title: The Potential Role of Allergen Immunotherapy in Stepping Down Asthma Treatment.
abstract: For patients whose asthma is controlled and who have a low risk for future exacerbations, current guidelines recommend gradually stepping down pharmacotherapy to identify the lowest dose needed to maintain control. This review article will discuss the benefits and risks of step down in asthma management and the different strategies of achieving step down with particular focus on allergen immunotherapy (AIT). A literature search was conducted to identify studies that assessed the effect of AIT on asthma step down and evaluated this and asthma control as one of the outcomes. Six studies were identified: 2 subcutaneous and 4 sublingual AIT studies. Five studies assessed house dust mite-induced asthma, whereas 1 study focused on birch-induced seasonal asthma. Regarding house dust mite-induced asthma, the AIT studies reviewed suggest that individuals with moderate rather than mild asthma are the patients who are more likely to benefit from the addition of AIT for their asthma condition. The potential value of AIT is likely to be in enabling successful step down of the inhaled corticosteroid dose in Global Initiative for Asthma step 3 or 4. It is important to further explore this effect so that affected individuals can benefit from this treatment.
authors.affiliation: Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Sorbonne Universités, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Demoly
authors.affiliation: Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom. Electronic address: melina.makatsori08@imperial.ac.uk.
authors.forename: Melina
authors.initials: M
authors.lastname: Makatsori
authors.affiliation: Morsani College of Medicine, University of South Florida, Tampa, Fla.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Casale
authors.affiliation: Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Moises A
authors.initials: MA
authors.lastname: Calderon
mesh_terms: D000286:Administration, Sublingual; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000276:immunology / Q000627:therapeutic use*; D001249:Asthma / Q000276:immunology / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000379:methods*; D018450:Disease Progression; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000628:therapy*; D007279:Injections, Subcutaneous; D017410:Practice Guidelines as Topic; D039981:Pyroglyphidae / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones; D039741:Antigens, Dermatophagoides
keywords: Allergen immunotherapy; Asthma control; House dust mite; Inhaled corticosteroids; Step down