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Severe asthma treatment in children

Ulrich Wahn, PhD MD
Department for Pediatric Pneumonology and Immunology
Charité Berlin
Berlin, Germany

Guidelines referring to asthma treatment recommend avoidance of potential allergic triggers and the stepwise approach of classical anti-inflammatory therapy. Asthma is considered to be severe, if it remains inadequately controlled by pharmacotherapy as determined by validated tests like the asthma control test (ACT) for children. Inadequate control includes an unacceptable number of emergency room visits or hospital admissions. A definition by impaired lung function alone has been shown not to be very helpful in children.

A more allergological appreciation of severity may refer to the frequently observed comorbidity with other allergic manifestations of the nose, the skin or concomitant food allergy, which may frequently be related to sensitization to panallergens inducing both airway as well as other allergic symptoms. Anti-IgE has been demonstrated to be of additional value in children older than 6 years, with a good safety profile. Beside its potential to improve asthma control in all age groups this intervention seems to be of special value in children and adolescents, since this group of patients is frequently allergic to multiple allergens, with a strong impact on quality of life.

In addition anti-IgE might prove to be particularly helpful for those children who due to severe asthma and polysensitization are not eligible for immunotherapy.

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