Allergen-specific immunotherapy

Mechanism of action and clinical significance

Allergen-specific immunotherapy differs cardinally from simple symptomatic treatment because it has a disease-modifying pathogenetic effect. Microdoses of the causally significant trigger (most commonly pollen or house dust allergens) are sequentially administered into the patient's body. The gradual dose increase leads to a restructuring of the immune system's function, forming specific hyposensitization.

The main clinical result of AIT is a significant reduction in the body's sensitivity to a specific irritant, which directly leads to a decrease in the frequency and severity of disease exacerbations. In addition, this method performs a crucial preventive function: therapy prevents the expansion of the sensitization spectrum (blocks the appearance of allergic reactions to new triggers) and is a reliable way to stop the transformation of allergic rhinitis (AR) into full-blown bronchial asthma (BA).

Place of AIT in the treatment of bronchial asthma

In pediatric and therapeutic practice, immunotherapy is an essential component of the baseline treatment for bronchial asthma, predominantly in its mild and moderate courses. Its prescription is especially justified and indicated for patients whose asthma occurs against the background of concomitant allergic rhinitis. The procedure is performed exclusively under the supervision of a specialized professional — an allergist.

It is important to consider the impact of the puberty period on the course of asthma. After puberty, the clinical picture can evolve according to three scenarios: complete regression of symptoms (remission), maintenance of the current disease severity, or worsening of the condition. Practice shows that the complete disappearance of attacks is typical primarily for children with an initially mild course of the disease. The main condition for a favorable prognosis is the earliest possible start of regular, adequate baseline therapy.

Routes of allergen administration

Modern medicine offers several options for delivering the allergen into the body, allowing the physician to select the optimal and most comfortable treatment regimen:

• Parenteral (classic injections);
• Sublingual (dissolving drops or tablets under the tongue);
• Endonasal (administration of drugs into the nasal passages);
• Oral (taking by mouth).

Comprehensive approach: non-pharmacological methods and education

Pharmacotherapy yields maximum effect only in synergy with a proper lifestyle and understanding of one's diagnosis. "Asthma Schools" are considered a mandatory stage in managing children with BA. Education is aimed at both the patients themselves and their parents. The main topics of the classes include:

1. Understanding the nature and essence of the disease;
2. Differences between the principles of baseline and symptomatic therapy;
3. Practicing the algorithm of actions during a sudden attack;
4. Training in the correct technique for using inhalers;
5. Discussing career guidance issues for the child.

Also, to achieve complete control over the disease, non-pharmacological methods are used: breathing exercises, strictly dosed physical activity, hardening procedures, therapeutic massage, and reflexology.

Prevention of allergic pathology

To reduce the severity of allergic inflammation and bronchial hyperresponsiveness, systemic prevention is critically important:

• Trigger elimination: absolute exclusion of contact with known allergens and tobacco smoke. It is important to remember that passive smoking causes significant harm and provokes symptoms.
• Early prevention of atopy: preventive measures should begin as early as the antenatal (intrauterine) period by limiting the mother's contact with potential allergens. In the first years of a child's life, supporting and maintaining breastfeeding is a proven protective factor.
• Environmental and infection control: creating a safe microclimate inside the home, improving the overall environmental situation, and minimizing the frequency of acute respiratory viral infections.

Class and exam questions

What else to study on this topic

• Mechanisms of hyposensitization formation upon administration of increasing doses of allergens
• Organization and curriculum of pediatric "Asthma Schools"
• The impact of the puberty period on the pathogenesis and course of bronchial asthma
• Methods of early antenatal prevention of atopic diseases
• The role of non-pharmacological methods (breathing exercises, hardening) in the complex therapy of BA

Other topics in "Chapter 5. Allergic Diseases"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.