Improving asthma medication therapy with allergy shots: for kids, less can be more

Stefan Zielen, MD; Peter Kardos, MD; Enzo Madonini, MD

With recent advances in understanding how to treat asthma, the main goal of asthma therapy has become symptom control. Medical guidelines recommend inhaled corticosteroids (ICS like Qvar, Flovent, Alvesco, Pulmicort and Asmanex) as the most effective medication for controlling symptoms in both adults and children. However, while experts tend to agree that low-to-moderate doses of ICS are safe in adults, there is some concern about the possible negative effects of long-term ICS use for children, effects such as growth retardation or changes in bone metabolism. Thus there’s strong interest in alternative treatments for asthmatic kids that don’t rely solely on ICS.

In a report available online now from the Journal of Allergy and Clinical Immunology at www.jacionline.org, Zielen et al present the results of their study of the effects of adding immunotherapy (allergy shots) to an ICS regimen on the amount of ICS that kids with allergic asthma would need. Sixty-five children, age 6 to 17, participated in the study. All were allergic to dust mites that triggered their asthma and all were able to get good asthma symptom control with ICS therapy. For 2 years, half of the children received ICS (fluticasone propionate) only, and half received fluticasone propionate plus allergy shots (SCIT) made with a chemically modified dust mite allergen called an allergoid. During the winter periods of the study – the season when mite exposure is highest – doctors adjusted each child’s ICS dose down to the lowest possible amount that could still maintain good asthma control. The study results showed that the children who were treated with house dust mite allergy shots and ICS were able to reduce their ICS dose by 50% compared with less than a 30% decrease in the control group who received only ICS. The kids receiving allergy shots also had significant improvement in other asthma markers over the group receiving only ICS. The authors’ findings suggest that adding mite allergoid immunotherapy to drug therapy in children with mite-induced allergic asthma is an effective and safe way to achieve good asthma control and significant reductions in the amount of ICS needed.

The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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