Allergen‐specific immunotherapy provides immediate, long‐term and preventive clinical effects in children and adults: the effects of immunotherapy can be categorised by level of benefit ‐the centenary of allergen specific subcutaneous immunotherapy

Abstract

Allergen Specific Immunotherapy (SIT) for respiratory allergic diseases is able to significantly improve symptoms as well as reduce the need for symptomatic medication, but SIT also has the capacity for long-term clinical effects and plays a protective role against the development of further allergies and symptoms. The treatment acts on basic immunological mechanisms, and has the potential to change the pathological allergic immune response. In this paper we discuss some of the most important achievements in the documentation of the benefits of immunotherapy, over the last 2 decades, which have marked a period of extensive research on the clinical effects and immunological background of the mechanisms involved. The outcome of immunotherapy is described as different levels of benefit from early reduction in symptoms over progressive clinical effects during treatment to long-term effects after discontinuation of the treatment and prevention of asthma. The efficacy of SIT increases the longer it is continued and immunological changes lead to potential long-term benefits. SIT alone and not the symptomatic treatment nor other avoidance measures has so far been documented as the therapy with long-term or preventive potential. The allergic condition is driven by a subset of T-helper lymphocytes (Th2), which are characterised by the production of cytokines like IL-4, and IL-5. Immunological changes following SIT lead to potential curative effects. One mechanism whereby immunotherapy suppresses the allergic response is through increased production of IgG4 antibodies. Induction of specific IgG4 is able to influence the allergic response in different ways and is related to immunological effector mechanisms, also responsible for the reduced late phase hyperreactivity and ongoing allergic inflammation. SIT is the only treatment which interferes with the basic pathophysiological mechanisms of the allergic disease, thereby creating the potential for changes in the long-term prognosis of respiratory allergy. SIT should not only be recognised as first-line therapeutic treatment for allergic rhinoconjunctivitis but also as secondary preventive treatment for respiratory allergic diseases.

Intradermal immunotherapy with low-dose house dust mite allergens in patients with allergic rhinitis: A proof-of-concept study

“…It has been shown to reduce symptoms and medication usage while improving patient's quality of life. 3,4 A well-known unique feature of AIT is the modifi cation of the natural course of allergic diseases, inducing sustained long-term eff ects persisting years beyond treatment discontinuation. 2,3,5 In tropical/subtropical areas of the world with high levels of relative humidity all year round, domestic mites are main sources of sensitization; 6,7,8,9,10,11 perennial symptoms prevail and pollinosis, for the most part, is a non-relevant clinical issue.…”

Current Issues on Immunotherapy in Children

“…T-reg stimulates the proliferation and differentiation of IL-10-secreting dendritic cells, which have a crucial role in the activation and differentiation of different subtypes of T cells. Reducing the number of cell mastocytes, eosinophils, and basophils, increasing IgG4 and IgA synthesis, re-orientation from Th2 to Th1, increasing the number, and function of IL-10 producing T-reg cells play a significant role in the development of immune tolerance and long-lasting immunotherapy effect on the overall immune function and on the immune response to allergens [113][114][115][116].…”

Allergen-Specific Immunotherapy in Children: Prospects of Prevention and Treatment

“…• длительное действие (в отличие от всех существующих методов лечения атопических заболеваний, поло-жительный эффект АСИТ сохраняется на длительный период -в течение нескольких лет) [9,12,13]. Клинически лечебное действие АСИТ достигается по завершении 3-5 повторных курсов лечения, но может наступить и после 1-го курса.…”

“…Клинически лечебное действие АСИТ достигается по завершении 3-5 повторных курсов лечения, но может наступить и после 1-го курса. При этом чем в более раннем возрасте и на более ранних стадиях заболевания прове-дена АСИТ, тем выше лечебное действие [6,7,9,11,13].…”