Efficacy of specific immunotherapy in allergic asthma: myth or reality?

Accepted for publiciAsthma, which long was alUibuted to neuromuscular dysfunction of the bronchial tree, is actually a complex disease with a multiiactorial pathogenesis in which allergic and nonallergic stimuli interact, causing bronchial inflammation and obstruction.Even though the role of inhalant allergens has been clearly demonstrated in the exacerbation of asthma, the efficacy of specific immunotherapy (SIT) remains controversial; some authors believe that such therapy is of no benefit to the patient (1, 2), while others recognize its efficacy under proper conditions (3-5).With the commercial introduction of standardized (i.e., more potent) allergenic extracts, very encouraging clinical results have been obtained; however, at an initial price, of an increased number of undesirable systemic reactions.At present, SIT for asthma is not used in the UK and only rarely in Scandinavia; however, it is widely accepted in other European countries and the USA.The appropriate use of standardized allergenic extracts in selected patients results in an acceptable level of mild systemie side-effects, making SIT an efficacious form of therapy.To minimize the risks and improve efficacy, SIT should be prescribed mainly by allergologists and administered only by physicians expert in treating the possible systemic reactions.