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Immunotherapy as prevention for asthma remains debatable
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There is evidence supporting immunotherapy’s potential for preventing pediatric asthma and allergy.
Ulrich Wahn, MD, of Charité Berlin in Germany, said that one problem with analyzing immunotherapy is that the treatment should not be examined as a whole. He noted that symptom–dose relationships should be taken into account because not all products are equally effective. Additionally, he reported differences between European and American views on immunotherapy, indicating that European agencies are approaching the treatment as a drug that will address allergy symptoms. Consequently, European investigators are focusing research in that area.
Wahn said evidence from the Preventative Allergy Treatment (PAT) study illustrated immunotherapy’s effectiveness for reducing allergy and asthma symptoms. The primary endpoint of completely preventing asthma was not reached, but three-year follow-up data indicated that almost half of the children who were assigned to placebo instead of immunotherapy developed seasonal allergy symptoms. Further investigation would provide more insight into how to best implement immunotherapy in asthma prevention, according to Wahn.
In response, Robert A. Wood, MD, of Johns Hopkins Hospital, said that he had difficulty locating research that cast immunotherapy in a negative light, suggesting the possibility that researchers have inadvertently slanted information.
“I think as allergists, immunotherapy is the one thing we have, and we tend to be a little emotional about it and tend to overextend some of its potential,” Wood said.
Wood said there are merits to the PAT study, but he also underscored its limitations as well — such as the possible skewing of retention data toward children with asthma and that the research was industry-supported. Furthermore, Wood expressed concern that the PAT trial’s credibility was decreased by its inability to measure up to CONSORT criteria. He also indicated that the study findings related to a unique subset of patients and the treatment might not translate to all people with asthma.
Despite different opinions on the validity of immunotherapy research, both Wahn and Wood agreed that it is an area that deserves further exploration. – by Melissa Foster
Baena-Cagnani CE. #3524. Presented at: 2010 Annual Meeting of the American Academy of Asthma, Allergy and Immunology; Feb. 26-March 2, 2010; New Orleans.
Immunotherapy has a significant positive effect on allergic rhinitis and the allergic component of asthma. To further justify its importance, it is imperative that a good study that yields solid data on the prevention of asthma be conducted in the United States.
–Gary S. Rachelefsky, MD
Infectious
Diseases in Children Editorial Board