Affiliation: 608 Daniel Court Nashville, TN 37221, USA.
Epidemiological studies clearly demonstrate that the prevalence of allergic diseases has increased, and that the higher diagnosis rates are due not simply to changes in diagnostic fashion or improvements in detection. Additionally, the increasing recognition that allergic rhinitis and allergic asthma frequently co-exist has led to the concept of the “United Airways”, namely that these seemingly separate disorders are manifestations of the same disease expressed in either the upper or the lower airways. Current asthma management guidelines emphasize the importance of early intervention with inhaled corticosteroids as first-line anti-inflammatory therapy. Several studies have demonstrated that certain second generation of antihistamines possess anti-inflammatory activity. Studies were also conducted investigating their effects in combination with leukotriene receptor antagonists versus intranasal and / or inhaled corticosteroids in both allergic rhinitis and asthma. Amongst the novel anti-cytokine therapies, treatments with anti-IL-5, anti-IL-13, anti-TNF-α, as well as soluble IL-4 receptor antagonists are currently being studied in asthmatics. Monoclonal antibodies against adhesion molecules, as well as T cell-specific peptides are also new and evolving fields of research. Therapeutic agents inhibiting IgE-mediated responses have also been designed. Of those, a recombinant humanized monoclonal antibody to IgE has been shown to block the biologic effects of IgE. Allergen immunotherapy (allergy vaccination) is an important therapeutic tool for the management of United Airways Disease and it is indicated in patients with concomitant rhinitis and asthma. Immunotherapy can modify the natural history of the disease and maintains its effects for years after discontinuation.