11. Allergy Immunotherapy and Biologic Therapy

If there is a concern for refractory asthma or allergic asthma, the patient can be referred to subspecialty clinics, Allergy/Immunology or Pulmonary Medicine, for evaluation of advanced therapies. One should consider subspecialty referral for patients in Step 4 and above or if patient is refractor to treatment.

Allergy Immunotherapy

EPR4 guidelines recommend evaluating the use of subcutaneous immunotherapy as an adjunct for patients with controlled asthma.

Allergen Immunotherapy is a treatment mechanism used for allergic asthma. This involves receiving subcutaneous injections in an ambulatory setting to antigens that the patient is sensitized to and can lead to lifelong tolerance. The decision to start allergen immunotherapy is between and allergist and family. If considering as a possible modality for treatment of asthma, we recommend referral to Allergy/Immunology Clinic. Would note that uncontrolled asthma is a strong contraindication for allergen immunotherapy given the high risk of reactions that can occur.

Biologic Therapies for Asthma

There are now several options for biologic therapies for pediatric asthma. These are subcutaneous injections that help the patients to mitigate risk and impairment from asthma. These medications are typically prescribed while under the care of a specialist. Phenotyping is necessary to decide the appropriate biologic therapy as well as a careful conversation regarding risks and benefits.

Asthma Biologics