Page 1274 - Clinical Immunology_ Principles and Practice ( PDFDrive )
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1234         Part tEN  Prevention and Therapy of Immunological Diseases


        CpG ODN  can be coupled  to the allergenic protein, which   Please check your eBook at https://expertconsult.inkling.com/
        enhances immunogenicity in terms of eliciting a Th1-type   for self-assessment questions. See inside cover for registration
        response to the allergen but reduces its allergenicity and stimulates   details.
        Th1 cytokine expression in cultured human peripheral blood
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        mononuclear cells (PBMCs).  Initial clinical trials confirmed
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        that the hybrid vaccine elicits a Th1-pattern response,  but the   REFERENCES
        results of subsequent trials have been inconclusive. A contrasting
        approach  is immunization  with  allergen-specific  naked  DNA   1.  Frew AJ. 100 years of immunotherapy. Clin Exp Allergy 2011;41:1221–5.
                                                                2.  Jutel M, Akdis CA. Immunological mechanisms of allergen-specific
        sequences. This technology is still in its infancy, but preliminary   immunotherapy. Allergy 2011;66:725–32.
        data suggest that administration of naked DNA leads to produc-  3.  Creticos P, Van Metre TE, Mardiney MR, et al. Dose-response of IgE and
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        tion of allergens from within the airway epithelial cells.  It seems   IgG antibodies during ragweed immunotherapy. J Allergy Clin Immunol
        that the endogenously produced allergen elicits a Th1-type   1984;73:94–104.
        response, due to the different handling pathways for endogenous   4.  Iliopoulos O, Proud D, Adkinson NF, et al. Effects of immunotherapy on
        and exogenous allergens. If this can be reproduced in humans   the early, late and rechallenge nasal reaction to provocation with allergen:
        with allergies, this may overcome the existing Th2-pattern   changes in inflammatory mediators and cells. J Allergy Clin Immunol
        response and eliminate the allergy. However, the potential for   1991;87:855–66.
        generating a powerful Th1-type response to ubiquitous agents   5.  Golden DB, Moffitt J, Nicklas RA, et al. Stinging insect hypersensitivity:
        means that this approach needs careful evaluation in animal   a practice parameter update 2011. J Allergy Clin Immunol 2011;127:
                                                                  852–4.
        models before it can be pursued in humans.              6.  Golden DB, Kelly D, Hamilton RG, et al. Venom immunotherapy reduces
           The recent introduction of monoclonal antibodies (mAbs)   large local reactions to insect stings. J Allergy Clin Immunol
        directed against IgE offers another option. Treatment with anti-IgE   2009;123:1371–5.
        reduces immediate and late-phase responses to inhaled allergens   7.  Bousquet J, Schünemann HJ, Bousquet PJ, et al. How to design and
        and should also reduce the risk of adverse effects from SIT   evaluate randomized controlled trials in immunotherapy for allergic
        injections. Moreover, when anti-IgE is combined with conven-  rhinitis: an ARIA-GA(2)LEN statement. Allergy 2011;66:765–74.
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        tional SIT, the effects on seasonal allergic rhinitis are additive.    8.  Gueguen C, Bouley J, Moussu H, et al. Changes in markers associated
        However, the high cost of anti-IgE and the need for regular   with dendritic cells driving the differentiation of either TH2 cells or
        injections are likely to limit its use to patients who have severe   regulatory T cells correlate with clinical benefit during allergen
                                                                  immunotherapy. J Allergy Clin Immunol 2016;137:545–58.
        allergic disease that cannot be managed by other means, and   9.  Shamji MH, Ljorring C, Francis JN, et al. Functional rather than
        these patients are not generally suitable candidates for SIT.  immunoreactive levels of IgG4 correlate closely with clinical response to
                                                                  grass pollen immunotherapy. Allergy 2012;67:217–26.
