Focusing the mechanism of action to dissect the different treatments of respiratory allergy

Abstract

The treatment of respiratory allergy is based on several drugs with different mechanisms of action, which encompass an effect only on symptoms, limited factors of inflammation or the whole process of inflammation. Dissecting the different treatments by their mechanism of action is relevant for the management of allergic patients. Corticosteroids, administered as nasal sprays in rhinitis or by inhalation devices in asthma, and allergen immunotherapy (AIT) are the most effective treatments for respiratory allergy, achieving the control on inflammation by a number of cellular and molecular mechanisms. What distinguishes corticosteroids from AIT is the duration of clinical outcomes that ends with treatment withdrawal for the former but persists after stopping for AIT, due to its disease-modifying effect.

Keywords:

• allergen immunotherapy
• antinflammatory action
• asthma
• corticosteroids
• drug treatment
• respiratory allergy
• rhinitis
• symptomatic effect

Financial and competing interests disclosure

The authors were supported by Stallergenes. F Frati and S Buttafava are employees of Stallergenes Italy; P Moingeon is an employee of Stallergenes SA; C Incorvaia is a scientific consultant for Stallergenes Italy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• The treatment of respiratory allergy is based on several drugs with different mechanisms of action that encompass an effect only on symptoms, limited factors of inflammation or the whole process of inflammation.

• Dissecting the different treatments by their mechanism of action is a critical point when prescribing the most appropriate treatment.

• Nasal decongestants in rhinitis and bronchodilators (including β2-agonists and muscarinic antagonists) in asthma have only symptomatic effect, while antihistamines, leukotriene receptor antagonists and the anti-IgE antibody omalizumab target specific components of inflammation.

• Corticosteroids and allergen immunotherapy (AIT) exert a larger anti-inflammatory action. Corticosteroids, administered as nasal sprays in rhinitis or by inhalation devices in asthma, are the most effective drugs in respiratory allergy, achieving the control on inflammation by a number of cellular and molecular mechanisms, some of them, such as the induction of regulatory T cells, shared with AIT.

• What distinguishes corticosteroids from AIT is the duration of clinical outcomes that ends with treatment withdrawal for the former, while persisting also after stopping for AIT, due to its disease-modifying effect.

Notes