The Role of Allergen Immunotherapy For Asthma Management

Asthma is a chronic respiratory condition that affects over 334 million people worldwide. According to the World Health Organization, asthma is responsible for 417,918 deaths annually.

Living with asthma can be challenging, especially when allergies worsen it. Allergies associated with asthma can cause wheezing and chest tightness that can disrupt daily life. While medication is often the first line of defense, it may not always provide complete relief, prompting many to search for more effective ways to manage their asthma and allergies.

In this article, you will learn about the causes of asthma and the effectiveness of immunotherapy in treating this condition. We will also discuss the different types of immunotherapy for asthma and explore alternative treatments for managing asthma.

What Is Asthma?

Asthma is a chronic respiratory condition that causes inflammation and constriction of the airways, leading to difficulty in breathing. The inflammation makes the airways swollen and sensitive, causing them to react to various triggers such as allergens and respiratory infections.

This reaction results in the narrowing of the airways, making it difficult to breathe in and out. It is a complex condition that requires proper diagnosis and management to prevent exacerbations and improve quality of life. Common symptoms include:

• Wheezing
• Coughing
• Shortness of breath
• Chest tightness

What Causes Asthma?

Asthma is primarily triggered by genetic and environmental factors, resulting in chronic airway inflammation and hypersensitivity. Its development is influenced by a combination of genetic and environmental influences, as well as immune system dysregulation.

Let’s explore more of these factors:

1. Genetics

Asthma has been found to have a strong genetic component, as twin studies have shown that genetic factors account for almost 70% of the variation in susceptibility to the disease. This highlights the significant role that genetics play in the development of asthma, as it includes:

• Family history: If one parent has asthma, it can increase a person's risk by up to 25%. However, if both parents have asthma, the risk increases to 50%.
• Specific genes: Several genes, such as ADAM33, IL-4, and IL-13, have been linked to asthma development. These genes are associated with airway hyperresponsiveness, inflammation, and the production of allergic antibodies. Variations in these genes can elevate the risk of asthma.
• Ethnicity: The susceptibility to asthma is also influenced by ethnicity. For example, African Americans and Puerto Ricans (19%) are more prone to developing asthma as compared to other ethnic groups like Asians (4-5%). This suggests that the genetic factors contributing to asthma may vary among ethnic backgrounds.

2. Environmental Factors

Exposure to certain environmental factors can play a significant role in asthma development. These include:

• Allergens: Allergens are substances that provoke allergic reactions, and they are a common trigger for asthma. Examples of common allergens include pollen, dust mites, pet dander, and mold spores. Exposure to these allergens can cause airway inflammation and bronchoconstriction in sensitized individuals.
• Irritants: Certain environmental irritants can exacerbate or even induce asthma symptoms. Tobacco smoke, air pollution, strong odors, and chemical fumes are known irritants that can inflame the airways, leading to asthma attacks.
• Respiratory Infections: Viral respiratory infections, particularly during early childhood, raise the likelihood of developing asthma. The respiratory syncytial virus (RSV) and rhinovirus are notable viruses linked to asthma development.
• Childhood Exposures: Early life exposures to allergens and irritants, such as secondhand smoke, can raise the likelihood of asthma development. In fact, passive smoke exposure during childhood is known to be a significant risk factor.
• Obesity: Obesity is one of the risk factors for asthma, especially among adults. Individuals with obesity have a 92% higher chance of developing asthma than those with lower body weight, especially among women.

Does Immunotherapy Work For Asthma?

Yes. Allergen immunotherapy for asthma is a treatment approach that aims to reduce the severity and frequency of asthma symptoms by addressing the underlying allergic triggers that contribute to the development of the condition.

This therapy involves gradually increasing the amount of the allergen the patient is sensitive to to desensitize the immune system to its effects. As the treatment progresses, the body becomes less reactive to the allergen, which can lead to a reduction in inflammation and symptoms such as:

• Wheezing
• Coughing
• Shortness of breath

Allergen immunotherapy is typically recommended for patients who have identified specific allergens that trigger their asthma and have not found sufficient relief with other treatments.

It can take several months to years to complete a full course of immunotherapy, but the benefits can last for many years after treatment is completed.

What Are The Types Of Allergen Immunotherapy For Asthma?

Two main types of allergen immunotherapy for asthma are subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Here's an explanation of each type:

1. Subcutaneous Immunotherapy (SCIT)

Subcutaneous Immunotherapy (SCIT), commonly known as allergy shots, is a treatment that involves injecting a small amount of allergen extract under the patient's skin, usually in the upper arm. This treatment gradually exposes the patient's immune system to the allergen, making it less sensitive.

The treatment starts with a build-up phase, where injections containing increasing amounts of allergens are given 1 to 2 times a week until the desired dose is reached. The target dose can be achieved in 3 to 6 months with a conventional schedule or in a shorter period with accelerated schedules, such as a cluster that administers 2-3 dose increases per visit.

This therapy is considered a long-term solution for allergies, particularly for patients with severe allergies or those who don't respond well to other treatments. However, it's essential to understand that SCIT demands a significant commitment from patients, involving regular injections over several years.

