Immunotherapy and Immunomodulators

Treatment of asthma should follow a stepwise approach according to asthma guidelines. Allergen immunotherapy and immunomodulators are both considerations in the treatment of severe asthma. Allergen immunotherapy has been shown to be effective in the treatment of allergic asthma. Although both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) decrease asthma exacerbations and asthma medication use, severe asthma is a risk factor for immunotherapy, and if severe asthma is uncontrolled by pharmacotherapy, immunotherapy is contraindicated. Several phenotypes with distinct endotypes have been described in asthma. As more is being discovered about the immunological mechanisms underlying these endotypes, targeted therapies are being developed and used in the treatment of asthma. Biologics are recommended for patients with moderate to severe persistent asthma that is uncontrolled despite the use of inhaled corticosteroids. There are five FDA-approved biologics for the treatment of asthma in children and adolescents (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab). Multiple other potential targets are currently being investigated.