Treatment of allergic asthma – new perspectives and therapeutic approaches

Abstract

Asthma management has changed fundamentally over the past two decades. Central to these advances have been the further elucidation of the T2 mechanisms of airway inflammation and the use of biomarkers. In addition, epithelial cells are proving to be important contributors to inflammation by generating alarmins to initiate local lesions, as well as downstream pathways. International guidelines attest to the efficacy of inhaled corticosteroids in combination with long-acting β2-agonists for both control and as-needed treatment. Revolutionizing the approach to severe asthma, five biologics, such as mepolizumab, benralizumab, reslizumab, dupilumab and tezepelumab, have joined omalizumab, significantly contributing to the prevention of exacerbations and reducing the need for systemic corticosteroids, thus minimizing their side effects. For patients with allergic asthma, one of the most common asthma phenotypes, allergen immunotherapy can be an effective adjunctive treatment alongside pharmacological therapy. This review explores the integrated modalities for symptoms control and quality of life improvement in patients with asthma and aims to provide insight into current recommendations for therapies targeting the inflammatory pathway in allergic asthma, as well as the importance of combining allergen immunotherapy on disease progression.