Immunity, inflammation and disease
Allergen Immunotherapy and 36-Month Allergic Respiratory Disease Trajectories: A Target-Trial
By Gonzalez-Uribe V, Moreno-Castro S, Cardoso-Perez V and 5 others.
Abstract
Background
Allergen immunotherapy (AIT) may modify allergic respiratory disease, but its association with progression and remission in routine practice remains uncertain.
Materials and methods
We emulated a target trial in a single-center retrospective cohort at AlergiaMx, Mexico City, using data from 2020 to 2025. We compared sublingual allergen immunotherapy initiation within a 14-day grace period with non-initiation among AIT-eligible patients. Follow-up extended up to 36 months, and propensity-score overlap weighting addressed baseline confounding.
Results
Among 2,713 patients, 1,971 initiated AIT and 742 did not. Weighted disease worsening was 46.3% versus 63.6% (relative risk [RR] 0.73, 95% confidence interval [CI] 0.65-0.82), and sustained progression was 8.4% versus 17.0% (RR 0.49, 95% CI 0.35-0.69). At 36 months, clinical remission was 47.0% versus 18.3% (RR 2.57, 95% CI 1.93-3.43), and treatment-associated remission was 31.7% versus 5.8% (RR 5.44, 95% CI 3.23-9.16). Longitudinal differences favored AIT for asthma control, quality of life, and fractional exhaled nitric oxide.