Long-term efficacy of allergen-specific immunotherapy of bronchial asthma
Sidorenko E.V., Vykhristsenko L.R.
Vitebsk State Medical University, Vitebsk, Belarus
Aims. Evaluation of the clinical efficacy of intradermal allergen-specific immunotherapy in bronchial asthma based on the results of 7-year follow-up in real clinical practice.
Materials and Methods. On the basis of the allergology department of the Vitebsk regional clinical hospital and allergological offices of the regional and city levels, 364 patients with allergic and mixed (allergic and non-allergic) bronchial asthma (BA) aged 18 to 60 years were observed for 7 years (2013-2019). Àllergen-specific immunotherapy (ASIT) with intradermal administration of a mixture of water-salt extracts of household allergens. The effectiveness of ASIT was studied annually according to the patient's opinion (asthma symptoms did not change, decreased slightly, decreased significantly, were absent), taking into consideration the number, severity of asthma exacerbations, factors that could affect the course of asthma, the duration of post-immunotherapeutic remission (the duration of the period before the first exacerbation of asthma) within 5 years after completion of ASIT, factors affecting its effectiveness and safety of treatment (local and systemic reactions).
Results. The majority of patients - 95.3% (347/364) received ASIT for 2 to 5 years. The duration of ASIT was at least 1 year in 4.7% (17/364) patients, maximum 5 years in 7.7% (28/364) patients. After 3 courses (the course corresponds to 12 months of treatment) of ASIT, the duration of post-immunotherapeutic remission was 3 years in 48% (175/364) patients, and more than three years in 151 (41.5%) patients after 2 to 5 courses. According to the patient, the effectiveness of ASIT was 17-28.5% (excellent result), 70.4-86.6% (good result), 0.6-4.9% (satisfactory result). In allergic BA, the positive effect of ASIT for 3 or more years was observed in 96.6% (221/229) patients versus 77.7% (105/135) with mixed BA (p <0.01). Complete adherence to treatment (ASIT within 3 years) was observed in 89.6% (326/364) of patients, while the duration of post-immunotherapeutic remission was 3 to 5 years. General adverse reactions were observed in 25.8% (94/364) of patients, they belonged to the light degree category, were short-term.
Conclusion. Intradermal ASIT is an effective and safe method of treating allergic and mixed asthma with initially controlled or partially controlled course. The duration of post-immunotherapeutic remission from 3 to 5 years was observed after ASIT for 3 years. The presence of obesity and chronic obstructive pulmonary disease in patients had a negative impact on the results of ASIT.