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Allergen Immunotherapy and 36‐Month Allergic Respiratory Disease Trajectories: A Target‐Trial

Year: 2026

Type: article

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. DISCUSSION: AIT initiation was associated with less worsening, greater remission, and favorable clinical and inflammatory trajectories over 36 months. These observational findings do not establish a causal disease-modifying effect; residual confounding and differential follow-up remain possible.

Source: Immunity Inflammation and Disease

DOI: 10.1002/iid3.70569