Article
The moderating role of allergy immunotherapy in asthma progression
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Authors
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Falko Tesch
- TU Dresden, Medical Faculty Carl Gustav Carus, Center for Evidence-Based Healthcare, Dresden, Germany
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Eike Wüstenberg
- TU Dresden, Medical Faculty Carl Gustav Carus, Department for Otorhinolaryngology/ALK-Abelló Medical Department, Hamburg, Germany
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Victoria Mücke
- ALK-Abelló, Medical Department, Hamburg, Germany
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Denise Küster
- TU Dresden, Medical Faculty Carl Gustav Carus, Center for Evidence-Based Healthcare, Dresden, Germany
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Jochen Schmitt
- TU Dresden, Medical Faculty Carl Gustav Carus, Center for Evidence-Based Healthcare, Dresden, Germany
| Published: | December 5, 2017 |
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Outline
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Background: Allergic rhinitis (AR) is one of the most important risk factors of asthma. Several pharmaceutical interventions exist for the treatment of AR and asthma. However, allergy immunotherapy (AIT) constitutes the only available causal therapy option for AR. The aim of this study was to estimate whether the use of AIT can delay progression in asthma severity.
Materials and Methods: The analysis was based on the data from a statutory health insurance AOK PLUS over the time span 2005 to 2014. It included all beneficiaries who did not change their insurance status over the time period and survive at least until 2007 (1.74 million people). Patients with asthma were defined as being diagnosed at least twice for having asthma (ICD-10 Code J45) in outpatient care and having received at least two recipes of short-acting beta agonists, inhaled corticosteroids or combinations of inhaled corticosteroids and long-acting beta agonists during four consecutive quarters. People who did not meet this definition in the years 2005-06 but in later years were classified as incident cases of asthma. The severity of asthma was measured by medication according to the guideline of the global initiative for asthma (GINA). Transitions between the GINA steps were analyzed using Cox regression models controlling for age and sex.
Results: About 40 thousand people with incident asthma were followed through their path of asthma progression. Because step two and step five GINA medication were rarely prescribed, only transitions from GINA step 1 to GINA step 3 and GINA step 3 to GINA step 4, were modeled. Significant reduction in time to next step of asthma medication was found for people receiving AIT. The delay in progression due to AIT was stronger in the second transition, which was also independent of age and sex. Because of poor separation between asthma and COPD in outpatient data for older people, it is possible that the protective effect of AIT in this group is underestimated.
Conclusion: The results of our study provide evidence that the treatment with AIT could change the course of asthma. As long as there is no primary prevention for allergic diseases, a treatment thru allergy immunotherapy should be considered.
