INFORMATION

The specific immunotherapy with allergens has demonstrated to be effective in studies realized severely, controlled to blind double with placebo, both in children and in adults. Different reviews of the bibliography, published in the last years they conclude that the individuals included at random in the group of Immunotherapy show less asthma symptoms, need less medication and present a minor both specific and unspecific bronchial hyperreactivity, compared to those included in the group placebo.

Also studies realized exclusively in asthmatic patients confirm the efficacy of this form of treatment, so much on the symptoms of the asthma as the needs for medication and hyperreactivate it bronchial specific and unspecific.

According to a study realized by Adkinson and collaborators the immunotherapy in allergic children with asthma is effective when those present asthma of medium gravity, they are young children and with short evolution of his illness.

In the last years there has developed the skill of the goal analysis as a useful tool to value of global form the results of the different studies of investigation related to a certain problem.

The well realized meta-analyses are accepted like an ideal way of expressing the results of the different studies under a common point of view.

In 1995 Abranson published the first meta-analysis on the efficacy of the immunotherapy with specific allergens in the treatment of the asthma. The authors conclude that the patients who had received immunotherapy were presenting less asthma symptoms, they had less probability of deterioration of his asthma, they needed less antiasthmatic medication and were presenting a significant reduction of the specific bronchial hyperreactivity opposite to the allergens person in charge. The result of these meta-analyses reveals that it does not improve the pulmonary function of the patients and that there is obtained a very light improvement of the unspecific bronchial hyperreactivity. The authors conclude so that the antiallergic vaccines are an option cost for the patients' treatment with asthma allergic.

In 1999 again Abramson and collaborators publish his last meta-analysis on Immunotherapy in which they include 62 works published between 1954 and 1998.

The result of the latter meta-analysis realized by Abramson and collaborators is the following one:

• 1. Asthmatic symptoms:
  The global results point at a significant reduction of the asthmatic symptoms after the treatment with mites immunotherapy and pólenes, without significant improvement when the treatment is realized with extract of dog, cat or multiple allergens.
  On the other hand the statistical analysis determined that the patients treated with immunotherapy have less probability of presenting a worsening of his asthmatic clinic that those who had received placebo. These results were similar with independence of the composition of the used extract.
• 2. Needs for medication:
  The statistical study of the meta-analysis revealed a significant reduction in the needs for medication in the patients who received mites immunotherapy and of pólenes.
  The study shows up, also, how the patients treated with immunotherapy present less probability of increasing the medication that those patients who had received placebo.
• 3. Pulmonary function:
  In the studies that were valuing the evolution of the pulmonary function, along the immunotherapy, it is appreciated that there was no tendency to a deterioration of the pulmonary function after the immunotherapy.
• 4. Unspecific bronchial hyperreactivity (HRB):
  In the study a global reduction of the HRB is observed after the treatment with Immunotherapy, although with very heterogeneous results and that the patients who have received Immunotherapy had less probability of which his unspecific bronchial hyperreactivity was increasing.
• 5. Bronchial hyperreactivity alérgeno specifies:
  The global result of the analytical evaluation indicates that a significant reduction exists in the reactivity alérgeno specific after the Immunotherapy, being this great effect more marked in Immunotherapy with mites and similar when they are used pólenes or epitheliums.

As final conclusions of these studies compilations and comparative they could have extracted like benefits of the immunotherapy:

A six times major decrease in the specific bronchial reactivity opposite to allergen.

The long-term efficacy has been demonstrated in diverse works that they retire in consensus on the utility of the immunotherapy of 1997. Between them one emphasizes the work of Des-Roches (14) that demonstrated the efficacy of the long-term immunotherapy when it had been realized correctly by a period of 3 years.

Also Hedlin and cols (15) they have verified that after three years of immunotherapy with cat allergens the tolerance to the exhibition was surviving the same ones in a third of the cases.

TO SEE ALSO

• Immunization against the allergy
• Side effects of the vaccine of the allergy
• Indications of the vaccine of the allergy
• Consult the Specialist

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Source: WHO Position Paper. Allergen immunotherapy: therapeutic vaccines for allergic diseases. J Busquet, R Lockey, H J Malling. Allergy 1998; 53: 1-43