© 2002 American Thoracic Society
Immunotherapy for asthmaTo the Editor :The recent Pro/Con editorials, "Immunotherapy is/is not clinically indicated in the management of allergic asthma" (1, 2) is of the utmost interest for the 18 million people in the United States who suffer from asthma. Unfortunately, discussing it in absolute yes or no terms does a disservice to these patients as well as the thousands of physicians caring for them. Immunotherapy for asthma is not an all or none therapy. Immunotherapy is not indicated for all patients with asthma, but for selected patients it is an extremely useful therapy. Recently, a 2-day meeting was held in New York to discuss this subject, not in a debate format but rather a review and in-depth evaluation of the current literature (3). Dr. Adkinson's group was represented by Dr. Creticos, and Professor Bousquet was there as well. All the speakers agreed with the consensus that was reached at the meeting and by correspondence afterwards. The consensus statements are: (1) Specific allergen immunotherapy (allergy shots) has been shown, through documentation of well-controlled studies, to be effective for the treatment of allergic asthma. (2) There is emerging evidence that allergen immunotherapy can be an effective means of preventing the onset of asthma in children with allergic rhinitis. (3) Specific allergen immunotherapy should be considered as a mode of therapy in all patients with allergic asthma and disorders that predispose to asthma, such as hay fever, after appropriate diagnosis. (4) Environmental control, appropriate use of pharmacotherapy, and allergen immunotherapy are each treatment modalities to be considered carefully with respect to therapeutic intervention for the patient with allergic respiratory disease. (5) We strongly encourage future research in allergen standardization, appropriate dosage, treatment methods, improving safety, using new reagents, and quality of life issues and compliance (2). Rather than make a decision based on two flawed studies (4) planned nearly a decade ago, a review of the current literature and two independent meta-analyses (5, 6) have affirmed that immunotherapy plays an important role in the currently available treatments for allergic asthma. Drs. N. Franklin Adkinson and Jean Bousquet were given an opportunity to respond to this letter, but declined to do so.
a St. Luke's-Roosevelt Hospital Center New York, New York REFERENCES
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