Allergic sensitization to environmental allergens in the first years of life is a strong predictor of asthma morbidity in children. Allergy immunotherapy can improve asthma and allergy outcomes, but its efficacy in atopic, inner-city children < 4 years of age with recurrent wheeze has not yet been established.
The objective of this study was to determine if subcutaneous allergy immunotherapy improves asthma in a population of U.S. inner-city children when started at < 4 years of age.
In a randomized controlled, open-label phase I/II single center trial in the Bronx, New York, 58 children with recurrent wheeze or physician-diagnosed asthma were randomized to receive asthma standard of care treatment with or without a 3-year course of multiple allergen subcutaneous immunotherapy.
23 children in the control group and 27 children in the immunotherapy group began the study. 20 of 27 children commencing immunotherapy completed at least 2 years of immunotherapy. There was no difference in asthma medication and symptom scores between the treatment or control groups over time. Similarly, naso-ocular symptoms and allergy medication use were similar in both groups over time. Nevertheless, asthma related quality of life improved in the immunotherapy group compared to the control group (p=0.03).
With the exception of asthma related quality of life, allergy immunotherapy was ineffective in improving asthma outcomes in this population of inner-city children < 4 years of age. These findings suggest that the effects of allergy immunotherapy depend on population specific factors and highlight the importance of precise predictors of immunotherapy efficacy.

Copyright © 2020. Published by Elsevier Inc.