Page 1274 - Clinical Immunology_ Principles and Practice ( PDFDrive )
P. 1274
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
43
mononuclear cells (PBMCs). Initial clinical trials confirmed
44
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
45
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.
46
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.

