This is one of the most important and clinically exciting questions in allergy medicine, and the answer based on current clinical evidence is: yes, allergen immunotherapy in children with allergic rhinitis appears to reduce the risk of progressing to asthma. This evidence is one of the most compelling arguments for considering immunotherapy in a child whose disease is currently limited to rhinitis, particularly in children with a strong family history of asthma, significant allergen sensitisation, and rhinitis that is poorly controlled despite pharmacotherapy. The allergic march - the progression from eczema to rhinitis to asthma - is not universal and not inevitable. The immune mechanisms driving rhinitis and those driving asthma are closely related, and interrupting the immune dysregulation at the rhinitis stage with immunotherapy appears, in several well-conducted studies, to reduce the probability of the next step in the march occurring. The mechanism is the same as for symptom reduction: immunotherapy shifts the immune response from allergen reactivity toward tolerance, and this shift at the mucosal immune level affects both the nasal and bronchial surfaces of the unified airway. For a child in Varanasi with confirmed house dust mite sensitisation and allergic rhinitis who has not yet developed asthma, considering immunotherapy at this stage - rather than waiting for asthma to develop and then treating both conditions - represents an opportunity to intervene at a point in the disease trajectory where the intervention may change what the next ten years of that child's respiratory health look like.
To book a consultation with Dr. Divyank Pathak at Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, call +91 9838713111 or visit linqmd.com/doctor/divyank-pathak
Written by Dr. Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA (Diploma in Paediatric Allergy and Asthma), FNPP, DPSM (USA), FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Orderly Bazar, Varanasi, Uttar Pradesh 221002. Phone: +91 9838713111.
