Mongkol Lao-Araya,1 Mongkhon Sompornrattanaphan,2,5 Dichapong Kanjanawasee,3,5 Pongsakorn Tantilipikorn,4,5 and the Allergy Asthma and Immunology Association of Thailand (AAIAT) interesting group on immunotherapy

1 Division of Allergy and Clinical Immunology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
2 Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
3 Biodesign Innovation Center, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
4 Division of Rhinology and Allergy, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
5 Center of Research Excellence in Allergy and Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Abstract

Allergen-specific immunotherapy (AIT) is the only treatment that modifies the underlying pathophysiology of IgE-mediated allergic diseases. Evidence shows the efficacy in achieving better control of the symptoms and reduction in medication use in patients with allergic rhinoconjunctivitis and/or asthma. It should be used in association with proper pharmacotherapy for at least three years. The benefits are sustained for several years after discontinuation of treatment. Moreover, it may prevent the development of new sensitization and progression of disease from allergic rhinitis to asthma in children. The favorable efficacy of AIT is associate to the appropriate selection of patients, allergen extracts, adherence, and duration of treatment. Safety during AIT is another concerning issue. AIT has an acceptable safety profile if administered under the appropriate circumstances. Future studies investigating the prescription, efficacy, and safety need to be developed. The new application routes, use of adjuvants, modification of allergens, and use of biologics are currently under evaluation. Moreover, there is an urgent need for real-world data in developing countries regarding the cost-effectiveness analysis, and optimization of AIT schedules and products, so that clinical practice and implementation of AIT for respiratory allergic diseases can be effective and safe.
Key words: Immunotherapy, Allergen, Allergic rhinitis, Asthma, Allergy