Allergen Immunotherapy for Airborne and Food Allergens: Efficacy and Immunological Mechanisms
Allergen immunotherapy (AIT) is a disease-modifying treatment for IgE-mediated diseases induced by aeroallergens and food allergens. The efficacy of AIT for airborne allergens is somewhat different from food allergens. The management of allergy induced by aeroallergens involves (i) allergen avoidance; (ii) the use of antihistamines and (iii) nasal corticosteroids. Those who do not respond to pharmacotherapy are than eligible to receive AIT. Long-term administration of AIT results in the modulation of innate and adaptive immune responses and the induction of tolerance. The disease-modifying effect is both antigen-specific and antigen-driven. Clinical improvement is accompanied by decreases in effector cells in target organs including mast cells, basophils, eosinophils and type 2 innate lymphoid cells. AIT also results in the suppression of Th2 immunity which occurs as a consequence of either deletion and/or anergy of antigen-specific Th2 cells, the induction of antigen-specific T regulatory cells and/or immune deviation in favor of Th1 responses. Moreover, AIT is associated with the induction of B regulatory cells that produce of blocking IgG antibodies that can inhibit IgE-dependent activation mediated via both FcεRI (mast cells and basophils) and FcεRII (facilitated antigen presentation) mediated pro-allergic responses.
The management of food allergy is rather challenging as there is no cure and avoidance is not always possible. AIT administered orally (OIT) has proven useful in desensitizing food-allergic patients. Unlike AIT that confers long-term clinical benefit, OIT only confers short term changes in the threshold of allergen concentration that can be tolerated. Although safe, novel approaches that utilize biologicals can be given in conjunction with AIT or OIT. For example, anti-IgE in conjunction with AIT/OIT allows the safe up-dosing the treatment and prevent severe adverse reactions. The immunological and molecular mechanisms underpinning efficacy and long-term disease-modifying properties of AIT and short-term for OIT remains to be investigated.
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Journal of Clinical & Experimental Dermatology Research