Johns Hopkins researchers have resolved a longstanding controversy by showing that allergy shots add little or no benefit to standard drug treatment for children with year-round moderate to severe asthma.

In a 10-year study of 121 children ages 5 to 14 with allergies and asthma, the shots had no significant benefits for patients whose asthma symptoms are controlled with medication and reasonable avoidance of dust, dander and other allergens.

“Allergy shots are probably not useful for these patients,” says Franklin Adkinson, M.D., a professor of medicine at Hopkins’ Asthma and Allergy Center. “This could be because anti-asthma drugs overshadow the shots’ effects. It’s also possible that exposure to allergens is less important to the start of an asthma episode in these children than we thought.”

Shots could still be useful, Adkinson says, in patients whose medication use is irregular or where avoiding exposure to allergens is difficult. “This is a complicated decision,” he notes. “For this group, sick asthmatic children, the shots don’t appear to help. Other groups of patients may still benefit, depending upon factors such as severity of disease, response to and acceptance of other treatments, and cost.”

Patients in the study, funded by the National Institute of Allergy and Infectious Diseases, were sensitive to several airborne allergens, including dust mites, ragweed, grass, oak, and mold. Half were randomly selected to get allergy shots; the other half received inert injections. Patients and their families kept diaries of symptoms and drug use. The study’s results were based on that information and on lung function tests.

“There were improvement trends in a small sub-group that took shots, the younger children with milder symptoms,” Adkinson notes. “It’s possible that shots begun shortly after allergic children start having asthma could alter the development of asthma or moderate the patient’s symptoms later in life. We’re going to need new studies to test this theory.”

Additional authors on the study included Peyton Eggleston, M.D., Hopkins Childrens’ Center professor of Pediatrics; James Tonascia, Ph.D., Hopkins School of Public Health professor of biostatistics; and Barbara Wheeler, R.N., the study’s clinical coordinator.

Medications and allergen extracts for the shots were donated by drug companies.

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Courtesy of Johns Hopkins Medical Institutions

Jan 13th, 2009

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