PrefaceThe only real argument for establishing a specific diagnosis in allergic diseases is the institution of a specific treatment. Allergen avoidance and immunotherapy represent the only specific treatments we are able to offer allergic patients. The capacity of drug treatment is limited to the elimination or diminishing of symptoms, and no studies have been able to show that pharmacologic treatment of allergic diseases, not even corticosteroids, modifies the spontaneous, long-term course of the disease. Costbenefit studies of immunotherapy present problems, and we recommend that immunotherapy be an integrated part of the treatment of allergic disorders, thus reducing the disease severity, improving the quality of life of allergics, and diminishing the risk and cost of pharmacotherapy.The first EAACI Immunotherapy Position Paper was published in 1988. New insights into the pathogenesis of allergic diseases and recent publications on immunotherapy have called for a revision of the Immunotherapy Position Paper. However, allergenspecific immunotherapy is a controversial treatment, and drafting this 1992 revised Position Paper is difficult since: 1) We intend to recommend that immunotherapy be performed in the most scientific way, but supportive data are not always sufficient. 2) Although clinical experience is encouraging, particularly with recent high-quality extracts, a further reduction in the number of patients treated by immunotherapy, while we wait for further scientific data, will make improvements more difficult, and eventually lead to a halt in the production of allergen extracts. Our Position Paper, therefore, aims at reaching a consensus, balancing science, theory, and current practice in most European countries, at the same time intending to improve the scientific value of the 1992 revised EAACI Immunotherapy Position Paper .The outlines of the 1992 revised EAACI Immunotherapy Position Paper were debated at a one-day meetingin February 1991, in Copenhagen, Denmark, sponsored by ALK, Denmark. The first edition was drafted at a three-day meeting in May 1991, in Madrid, Spain, organized by Dr Emilio Alvarez-Cuesta and kindly sponsored by Abell6, Spain. The final revised edition of the Position Paper represents the opinion of the members of the EAACI Immu-notherapy Subcommittee and includes comments from the EAACI associate European national societies of allergology. Hans-Jrargen Malling Bent Weeke aluminium-containing allergen extracts. Allergy 1985: 40: 59. FROSTAD AB, GRIMMER 0, SANDVIK L, MOXNES A. AAS K. Clinical effects of hyposensitization using a purified allergen preparation from timothy pollen as compared to crude aqueous extracts from timothy pollen and a four-grass pollen mixture respectively. Clin Allergy 1983: 13: 337-57. 60. FURIN MJ. NORMAN PS. CRETICOS PS, et al. Immunotherapy decreases antigen-induced eosinophil cell migration into the nasal cavity. J Allergy Clin Imrnunol 1991: 88: 27-32. 61. GEHA RS. Use of IgE-derived peptides to treat allergy. Ann Allergy 1991: 66: 359-60. 62. GEORGIT...
Immunotherapy represents the only allergen-specific treatment of allergic diseases. The clinical efficacy has been documented in a number of studies involving both rhinitis and asthma patients, although because of the multifactorial pathophysiology including hyperresponsiveness, asthma may not respond as satisfactorily as rhinitis. Owing to the capacity to reduce the release of allergic mediators and thereby the allergic inflammation, immunotherapy has advantages over the nonspecific drug treatment primarily interfering at the target level of mediators. The clinical efficacy may be improved and the risk of side effects reduced by the use of modified allergens or by immunological manipulation in parallel with allergen administration.
Sera from 73 grass pollen allergic patients in two double blind studies on hyposensitization were investigated for IgE response towards one major timothy allergen-antigen 19 (Ag 19) by means of crossed radioimmunoelectrophoresis (CRIE). The clinical efficacy of hyposensitization after initial preseasonal treatment was positively correlated with increase in specific IgE binding to Ag 19. It was possible to predict the clinical efficacy by comparing CRIE performed on sera before and after 3 months of treatment.
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