Articles
 

A Review of Allergy and Allergen Specific Immunotherapy

Abstract

Since 20th  century, when allergy was defined, an ongoing attempt for discovering the mechanisms underlying it and its treatment began. Defining allergens as well as cells such as regulatory T-cells and characterizing the antibodies involved in the pathogenesis (including blocking antibodies) have helped very much towards a better understanding of the immunologic process.However, Allergen specific immunotherapy (SIT), as a specific curative treatment for allergy also dates back to the beginning of the previous century and has progressed considerably during these years. SIT similar to natural immunomodulation, directs the immune response towards tolerance.
New strategies in this field, such as using recombinant allergens, T- and B-cell-epitope- containing peptides, and DNA vaccination have shown promising results. Sublingual immunotherapy, although not yet  FDA-approved, as an alternative  strategy in SIT  has demonstrated efficacy as well as safety.
Furthermore, allergen extracts, their standardization and their modification have also been the focus of much research. Undoubtedly, specific immunotherapy is proven to be an efficacious  method  to  treat  allergy,  so  its  cost-effectiveness  should  be  estimated  in developing countries in order to include it in the country's health priorities. Informing physicians about the new anti-vaccination movement is also crucial.

1. Larché M, Akdis CA, Valenta R. Immunological mechanisms of allergen-specific immunotherapy. Nat Rev Immunol 2006; 6(10):761-71.
2. Schmidt-Weber CB, Akdis M, Akdis CA. TH17 cells in the big picture of immunology. J Allergy Clin Immunol 2007; 120(2):247-54.
3. Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001 on the approximation of the laws, regulations and administrative provisions of the member states relating to the implementation of good clinical practice in the conduct of clinical trials on medicinal products for human use. Med Etika Bioet 2002; 9(1-2):12-9.
4. Akdis CA. Allergy and hypersensitivity: mechanisms of allergic disease. Curr Opin Immunol 2006; 18(6):718-26.
5. Akdis M, Akdis CA, Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol 2007;119(4):780-91.
6. Akdis M. Healthy immune response to allergens: Tregulatory cells and more. Curr Opin Immunol 2006;18(6):738-44.
7. Tavakkol Afshari J, Farid Hosseini R, Hosseini Farahabadi S, Heydarian F, Boskabady MH, Khoshnavaz R, et al. Association of the Expression of IL-4 and IL-13 Genes, IL-4 and IgE Serum Levels with Allergic Asthma. Iran J Allergy Asthma Immunol 2007;6(2): 67-72.
8. Rolland JM, Gardner LM, O'Hehir RE. Functional regulatory T cells and allergen immunotherapy. Curr Opin Allergy Clin Immunol 2010;10(6):559-66.
9. Ciprandi G, Filaci G, Fenoglio D. Th17 cells and allergic rhinitis: Is there clinical relevance? Otolaryngol Head Neck Surg 2010; 143(4): 604-5.
10. Durham SR. Allergen immunotherapy (desensitisation) for allergic diseases. Clin Med 2006; 6(4):348-51.
11. Passalacqua G, Durham SR. Global Allergy and Asthma European Network. Allergic rhinitis and its impact on asthma update: allergen immunotherapy. J Allergy Clin Immunol 2007; 119(4):881-91.
12. Farid R, Ghasemi R, Baradaran-Rahimi M, Jabbari F, Ghaffari J, Rafatpanah H. Evaluation of six years allergen immunotherapy in allergic rhinitis and allergic asthma. Iran J Allergy Asthma Immunol 2006; 5(1): 29-31.
13. Mohapatra SS, Qazi M, Hellermann G. Immunotherapy for allergies and asthma: present and future. Curr Opin Pharmacol 2010; 10(3):276-88.
14. Nelson HS. Allergen immunotherapy: where is it now? J Allergy Clin Immunol 2007; 119(4):769-79. 15. James LK, Durham SR. Update on mechanisms of allergen injection immunotherapy. Clin Exp Allergy 2008; 38(7):1074-88. 16. Senti G, Freiburghaus AU, Kundig TM. Epicutaneous/ transcutaneous allergen-specific immunotherapy: rationale and clinical trials. Curr Opin Allergy Clin Immunol. Curr Opin Allergy Clin Immunol 2010;10(6):582-6.
