Abstract
Allergic rhinitis (AR) is an IgE-mediated disease that is characterized by Th2 joint inflammation. Allergen-specific immunotherapy (AIT) is indicated for AR when symptoms remain uncontrolled despite medication and allergen avoidance. AIT is considered to have been effective if it alleviated allergic symptoms, decreased medication use, improved the quality of life even after treatment cessation, and prevented the progression of AR to asthma and the onset of new sensitization. AIT can be administered subcutaneously or sublingually, and novel routes are still being developed, such as intra-lymphatically and epicutaneously. AIT aims at inducing allergen tolerance through modification of innate and adaptive immunologic responses. The main mechanism of AIT is control of type 2 inflammatory cells through induction of various functional regulatory cells such as regulatory T cells (Tregs), follicular T cells (Tfr), B cells (Bregs), dendritic cells (DCregs), innate lymphoid cells (IL-10+ ILCs), and natural killer cells (NKregs). However, AIT has a number of disadvantages: the long treatment period required to achieve greater efficacy, high cost, systemic allergic reactions, and the absence of a biomarker for predicting treatment responders. Currently, adjunctive therapies, vaccine adjuvants, and novel vaccine technologies are being studied to overcome the problems associated with AIT. This review presents an updated overview of AIT, with a special focus on AR.
Highlights
Allergic rhinitis is a common upper airway disease
Inverse correlations were found between the symptom score, the rescue medication score, and the IgE-Facilitated allergen binding (FAB) result [35]. These findings suggest that the serum inhibitory activity for IgE could predict the final efficacy of Allergen-specific immunotherapy (AIT) as early as at the start of the maintenance phase of [105]
The inhibitory activity for IgE-facilitated allergen binding (IgE-FAB) of the nasal fluid and serum were significantly increased in the subcutaneous immunotherapy (SCIT) group and correlated with the total symptom improvement, indicating that specific IgG4 (sIgG4) produced locally in the nasal mucosa can be a potential biomarker for AIT efficacy [35, 110]
Summary
Allergic rhinitis is a common upper airway disease. Its prevalence varies around the world. The inhibitory activity for IgE-FAB of the nasal fluid and serum were significantly increased in the SCIT group and correlated with the total symptom improvement, indicating that sIgG4 produced locally in the nasal mucosa can be a potential biomarker for AIT efficacy [35, 110]. In a double-blinded randomized controlled trial, both SCIT and SLIT led to a decrease in Th2 cytokines, including IL-4, IL-5, and IL-13 in the nasal fluid after nasal allergen provocation after 2 years of continuous AIT, and those changes were associated with improvement in the clinical symptoms [19]. A recent systematic review and meta-analysis of 98 studies showed that SCIT and SLIT significantly reduced short-term symptom scores and medication use in patients with allergic asthma [155]. Several human studies have shown that probiotics reduce symptoms and improve the quality of life in AR patients
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