Advances in upper airway diseases and allergen immunotherapy

Abstract

Evidence of an increased prevalence of rhinitis in patients with asthma, and asthma in patients with rhinitis, supports the 1 airway concept. However, there are basic differences between the upper and lower airways, such as the virtual absence of remodeling in the nose compared with the bronchi, despite the presence of similar inflammation. Etiologic factors in chronic rhinosinusitis (CRS) attract increasing interest. Peripheral blood monocytes from patients with CRS release IL-4, IL-13, and IFN-gamma on stimulation with fungal antigens, especially those from Alternaria. This is not seen with cells from normal controls. However, a double-blind trial of intranasal amphotericin in CRS was negative. Evidence continues to accumulate of the pivotal role of regulatory T-lymphocytes secretion of IL-10 in the response to allergen immunotherapy. In patients with asthma and house dust mite allergy who are receiving appropriate pharmacotherapy and have instituted environmental controls, house dust mite immunotherapy provides marginal additional benefits in asthma control. Immunotherapy with cat dander extract at a maintenance dose containing 15 microg Fel d 1 produces a more consistent immunologic response than with maintenance doses containing 3.0 microg, whereas doses containing only 0.6 microg are no more effective than placebo. Sublingual immunotherapy for seasonal grass allergy can be safely administered by general practitioners, but symptom relief begins only in the second season of therapy. Sublingual immunotherapy for seasonal grass allergy in children reduced symptoms and onset of new asthma symptoms but, again, beginning only in the second year of treatment. A course of 6 weekly injections of ragweed Amb a 1 bound to cytosine phosphorothionate guanosine containing DNA produced a shift from T H 2 to T H 1 cytokine release both in peripheral blood cells and in the nose after allergen challenge. No symptom improvement was seen the first year, but symptoms were reduced the second year without further treatment.

Intralymphatic Injections as a New Administration Route for Allergen-Specific Immunotherapy

“…One approach for improving SIT focuses on the route of allergen administration. In this respect, sublingual immunotherapy, in which the allergen is given as soluble tablets or drops, and local nasal immunotherapy have proven promising and especially attractive for patients [1,25,26,27]. However, the treatment duration of sublingual immunotherapy and nasal SIT remains similar to that of current subcutaneous SIT [28], and the required allergen doses are at least 50–100 times higher than the dose needed for subcutaneous immunisation [29].…”

Anaphylaxis as a Manifestation of Horse Allergy

“…Patients with a previous severe anaphylactic systemic reaction should carry a preloaded epinephrine device and should be educated when and how to use this device. Allergen immunotherapy may be the treatment of choice in many cases of animal allergy, especially when the avoidance of allergen is not possible [29]. …”

Oral administration of Ag suppresses Ag-induced allergic conjunctivitis in mice: critical timing and dose of Ag

“…Oral tolerance induction has been used to treat autoimmune diseases in both humans and animals, with encouraging outcomes 5 6. Regarding allergic diseases, the effectiveness of oral tolerance therapy has been examined quite extensively in food allergy,7 asthma,8 atopic dermatitis9 and allergic rhinitis 10. In contrast, only two studies investigating the efficacy of oral tolerance induction in allergic conjunctivitis have been performed.…”