17. Lomnitzer R, Rabson AR. Lack of responsiveness of beekeeper mononuclear cells to in vitro stimulation with pure bee venom. J Allergy Clin Immunol 1986; 78(1 Pt 1):25-30.
18. Muller UR. Bee venom allergy in beekeepers and their family members. Curr Opin Allergy Clin Immunol 2005;5(4):343-7.
19. Akdis CA, Blesken T, Akdis M, Wüthrich B, Blaser K.Role of interleukin 10 in specific immunotherapy. J Clin Invest 1998; 102(1):98-106.
20. Akdis CA, Blaser and K. Role of IL-10 in allergen- specific immunotherapy and normal response to allergens. Microbes Infect 2001; 3(11):891-8.
21. Platts-Mills T, Vaughan J, Squillace S, Woodfolk J, Sporik R. Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based cross-sectional study. Lancet 2001; 357(9258): 752-6.
22. Schaub B, Liu J, Höppler S, Schleich I, Huehn J, Olek S, et al. Maternal farm exposure modulates neonatal immune mechanisms through regulatory T cells. J Allergy Clin Immunol 2009; 123(4):774-82. e5.
23. Lambrecht BN, Pauwels RA, Fazekas De St Groth B. Induction of rapid T cell activation, division, and recirculation by intratracheal injection of dendritic cells in a TCR transgenic model. J Immunol 2000;164(6):2937-46.
24. Jonuleit H, Schmitt E, Schuler G, Knop J, Enk AH.Induction of interleukin 10-producing, nonproliferating CD4(+) T cells with regulatory properties by repetitive stimulation with allogeneic immature human dendritic cells. J Exp Med 2000; 192(9):1213-22.
25. Akdis M, Verhagen J, Taylor A, Karamloo F, Karagiannidis C, Crameri R, et al. Immune responses in healthy and allergic individuals are characterized by a fine balance between allergen-specific T regulatory 1 and T helper 2 cells. J Exp Med 2004; 199(11):1567-75.
26. Jutel M, Akdis M, Blaser K, Akdis CA. Mechanisms of allergen specific immunotherapy--T-cell tolerance and more. Allergy 2006;. 61(7):796-807.
27. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: A practice parameter third update. J Allergy Clin Immunol 2011;127(1 Suppl):S1-55.
28. Groß F, Metzner G, Behn U. Mathematical modeling of allergy and specific immunotherapy: Th1-Th2- Treginteractions. J Theor Biol 2011; 269(1):70-8.
29. Denépoux S, Eibensteiner PB, Steinberger P, Vrtala S, Visco V, Weyer A, et al. Molecular characterization of human IgG monoclonal antibodies specific for the major birch pollen allergen Bet v 1. Anti-allergen IgG can enhance the anaphylactic reaction. FEBS Lett 2000;465(1):39-46.
30. Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol 2007; 120(3Suppl):S25-85.
31. Uermösi C, Beerli RR, Bauer M, Manolova V, Dietmeier K, Buser RB, et al. Mechanisms of allergen- specific desensitization. J Allergy Clin Immunol 2010;126(2):375-83.
32. Pauli G, Malling HJ. The current state of recombinant allergens for immunotherapy. Curr Opin Allergy Clin Immunol 2010; 10(6):575-81.
33. Nouri-Aria KT, Wachholz PA, Francis JN, Jacobson MR, Walker SM, Wilcock LK , et al. Grass pollen immunotherapy induces mucosal and peripheral IL-10 responses and blocking IgG activity. J Immunol 2004;172(5):3252-9.
34. Aalberse RC, Schuurman J. IgG4 breaking the rules.Immunology 2002; 105(1):9-19.
35. Saltoun C, Avila PC. Advances in upper airway diseases and allergen immunotherapy in 2007. J Allergy Clin Immunol 2008; 122(3):481-7.
36. Valenta R, Niederberger V. Recombinant allergens for immunotherapy. J Allergy Clin Immunol 2007;119(4):826-30.
37. Larche M. Update on the current status of peptide immunotherapy. J Allergy Clin Immunol 2007;119(4):906-9.
38. Hiroi T, Takaiwa F. Peptide immunotherapy for allergic diseases using a rice-based edible vaccine. Curr Opin Allergy Clin Immunol 2006; 6(6):455-60.
39. Senti G, Johansen P, Kündig TM. Intralymphatic immunotherapy. Curr Opin Allergy Clin Immunol 2009;9(6):537-43.
40. Martínez-Gómez JM, Johansen P, Erdmann I, Senti G, Crameri R, Kündig TM. Intralymphatic injections as a new administration route for allergen-specific immunotherapy. Int Arch Allergy Immunol 2009;150(1):59-65.
41. Canonica GW, Passalacqua G. Noninjection routes for immunotherapy. J Allergy Clin Immunol 2003;111(3):437-48.
42. Green T, Burks A. Oral food desensitization. Curr Allergy Asthma Rep 2010; 10(6):391-7.