A study shows that patients who underwent SCIT treatment for a year had significantly improved symptom and medication scores. Specifically, 45.8% of patients experienced a decrease of at least 60% in their symptom and medication scores. Additionally, there were marked improvements in skin test results and allergen-specific bronchial challenges.

While both children and adults can undergo SCIT, it's generally not recommended for children under five years old. This is because young children may have difficulty cooperating with the treatment and expressing any adverse symptoms of an anaphylactic reaction. An anaphylactic reaction can cause:

• Swelling in the throat
• Wheezing
• Tightness in the chest
• Nausea
• Dizziness

2. Sublingual Immunotherapy (SLIT)

Sublingual Immunotherapy (SLIT), also known as allergy drops, is a non-FDA-approved allergy treatment that uses allergen drops or tablets under the tongue to desensitize the immune system to specific allergens.

While it's not covered by insurance in the US, it has a long history of use in Europe and can be prescribed "off-label." Your allergist will provide custom drops based on your allergen profile, administered under the tongue daily. The initial ten weeks involve a gradual dose increase, followed by a maintenance phase.

Studies involving asthma patients have demonstrated significant improvement in symptoms by up to 100% when treated with SLIT, leading to a better quality of life. This safe treatment option is suitable for both adults and children and is an effective alternative to traditional allergy shots.

While severe allergic reactions such as anaphylaxis are rare, some individuals may experience the following symptoms:

1. Mild reactions

• Mild swelling
• Itching of the lips
• Itching of the tongue
• Itching of the throat

2. Moderate reactions

• Lip irritation
• Mouth irritation
• Tongue irritation
• Nausea
• Vomiting
• Abdominal cramping
• Diarrhea
• Itching or redness of the eyes
• Nasal symptoms (sneezing, itching, or congestion)
• Increased severity of asthma symptoms
• Skin reactions (hives, itching, or swelling)

What Are The Alternative Treatments For Asthma And Allergies Besides Immunotherapy?

Alternative treatments for asthma and allergies are often sought by individuals who want to explore options beyond conventional medical treatments like immunotherapy or medications.

It's important to note that while some alternative treatments may provide relief or complement traditional therapies, their effectiveness can vary from person to person.

Here are some alternative treatments for asthma and allergies:

• Acupuncture: Acupuncture entails the precise insertion of fine needles into specific body points to stimulate energy flow. Some people find it helpful for managing allergy symptoms and improving overall well-being.
• Massage Therapy: Massage can help alleviate muscle tension and promote relaxation. While it doesn't treat the underlying causes of asthma or allergies, it may help relieve stress, which can exacerbate symptoms.
• Hypnosis: Hypnotherapy can be used to reduce anxiety and stress, which may, in turn, help manage asthma and allergy symptoms. Hypnosis may also be used to reframe the way individuals perceive their conditions.
• Diet: Making dietary changes can have a positive impact on asthma and allergies. Some people find relief by avoiding trigger foods by following anti-inflammatory diets, such as the Mediterranean diet, or eliminating certain allergenic foods.
• Exercise: Regular exercise can strengthen the respiratory system and improve lung function. Individuals with asthma should seek guidance from a healthcare expert to create an exercise plan tailored to their unique requirements and constraints.
• Herbal Medicine: Some herbal remedies may have anti-inflammatory or bronchodilator effects. Examples include butterbur for allergies and boswellia for asthma. However, it's essential to consult with a qualified herbalist or healthcare provider to ensure safety and efficacy.

Final Thoughts

Managing asthma effectively requires a comprehensive approach encompassing various factors, including genetic predispositions, environmental influences, and suitable treatment strategies. Allergen immunotherapy, which includes allergy shots and allergy drops, can help reduce asthma symptoms for those who are sensitive to specific allergens.

These treatments gradually make the immune system less reactive to the triggers, leading to less inflammation and better breathing. There are also alternative treatments like acupuncture, dietary changes, and breathing exercises that some people find helpful.

It's essential to consult a healthcare provider to find the best approach for managing asthma and allergies, as different treatments work for different people. In the end, with the right management, those living with asthma and allergies can breathe easier and enjoy a better quality of life.

FAQs On Immunotherapy For Asthma

Is it safe to continue receiving allergy shots while pregnant?

Yes. It is safe to continue taking allergy shots during pregnancy, but it is important to have your allergist monitor your dosage to minimize the chances of an allergic reaction. While such reactions are rare, their potential harm to the fetus should not be overlooked.

Is there an injection of allergen immunotherapy for asthma?

Omalizumab injection is a medication used to reduce the frequency of asthma attacks in adults and children of at least 6 years old who have allergic asthma. Allergic asthma is caused by inhaling dander, pollen, and dust mites. This medication is prescribed to patients whose symptoms are not adequately controlled with inhaled steroids.

How much is the cost of immunotherapy for asthma?

The median cost of immunotherapy for asthma is $3,247 per patient. However, it's important to note that the precise cost can fluctuate due to various variables, including the severity of your condition, the type of immunotherapy, and your insurance coverage.