|
|
 | |||||||||||||||||||||||||||||||||||||||||
 | |||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||
Background Injections of allergens are widely prescribed for patients with asthma, but little is known about the effectiveness of immunotherapy.
Methods We conducted a double-blind, placebo-controlled trial of multiple-allergen immunotherapy in 121 allergic children with moderate-to-severe, perennial (year-round) asthma. The children, who required daily medication for their asthma, were randomly assigned to receive subcutaneous injections of either a mixture of up to seven aeroallergen extracts or a placebo. Maintenance injections were continued for 18 months or longer. Medications were adjusted every two to three weeks on the basis of peak flow rates and symptoms. The principal outcome was the daily medication score. Bronchial sensitivity to methacholine (the concentration provoking a 20 percent decrease in the forced expiratory volume in one second [PC20]) was measured twice yearly.
Results The median medication score declined from 5.4 to 4.9 in the immunotherapy group (P<0.001) and from 5.2 to 5.0 in the placebo group (P<0.001), but there was no significant difference between the groups (P>0.6). The number of days on which oral corticosteroids were used was similar in the two groups. Partial or complete remission of asthma occurred in 31 percent of the immunotherapy group and in 28 percent of the placebo group (P>0.5). There was no difference between the groups in the use of medical care, symptoms, or peak flow rates. The median PC20 increased significantly in both groups, but again with no difference between the two groups.
Conclusions Immunotherapy with injections of allergens for over two years was of no discernible benefit in allergic children with perennial asthma who were receiving appropriate medical treatment.
Source Information
From the Asthma and Allergy Center and the Department of Medicine (N.F.A., R.G.H., M.E.W., H.A., B.W.) and the Department of Pediatrics (P.A.E., D.E., E.O.G., K.C.S., J.R.B.), Johns Hopkins University School of Medicine, and the Departments of Biostatistics and Epidemiology, Johns Hopkins School of Hygiene and Public Health (C.L.M., J.T.) — both in Baltimore.
Address reprint requests to Dr. Adkinson at 5501 Hopkins Bayview Cir., Baltimore, MD 21224-6801.
Related Letters:
Immunotherapy for Asthma
Wray B. B., Coifman R. E., Gordon B. R., Des Roches A., Paradis L., Paradis J., Bousquet J., Michel F.-B., Malling H.-J., Marino J. T., Marinkovich V. A., Adkinson N. F., Eggleston P. A.
Extract |
Full Text
N Engl J Med 1997;
336:1911-1913, Jun 26, 1997.
Correspondence
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | TERMS OF USE | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved. |
Previous
