Local immunotherapy with extract in asthma

Crimi, Emanuele; Voltolini, Susanna; Troise, C; Gianiorio, Piero; Crimi, Paolo; Brusasco, Vito; Negrini, Arsenio Corrado

doi:10.1016/0091-6749(91)90395-5

Cited by 42 publications

(23 citation statements)

References 14 publications

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“…These approaches include nasal insufflation, bronchial inhalation and sublingual absorption (see reviews [10,11]). Local bronchial immunotherapy was disappointing as, despite progressive improvement in symptoms and medication scores, there was no significant objective clinical response and bronchospasm was a common adverse event [12]. Local nasal im- Fig.…”

Section: Introductionmentioning

confidence: 99%

Sublingual Allergen Immunotherapy: Immunological Mechanisms and Prospects for Refined Vaccine Preparations

O’Hehir

Sandrini²,

Anderson³

et al. 2007

CMC

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Allergic diseases constitute a major health issue worldwide. Mainstay treatment constitutes allergen avoidance and pharmacotherapy for symptom relief, but allergen immunotherapy offers advantages of specific treatment with long lasting efficacy, and being able to modify the course of the disease. Conventional immunotherapy involves the subcutaneous injection of gradually increasing amounts of allergen extract but the use of current whole allergen extracts is restricted by the risk of adverse IgE-mediated events especially for potent allergens such as peanut and latex and for asthmatics. This has lead to interest in alternative routes of immunotherapy. Oral tolerance is a well-documented immune process and the sublingual route of administration of allergen immunotherapy is attracting interest. Recent meta-analyses show that sublingual allergen immunotherapy for grass pollen and house dust mite allergy is clinically effective and safer than injection immunotherapy. Some studies show SLIT induces changes of T cell anergy, immune deviation, blocking antibodies, and induction of regulatory T cells, as described for injection immunotherapy pointing to the need to target allergen-specific T cells, there is emergent evidence that the oral mucosa presents distinct regulatory features. Evidence suggests that oral dendritic cells play a key role in inducing tolerance especially when allergen is taken up via Fc receptor bound IgE. This suggests that although both would target allergen-specific T cells, allergen formulations may differ with respect to IgE epitopes for optimal SLIT compared with SCIT. Identification of the molecular nature of the allergen-DC receptor interaction is required to determine whether short peptides or recombinant allergen preparations and of suitable adjuvants specifically tailored for the sublingual route will allow the development of improved allergen formulations and delivery strategies for efficacy of treatment whilst decreasing IgE-mediated adverse effects.

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Section: Introductionmentioning

confidence: 99%

Sublingual Allergen Immunotherapy: Immunological Mechanisms and Prospects for Refined Vaccine Preparations

O’Hehir

Sandrini²,

Anderson³

et al. 2007

CMC

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“…The inhaled route proved ineffective in two clinical trials but was limited by bronchospasm [155,156]. The oral route has also been studied although results were disappointing [157][158][159].…”

