Abstract
Opinion statementIgE-mediated allergies today affect up to 30 % of the population in industrialized countries. Allergen immunotherapy is the only disease-modifying treatment option with a long-term effect. However, very few patients (<5 %) choose immunotherapy, due to the long treatment duration (between 3–5 years) and possible local and systemic allergic side effects of the allergen administrations. The latter occur when an allergen accidentally reaches the blood circulation. Therefore, the ideal application route for allergen immunotherapy should be characterized by two hallmarks: firstly, by a high number of potent antigen-presenting cells, which enhance efficacy and thus shorten treatment duration. Secondly, the allergen administration site is ideally non-vascularized, so that inadvertent systemic distribution of the allergen and consequent systemic allergic side effects are minimized. The epidermis contains high numbers of potent antigen-presenting Langerhans cells and, as an epithelium, is non-vascularized. Therefore, the epidermis represents an interesting administration route. Historical evidence for the clinical efficacy of epicutaneous allergy immunotherapy (EPIT) has now been strengthened by a number of recent double-blinded placebo-controlled clinical trials performed by independent groups. We review the immunological rationale, history and clinical experience with epicutaneous allergy immunotherapy.
Highlights
With a current prevalence of up to 30 % in industrialized countries, IgE-mediated allergies have become an important socioeconomic burden
Several groups achieved promising results with epicutaneous immunotherapy against skin cancer based on induction of potent CD8+ T cell responses [32, 33]
In 1917, Besredka showed that EPIT was able to induce specific antibodies [36], and the first case study on successful epicutaneous allergy immunotherapy was reported in 1921 by Vallery-Radot, who found that allergen administration onto scarified skin reduced systemic allergic symptoms in patients allergic to horses [37]
Summary
Subcutaneous I SLIT Sublingual allergen immunotherapy I TCI Transcutaneous allergen immunotherapy I Th Helper T cell I Treg Regulatory T cell
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