Considerations in allergen immunotherapy for allergic asthma in pediatric patients under 4 years of age

Children under 4 years old pose unique diagnostic and treatment challenges when it comes to allergic asthma. Both reliable lung function testing and medication choices are limited in this age group. Despite these challenges, early presentation may provide an opportunity to alter the natural progression of their atopic disease. Allergen immunotherapy (AIT) is the only current disease-modifying therapy for allergic asthma. Subcutaneous allergen immunotherapy (SCIT) has been found to cause an immunologic shift from a TH2 to a TH1 response.1 Given this potential for disease modification, AIT is an attractive therapeutic option for early intervention in children and for impeding the progression of allergic disease. However, the safety and efficacy in children with asthma continue to be an area of great interest. In this month?s issue of the Annals of Allergy, Asthma & Immunology, a new article2 looks to evaluate the effect of SCIT in children with asthma under 4 years of age. The benefits and limitations of AIT across all age groups were