IMMUNOTHERAPY FOR CHILD ASTHMA - IS THERE A RATIONAL FOR ITS USE

Objective: This paper reviews the literature regarding immunotherapy i n the management of childhood asthma. Immunotherapy is a well establis hed treatment of venom allergy and allergic rhinitis, however its use in asthma remains controversial. Data Sources: We reviewed the pediatr ic literature from 1966 to 1994 and evaluated the existing studies for clinical efficacy of immunotherapy in childhood asthma. Study Selecti on: Only 12 purely pediatric studies existed over the time period that we reviewed. The studies used a variety of different antigens includi ng house dust, house dust mite, grass, mold, cat, dog, and combination s of antigens. Results: In reviewing the studies, we assessed study du ration, number of subjects, whether it was blinded, placebo controlled or open labeled, the measures of clinical efficacy and the assessment s of specific and nonspecific bronchial reactivity. The studies were v ery heterogeneous, and therefore direct comparison a-nd extrapolation of conclusions was difficult. The majority of the studies demonstrated either an improvement in asthmatic symptoms or a decrease in bronchia l reactivity to the specific antigen employed, or both. The minority o f studies demonstrated no clinical efficacy. The most consistent evide nce of benefit was suggested in those trials employing house dust mite therapy, while immunotherapy for grass and cats demonstrated some ben efit but the number of studies employing these treatments was very sma ll. There are no trials that provide convincing evidence that immunoth erapy with dog and mold antigens is effective for childhood reactive a irway disease. Conclusion: Asthma is a multifactorial disease with man y triggers. In establishing a role for immunotherapy one must consider all the different aspects such as allergic triggers, environmental st resses, and viral infections. The literature is unclear as to when imm unotherapy should be initiated for childhood asthma. While there are s uggestions that immunotherapy should be considered for the child with mild or moderate asthma and dust mite sensitivity when pharmacotherapy is not efficacious, the immunomodulatory properties of immunotherapy may actually be more tailored for early intervention in asthma rather than for use once symptoms have occurred. More research is required in order to clarify whether immunotherapy should be recommended more oft en for the treatment of childhood asthma.