A randomized trial of subcutaneous allergy immunotherapy in inner-city children with asthma less than 4 years of age

• Published in: Annals of allergy, asthma, & immunology Vol. 126; no. 4; pp. 367 - 377.e5
• Main Authors: de Vos, Gabriele, Viswanathan, Shankar, Pichardo, Yikania, Nazari, Ramin, Jorge, Yurydia, Ren, Zhen, Serebrisky, Denise, Rosenstreich, David, Wiznia, Andrew
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2021
• Subjects: Allergens - immunology; Asthma - immunology; Asthma - therapy; Child, Preschool; Desensitization, Immunologic - methods; Female; Humans; Hypersensitivity - immunology; Hypersensitivity - therapy; Hypersensitivity, Immediate - immunology; Hypersensitivity, Immediate - therapy; Male; New York; Quality of Life; Respiratory Sounds - immunology; New York
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2020.12.016

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 inner-city, atopic children of less than 4 years of age with recurrent wheezing has not yet been established. To determine whether subcutaneous allergy immunotherapy improves asthma in a population of US inner-city children when started at less than 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 wheezing 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. A total of 23 children in the control group and 27 children in the immunotherapy group began the study. A total of 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 with the control group (P = .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 of less than 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. ClinicalTrials.gov Identifier: NCT01028560.