptom scores (standardised mean difference -0.59, 95% confidence interval -0.83 to -0.35) and it would have been necessary to treat three patients (95% CI 3 to 5) with immunotherapy to avoid one deterioration in asthma symptoms. Overall it would have been necessary to treat four patients (95% CI 3 to 6) with immunotherapy to avoid one requiring increased medication. Allergen immunotherapy significantly reduced allergen specific bronchial hyper-reactivity, with some reduction in non-specific bronchial hyper-reactivity as well. There was no consistent effect on lung function. If 16 patients were treated with immunotherapy, one would be expected to develop a local adverse reaction. If nine patients were treated with immunotherapy, one would be expected to develop a systemic reaction (of any severity).

Authors' conclusions:

Immunotherapy reduces asthma symptoms and use of asthma medications and improves bronchial hyper-reactivity. One trial found that the size of the benefit is possibly comparable to inhaled steroids. The possibility of local or systemic adverse effects (such as anaphylaxis) must be considered.

This record should be cited as:

Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD001186. DOI: 10.1002/14651858.CD001186.pub2

Assessed as up to date:

April 12, 2009

Find the research

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Primary Review Group:

Airways Group

Asthma topics:

Treating with Medications > Chronic Asthma > Antibodies and immunotherapy

Health topics:

Lungs & airways > Asthma (chronic) > Other medications

In the News

ABC2 News (USA) reports on benefits and risks of treating asthma with allergy shots

In early August, the US TV station ABC2 News aired a report discussing the findings of the recent Cochrane Review on allergen immunotherapy for treating asthma.

Times of India on new Cochrane evidence for injection allergen immunotherapy

The Times of India reports on new Cochrane Review looking at injection allergen immunotherapy for chronic asthma.

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Allergen immunotherapy for the treatment of chronic asthma

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