AIT is a well-known disease-modifying intervention for allergic diseases. Its benefit in allergic asthma, ranging from prevention to facilitating asthma control, is yet to be clarified.
In 2017, following several well-designed RCTs with HDM sublingual (SLIT) tablets in asthma, GINA guidelines highlighted the need to treat the allergic component of asthma. In 2019, the European Academy of Allergy and Clinical Immunology published the first comprehensive guidelines for HDM AIT in allergic asthma, formulating separate recommendations for subcutaneous, SLIT drops, and SLIT tablets. Researchers undertook significant steps in understanding the mechanisms of allergic asthma, facilitating the stratified approach for selecting responders and translating the immune-modulation effect in achieving long-term control of the chronic inflammation in asthma.
Currently, existing guidelines recommend AIT as a therapeutic option in controlled or partially controlled HDM allergic asthma. Limited data are available for pollen, moulds and pets, and the severe allergic asthma population. The challenge for future research will be to clarify the subgenotypes of allergic asthma responding to AIT, the mechanisms facilitating its’ preventive and disease-modifying effect, the optimal duration of the treatment, and the route of administration.