Abstract
Allergic asthma, an important subtype of asthma endotypes, is characterized by allergen-specific and Th2 cellmediated airway inflammation. Except for pharmacologic treatment, Allergen-specific immunotherapy (ASIT) has also been considered as a potential therapy for allergic asthma. House dust mite (HDM) is a common airborne allergen among patients with allergic asthma. This review is focused on the relationship between HDM allergy and allergic asthma, underlying mechanism of ASIT, and current evidence of HDM-specific immunotherapy for allergic asthma. It was demonstrated that HDM allergy is a risk factor associated with disease development of allergic asthma. The induction of immune tolerance by regulatory T cells was proved to play a pivotal role in the immunological mechanisms of ASIT. Experimental studies in murine models of allergic asthma reveal that HDM-specific immunotherapy has not only therapeutic efficacy but also preventive potential for disease development. The clinical trials also demonstrated the efficacy of HDM-specific immunotherapy in reducing asthma symptoms and medication use. Today, the clinical application of ASIT in allergic asthma has limitation when considering the extent of benefit and systemic adverse reactions. Although sublingual immunotherapy with HDM extract was demonstrated to have better safety profile when comparing with subcutaneous immunotherapy. To make HDM-specific immunotherapy more practicable in clinical application, further advances in the development of immunotherapy and clinical trials are needed.
Highlights
There is an increasing trend in the global prevalence, morbidity, and economic burden associated with asthma in recent decades [1]
IL-10 mediated by Treg cells affects tolerance in effector T cells, and regulates the allergen-specific antibody isotype formation from IgE toward a non-inflammatory antibody of IgG4 [46]. These findings reveal that induction of immune tolerance by regulatory T cells play a pivotal role in the immunological mechanisms of allergen-specific immunotherapy
Much accumulating evidence is demonstrating that house dust mite (HDM) allergy play important roles in asthma exacerbations and in allergic asthma development
Summary
There is an increasing trend in the global prevalence, morbidity, and economic burden associated with asthma in recent decades [1]. The Global Strategy for Asthma Management and Prevention Report [2] defined asthma as a chronic inflammatory disorder of the airways in which many cells and cellular elements are involved. Both host factors (primarily genetic) and environmental factors (primarily allergen exposure) are considered to contribute to the development and expression of asthma [3]. Recent research revealed that asthma is more likely a heterogenous disease in view of clinical manifestations or pathophysiologic mechanisms, and asthma phenotypes or endotypes are evolving to classify subgroups of asthmatic patients [4,5]. The aim of this review is to discuss the risk factor of HDM allergy on allergic asthma, potential strategy of HDM-specific immunotherapy and underlying mechanism, and both experimental and clinical studies of HDM-specific immunotherapy for allergic asthma
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