Abstract
Allergen immunotherapy (AIT) is the sole disease-modifying treatment for allergic rhinitis; it prevents rhinitis from progressing to asthma and lowers medication use. AIT against mites, insect venom, and certain kinds of pollen is effective. The mechanism of action of AIT is based on inducing immunological tolerance characterized by increased IL-10, TGF-β, and IgG4 levels and Treg cell counts. However, AIT requires prolonged schemes of administration and is sometimes associated with adverse reactions. Over the last decade, novel forms of AIT have been developed, focused on better allergen identification, structural modifications to preserve epitopes for B or T cells, post-traductional alteration through chemical processes, and the addition of adjuvants. These modified allergens induce clinical-immunological effects similar to those mentioned above, increasing the tolerance to other related allergens but with fewer side effects. Clinical studies have shown that molecular AIT is efficient in treating grass and birch allergies. This article reviews the possibility of a new AIT to improve the treatment of allergic illness.
Highlights
In 1954, the first controlled clinical trial was developed, and Allergen immunotherapy (AIT) improved the symptoms in the group receiving the pollen extract compared with the control group [2]
There is evidence that the rupture of the skin barrier facilitates the penetration of allergens into the epidermis, causing Langerhans cells to catch allergens and travel to regional lymph nodes, with the subsequent stimulation and differentiation of T lymphocytes toward a Th2 profile [31]
Virus-like Particles (VLPs) are produced from viral capsid proteins and have the potential to activate the immune system through innate mechanisms (PAMPs) that are not dependent on T
Summary
Allergen immunotherapy (AIT) originated in the early twentieth century [1]. In 1954, the first controlled clinical trial was developed, and AIT improved the symptoms in the group receiving the pollen extract compared with the control group [2]. AIT is recommended for the treatment of allergic rhinitis (AR) and asthma by many medical organizations, based on controlled clinical trials and meta-analyses [3–5]. Many of these beneficial effects are due to AIT being the unique therapy able to induce allergen long-term tolerance after discontinuation. Subcutaneous immunotherapy (SCIT) comprises a build-up phase (in which the allergen concentration increases gradually) and a maintenance phase (in which the projected dose is applied), which must be administered for at least three years (Figure 1a).
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