Specific immunotherapy in house dust mite allergy.

Abstract

Specific immunotherapy (SIT) was introduced in 1911 (1) and for many years remained based on empiricism. Extracts of unknown quality and shelf-life (e.g., house dust, Candida albicans, bacteria) were used and the efficacy of SIT was seriously questioned. The introduction of standardized extracts made it possible to increase the efficacy of immunotherapy and double-blind placebo-controlled studies have demonstrated the efficacy of this form of therapy in rhinitis, asthma, and conjunctivitis. The increased efficacy of immunotherapy was associated with an increased risk of anaphylactic reactions (2-4), leading again to question the future of SIT (5). International guidelines have been issued to improve the use of SIT (6-8). SIT is the only treatment intervention that may alter the course of allergic diseases and new methods of specific and nonspecific immunotherapy are being proposed and may prove to be efficacious and safe (9). SIT is still widely used throughout the world. In the future several approaches may be interesting, but all of them are based on the perfect characterization of allergenic molecules and epitopes causing the IgE-mediated immune response. New technologies using molecular biology and genetic engineering have made significant progress in the characterization and preparation of allergens.