        CONCLUSIONS                                            10.  Frew AJ, Powell RM, Corrigan CJ, et al. Efficacy and safety of specific
                                                                  immunotherapy with SQ allergen extract in treatment-resistant seasonal
                                                                  allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006;117:319–25.
            ON tHE HOrIZON                                     11.  Durham SR, Walker SM, Varga EM, et al. Long-term clinical efficacy of
                                                                  grass pollen immunotherapy. N Engl J Med 1999;341:468–75.
         New Technologies for Immunotherapy                    12.  Cox L, Esch RE, Corbett M, et al. Allergen immunotherapy practice in the
          •  Recombinant allergens                                United States: guidelines, measures, and outcomes. Ann Allergy Asthma
          •  T-cell peptide vaccines                              Immunol 2011;107:289–99.
          •  T-helper cell-1 (Th1) immunostimulants (e.g., mycobacteria, CpG)  13.  Varney VA, Edwards J, Tabbah K, et al. Clinical efficacy of specific
          •  Allergen-immunostimulant complexes                   immunotherapy to cat dander: a double blind placebo controlled trial.
          •  Anti–immunoglobulin E (IgE)                          Clin Exp Allergy 1997;27:860–7.
          •  New routes of administration:                     14.  Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy
           •  Sublingual                                          for asthma. Cochrane Database Syst Rev 2010;(8):CD001186.
           •  Intralymphatic                                   15.  Gorelik M, Narisety SD, Guerrerio AL, et al. Suppression of the
           •  Epicutaneous                                        immunologic response to peanut during immunotherapy is often
           •  Liposome encapsulation                              transient. J Allergy Clin Immunol 2015;135:1283–92.
                                                               16.  Zuidmeer-Jongejan L, Huber H, Swoboda I, et al. Development of a
                                                                  hypoallergenic recombinant parvalbumin for first-in-man subcutaneous
        SIT has been established as a treatment for allergic rhinitis and
        for venom hypersensitivity but is more controversial for treating   immunotherapy of fish allergy. Int Arch Allergy Immunol
                                                                  2015;166:41–51.
        allergic asthma. When used in appropriately selected patients,   17.  Des Roches A, Paradis L, Menardo JL, et al. Immunotherapy with a
        SIT is effective and acceptably safe, but care must be exercised   standardized Dermatophagoides pteronyssinus extract. VI. Specific
        in recognizing and treating adverse reactions. Appropriate training   immunotherapy prevents the onset of new sensitizations in children. J
        of allergists and SIT clinic support staff is essential. Despite a   Allergy Clin Immunol 1997;99:450–3.
        century of use, the precise mechanisms of action of SIT remain   18.  Eng PA, Borer-Reinhold M, Heijnen IA, et al. Twelve-year follow-up after
        uncertain. Current emphasis on the role of Tregs is leading to   discontinuation of pre-seasonal grass pollen immunotherapy in
        renewed attempts to simplify SIT regimes and reduce its risks.   childhood. Allergy 2006;69:198–201.
        Future directions in SIT include the development of vaccines   19.  Marogna M, Tomassetti D, Bernasconi A, et al. Preventive effects of
        that are better standardized and the use of recombinant allergens,   sublingual immunotherapy in childhood: an open randomized controlled
                                                                  study. Ann Allergy Asthma Immunol 2008;101:206–11.
        both of which should improve the safety profile of SIT. In parallel,   20.  Horak F. Manifestation of allergic rhinitis in latent sensitised patients. A
        and perhaps for the longer term, we should explore the develop-  prospective study. Arch Otorhinolaryngol 1985;242:242–9.
        ment of general immunomodulatory therapies, which would be   21.  Niggemann B, Jacobsen L, Dreborg S, et al. Five-year follow-up on the
        particularly advantageous for those patients sensitized to multiple   PAT study: specific immunotherapy and long-term prevention of asthma
        allergens.                                                in children. Allergy 2006;61:855–9.
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