Section: Alternative Routes Of Immunotherapymentioning

confidence: 99%

Immunotherapy for allergic rhinitis

Walker¹,

Durham

Till

et al. 2011

Clin Experimental Allergy

146

125

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SummaryAllergic rhinitis (AR) affects more than 20% of the population in the United Kingdom and western Europe and represents a major cause of morbidity that includes interference with usual daily activities and impairment of sleep quality. This guidance prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) is for the management of AR in patients that have failed to achieve adequate relief of symptoms despite treatment with intranasal corticosteroids and/or antihistamines. The guideline is based on evidence and is for use by both adult physicians and paediatricians practising allergy. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are indications and contraindications for immunotherapy, criteria for patient selection, the evidence for short-and long-term efficacy of subcutaneous and sublingual immunotherapy, and discussion on safety and the different modes of immunotherapy including, pre-seasonal and co-seasonal treatments. There are sections on children, allergen standardization, vaccines used in the United Kingdom, oral allergy syndrome, cost effectiveness of immunotherapy and practical considerations of undertaking immunotherapy including recommendations on who should undertake immunotherapy and dosing schedules. Finally, there is discussion on potential biomarkers of response to immunotherapy, the use of component-resolved diagnostics, novel approaches, alternative routes and potential areas for future research.Keywords aeroallergens, allergen, allergic rhinitis, allergen standardization, allergy to animals, allergy to house dust mites, asthma, BSACI, cat allergy, component-resolved diagnostics, cost effectiveness, dosing schedules, grass pollen, guideline, immunotherapy, oral allergy syndrome, perennial rhinitis, pollinosis, ragweed allergy, SAR, seasonal pollen induced rhinitis, subcutaneous immunotherapy, sublingual immunotherapy, tree pollen Submitted 19 February 2011; revised 6 May 2011; accepted 9 May 2011. Executive summaryUntreated rhinitis represents a major cause of morbidity that includes interference with usual daily activities and impaired sleep quality. Immunotherapy, both subcutaneous and sublingual, is an effective treatment for adults and children with severe allergic rhinitis (AR) that does not respond to conventional pharmacotherapy and allergen avoidance measures. The efficacy of immunotherapy depends on correct patient selection, the type of allergen and the product chosen for treatment. Each vaccine requires individual assessment before recommendation for routine use.

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“…131 The clinical trial results for tracheal administration have suggested that clinical efficacy is unproven and that the risk/benefit ratio is unfavorable. 132,133 SLIT The mechanisms behind SLIT include the production of blocking IgG4 antibodies, 134,135 the presence of high numbers of tolerogenic DC subsets, the induction of regulatory T cells, 136,137 and the programming of the immune system toward a regulatory state of unresponsiveness to specific allergens. SLIT may also increase IL-10, which has a clear role in suppressing allergic immune responses.…”

Section: Oralmentioning

confidence: 99%

Strategies of mucosal immunotherapy for allergic diseases

Chuang

Chiang

2011

Cell Mol Immunol

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Incidences of allergic disease have recently increased worldwide. Allergen-specific immunotherapy (SIT) has long been a controversial treatment for allergic diseases. Although beneficial effects on clinically relevant outcomes have been demonstrated in clinical trials by subcutaneous immunotherapy (SCIT), there remains a risk of severe and sometimes fatal anaphylaxis. Mucosal immunotherapy is one advantageous choice because of its non-injection routes of administration and lower side-effect profile. This study reviews recent progress in mucosal immunotherapy for allergic diseases. Administration routes, antigen quality and quantity, and adjuvants used are major considerations in this field. Also, direct uses of unique probiotics, or specific cytokines, have been discussed. Furthermore, some researchers have reported new therapeutic ideas that combine two or more strategies. The most important strategy for development of mucosal therapies for allergic diseases is the improvement of antigen formulation, which includes continuous searching for efficient adjuvants, collecting more information about dominant T-cell epitopes of allergens, and having the proper combination of each. In clinics, when compared to other mucosal routes, sublingual immunotherapy (SLIT) is a preferred choice for therapeutic administration, although local and systemic side effects have been reported. Additionally, not every allergen has the same beneficial effect. Further studies are needed to determine the benefits of mucosal immunotherapy for different allergic diseases after comparison of the different administration routes in children and adults. Data collected from large, well-designed, double-blind, placebo-controlled, and randomized trials, with post-treatment follow-up, can provide robust substantiation of current evidence.

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Local immunotherapy with extract in asthma

Cited by 42 publications

References 14 publications

Sublingual Allergen Immunotherapy: Immunological Mechanisms and Prospects for Refined Vaccine Preparations

Sublingual Allergen Immunotherapy: Immunological Mechanisms and Prospects for Refined Vaccine Preparations

Immunotherapy for allergic rhinitis

Strategies of mucosal immunotherapy for allergic diseases

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