J Bousquet1, P Demoly, F B Michel. 1. Service des Maladies Respiratoires, INSERM U454 Hĵpital Arnaud de Villeneuve, Montepelier, France. bousquet@montp.inserm.fr
Abstract
OBJECTIVE: The primary objective of this review is to discuss the efficacy of immunotherapy on combined lung and nasal symptoms, as well as data suggesting that allergen-specific immunotherapy (SIT) may, by altering the natural course of allergic disease, have a preventive effect on rhinitis and asthma. DATA SOURCES: A review of literature published on allergen-specific immunotherapy in the treatment of allergic rhinitis and asthma was performed. The review represents a synthesis of these sources and the expert opinion of the author. STUDY SELECTION: The expert opinion of the authors was used to select the relevant data for the review. RESULTS: Epidemiologic studies have consistently shown that asthma and rhinitis often co-exist in the same patients, and rhinitis often precedes the onset of asthma. SIT has been shown to be effective as a curative treatment for these allergic diseases, but there is increasing evidence indicating that SIT also may have a preventive effect. A study of children monosensitized to house dust mites showed that immunotherapy altered the natural course of allergy in preventing the development of additional sensitizations. CONCLUSIONS: At present, SIT seems to be the only treatment that may modify the course of the disease, either by preventing the development of new sensitivities or by altering the natural history of asthma. When SIT is introduced to patients with only allergic rhinoconjunctivitis, it may stop the development of asthma. SIT should be started early in the disease process, as soon as allergy has been diagnosed, to modify the spontaneous long-term progress of the allergic inflammation and disease.
OBJECTIVE: The primary objective of this review is to discuss the efficacy of immunotherapy on combined lung and nasal symptoms, as well as data suggesting that allergen-specific immunotherapy (SIT) may, by altering the natural course of allergic disease, have a preventive effect on rhinitis and asthma. DATA SOURCES: A review of literature published on allergen-specific immunotherapy in the treatment of allergic rhinitis and asthma was performed. The review represents a synthesis of these sources and the expert opinion of the author. STUDY SELECTION: The expert opinion of the authors was used to select the relevant data for the review. RESULTS: Epidemiologic studies have consistently shown that asthma and rhinitis often co-exist in the same patients, and rhinitis often precedes the onset of asthma. SIT has been shown to be effective as a curative treatment for these allergic diseases, but there is increasing evidence indicating that SIT also may have a preventive effect. A study of children monosensitized to house dust mites showed that immunotherapy altered the natural course of allergy in preventing the development of additional sensitizations. CONCLUSIONS: At present, SIT seems to be the only treatment that may modify the course of the disease, either by preventing the development of new sensitivities or by altering the natural history of asthma. When SIT is introduced to patients with only allergic rhinoconjunctivitis, it may stop the development of asthma. SIT should be started early in the disease process, as soon as allergy has been diagnosed, to modify the spontaneous long-term progress of the allergic inflammation and disease.