Immunotherapy
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Although it is recognized that airway inflammation is key to asthma pathogenesis, the marked heterogeneity in its clinical course and variations in response to treatment make it a challenging condition for the development of novel and effective biologic-based therapies. Biopharmaceutical approaches have identified new therapies that target key cells and mediators that drive inflammatory responses in the asthmatic lung. Such an approach resulted in the development of biologics targeted at inhibiting IL-4, IL-5 and IL-13. ⋯ It is becoming apparent that significant clinical effects with anticytokine-based therapies are more likely in carefully selected patient populations that take asthma phenotypes into account. The development of discriminatory biomarkers and genetic profiling may aid identification of such patients with asthma. This review summarizes recent evidence demonstrating the effectiveness or otherwise of monoclonal antibody-based therapies in patients with asthma.
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Review Meta Analysis
Sublingual immunotherapy for allergic rhinitis and conjunctivitis.
Sublingual immunotherapy (SLIT) for allergic respiratory diseases was first described in 1986 and immediately appeared as a viable alternative to the traditional subcutaneous route. Since then, more than 60 randomized controlled trials have been published, almost all with very favorable results. The average improvement over placebo in symptom score and medication use was always greater than 20%. ⋯ SLIT is characterized by a satisfactory safety profile, its side effects being mainly limited to oral discomfort. Only six anaphylaxes and no fatalities have been so far reported. Due to the good risk:benefit ratio, SLIT is currently being investigated in diseases other than respiratory allergy, such as food allergy and atopic dermatitis.