43. Leatherman BD, Owen S, Parker M, Chadwick S, Fornadley JA, Colson D, et al. Sublingual Immunotherapy: Past, present, paradigm for the future?A review of the literature. Otolaryngol Head Neck Surg 2007; 136(3 Suppl):S1-20.
44. Pajno GB. Sublingual immunotherapy: the optimism and the issues. J Allergy Clin Immunol 2007; 119(4):796-801.
45. Nelson HS. Advances in upper airway diseases and allergen immunotherapy. Journal of Allergy & Clinical Immunology 2007; 119(4):872-80.
46. Milani M, Pecora S, Burastero S. EFESO Investigators Study Group. Observational study of sublingual specific immunotherapy in persistent and intermittent allergic rhinitis: the EFESO trial. Curr Med Res Opin 2008;24(9):2719-24.
47. Becker WM, Vogel L, Vieths S. Standardization of allergen extracts for immunotherapy: where do we stand? Curr Opin in Allergy Clin Immunol 2006;6(6):470-5.
48. Lorenz AR, Luttkopf D, Seitz R, Vieths S. The regulatory system in europe with special emphasis on allergen products. Int Arch Allergy Immunol 2008;147(4):263-75.
49. Wheeler AW, Woroniecki SR. Allergy vaccines--new approaches to an old concept. Expert Opin Biol Ther 2004; 4(9):1473-81.
50. Barlan IB, Bahceciler N, Akdis M, Akdis CA. Role of bacillus Calmette-Guerin as an immunomodulator for the prevention and treatment of allergy and asthma. Curr Opin Allergy Clin Immunol 2005; 5(6):552-7.
51. Canonica GW, Baena-Cagnani CE, Bousquet J, Bousquet PJ, Lockey RF, Malling HJ, et al. Recommendations for standardization of clinical trials with Allergen Specific Immunotherapy for respiratory allergy. A statement of a World Allergy Organization (WAO) taskforce. Allergy 2007; 62(3):317-24.
52. Rank MA, Oslie CL, Krogman JL, Park MA, Li JT.Allergen immunotherapy safety: Characterizing systemic reactions and identifying risk factors. Allergy Asthma Proc 2008; 29(4):400-5.
53. Ciprandi G, Larosa M, Tesi CF, Cadario G, Fiocchi A, Romano A, et al. Doctors' and patients' educational levels affect immunotherapy prescription. Int J Immunopathol Pharmacol 2008; 21(2):477-9. 54. Behrmann J. The anti-vaccination movement and resistance to allergen-immunotherapy: a guide for clinical allergists. Allergy Asthma Clin Immunol 2010;6(1):26. 55. Bullens DM. Monitoring the effect of allergen immunotherapy: a clinician's dream comes true? Clin Exp Allergy 2010; 40(7):958-61.

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IssueVol 10, No 1 (2011) QRcode
SectionArticles
Keywords
Allergens Allergen Immunotherapy Allergy Blocking Antibodies T Cells

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1.
Bidad K, Nicknam MH, Farid R. A Review of Allergy and Allergen Specific Immunotherapy. Iran J Allergy Asthma Immunol. 1;10(1):1-9.