Transylvania University, Faculty of Medicine.
Theramed Healthcare, Brasov, Romania.
Curr Opin Allergy Clin Immunol. 2020 Dec;20(6):602-608. doi: 10.1097/ACI.0000000000000686.
Allergen immunotherapy (AIT) is a well-known disease-modifying intervention for allergic diseases. Its benefit in allergic asthma, ranging from prevention to facilitating asthma control, is yet to be clarified.
In 2017, following several well-designed randomised controlled trials (RCTs) with house-dust mites (HDM) sublingual (SLIT) tablets in asthma, global initiative for asthma (GINA) guidelines highlighted the need to treat the allergic component of asthma. In 2019, the European Academy of Allergy and Clinical Immunology published the first comprehensive guidelines for HDM AIT in allergic asthma, formulating separate recommendations for subcutaneous, SLIT drops, and SLIT tablets. Significant steps were undertaken in understanding the mechanisms of allergic asthma, facilitating the stratified approach for selecting responders and in translating the immune-modulation effect in achieving long-term control of the chronic inflammation in asthma.
Currently existing guidelines recommend AIT as a therapeutic option in controlled or partially controlled HDM allergic asthma. Limited data are available for pollen, molds and pets, as well as for the severe allergic asthma population. The challenge for the future research will be to clarify the subendotypes of allergic asthma responding to AIT, the mechanisms facilitating its' preventive and disease-modifying effect, the optimal duration of the treatment, and route of administration.
变应原免疫疗法（AIT）是一种众所周知的可改变疾病进程的变应性疾病干预措施。其在变应性哮喘中的获益，从预防到促进哮喘控制，仍有待阐明。
2017 年，在几项设计良好的针对屋尘螨（HDM）舌下（SLIT）片剂治疗哮喘的随机对照试验（RCT）之后，全球哮喘倡议（GINA）指南强调需要治疗哮喘的变应性成分。2019 年，欧洲过敏与临床免疫学学会发布了首个针对变应性哮喘的 HDM AIT 综合指南，为皮下、SLIT 滴剂和 SLIT 片剂制定了单独的建议。在理解变应性哮喘的机制、促进分层选择应答者的方法以及将免疫调节作用转化为实现哮喘慢性炎症的长期控制方面，已经取得了重大进展。
目前的指南建议将 AIT 作为控制或部分控制的 HDM 变应性哮喘的治疗选择。花粉、霉菌和宠物以及严重变应性哮喘患者的相关数据有限。未来研究的挑战将是阐明对 AIT 有反应的变应性哮喘亚表型、促进其预防和疾病修正作用的机制、治疗的最佳持续时间和给药途径。
