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 the evaluation of advanced therapies. One should consider subspecialty referral for patients in Step 4 and above of asthma therapies or if patient is refractory to treatment.

Allergen Immunotherapy

EPR-4 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 an allergist and family. If considering as a possible modality for treatment of asthma, we recommend referral to Allergy/Immunology Clinics.

Biologic therapies for asthma

There are now several options for biologic therapies for pediatric asthma, such as omalizumab, mepolizumab, benralizumab, dupilumab and tezepelumab. These are subcutaneous injections 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 and a careful conversation regarding the risks and benefits.

A comparison chart of biologic therapies