New Directions in Immunotherapy

被引:56
作者
Cox, Linda [1 ]
Compalati, Enrico [2 ]
Kundig, Thomas [3 ]
Larche, Mark [4 ]
机构
[1] Nova SE Univ, Dept Med, Davie, FL USA
[2] Univ Genoa, Dept Internal Med, Allergy & Resp Dis Clin, I-16126 Genoa, Italy
[3] Univ Zurich Hosp, Dept Dermatol, CH-8091 Zurich, Switzerland
[4] McMaster Univ, Dept Med, Firestone Inst Resp Hlth, Hamilton, ON, Canada
基金
瑞士国家科学基金会; 加拿大创新基金会;
关键词
Allergy immunotherapy; Immunological adjuvants; T cell peptide; Intralymphatic immunotherapy; Epicutaneous immunotherapy; Recombinant allergens; Sublingual immunotherapy; Oral immunotherapy; Asthma; Allergic rhinitis; Food allergy; Hymenoptera hypersensitivity; ALLERGEN-SPECIFIC IMMUNOTHERAPY; COWS MILK ALLERGY; ORAL TOLERANCE INDUCTION; BIRCH POLLEN ALLERGEN; BET V 1; RANDOMIZED CONTROLLED-TRIAL; PLACEBO-CONTROLLED TRIAL; LATE ASTHMATIC REACTIONS; T-CELL PEPTIDES; SUBLINGUAL IMMUNOTHERAPY;
D O I
10.1007/s11882-012-0335-7
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Allergen immunotherapy (AIT) is effective in reducing the clinical symptoms associated with allergic rhinitis, asthma and venom-induced anaphylaxis. Subcutaneous (SCIT) and sublingual immunotherapy (SLIT) with unmodified allergen extracts are the most widely prescribed AIT regimens. The efficacy of these 2 routes appears comparable, but the safety profile with SLIT is more favorable allowing for home administration and requiring less patient time. However, both require that the treatment is taken regularly over several years, e.g., monthly in a supervised medical setting with SCIT and daily at home with SLIT. Despite the difference in treatment settings, poor adherence has been reported with both routes. Emerging evidence suggests that AIT may be effective in other allergic conditions such as atopic dermatitis, venom sting-induced large local reactions, and food allergy. Research with oral immunotherapy (OIT) for food allergies suggest that many patients can be desensitized during treatment, but questions remain about whether this can produce long term tolerance. Further studies are needed to identify appropriate patients and treatment regimens with these conditions. Efforts to develop safer and more effective AIT for inhalant allergies have led to investigations with modified allergens and alternate routes. Intralymphatic (ILIT) has been shown to produce long-lasting clinical benefits after three injections comparable to a 3-year course of SCIT. Epicutaneous (EPIT) has demonstrated promising results for food and inhalant allergies. Vaccine modifications, such as T cell epitopes or the use of viral-like particles as an adjuvant, have been shown to provide sustained clinical benefits after a relatively short course of treatment compared to the currently available AIT treatments, SLIT and SCIT. These newer approaches may increase the utilization and adherence to AIT because the multi-year treatment requirement of currently available AIT is a likely deterrent for initiating and adhering to treatment.
引用
收藏
页码:178 / 195
页数:18
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