Allergen immunotherapy: immunomodulatory treatment for allergic diseases.
Allergen immunotherapy: immunomodulatory treatment for allergic diseases.
复制标题
DOI：
10.1586/1744666x.2.4.533
复制
发表时间：
2006-07-01
影响因子：
4.4
通讯作者：
Cox, Linda
中科院分区：
文献类型：
--
作者：
Cox, Linda
过敏原免疫疗法是目前唯一一种治疗过敏性疾病的免疫调节疗法。目前主要用于治疗过敏性鼻炎、哮喘和毒液过敏。疗效似乎是剂量依赖的，免疫治疗临床疗效的免疫学机制仍在阐明中。与免疫治疗相关的免疫学变化包括T调节细胞的诱导，变应原特异性免疫球蛋白G4的增加，白细胞介素10的产生增加和T辅助分子2反应的下调。过敏原免疫治疗的缺点包括不良事件的风险、患者的时间和不便。免疫治疗的风险从大的局部反应到轻微的全身反应，如鼻炎。据报道，免疫疗法注射的死亡率约为每250万次注射中就有一人死亡。传统的皮下免疫治疗计划包括每次就诊增加一次剂量，患者可能需要几个月的时间才能达到治疗性维持剂量。加速时间表，如快速和集群，将使患者更快达到维持量，但可能会有更大的全身反应风险。目前免疫治疗研究的重点是开发更安全、更有效的疫苗。另一种提高免疫治疗安全性的方法是通过另一种给药方法。舌下免疫治疗显然比皮下免疫治疗更安全，但还需要进一步的研究来确定最佳剂量和合适的患者选择。
Allergen immunotherapy is currently the only immune-modifying treatment for allergic disease. At the present time it is indicated for the treatment of allergic rhinitis, asthma and venom hypersensitivity. Efficacy appears to be dose dependent, and the immunological mechanisms responsible for the clinical efficacy of immunotherapy are still being elucidated. Immunological changes associated with immunotherapy include induction of T regulatory cells, increase in allergen-specific immunoglobulin G4, increase in interleukin-10 production and downregulation of the T helper 2 response. The disadvantages of allergen immunotherapy include risk of adverse events and patient time and inconvenience. Risks of immunotherapy range from large local reactions to mild systemic reactions, such as rhinitis. Fatalities from immunotherapy injections have been reported at a rate of approximately one fatality per 2.5 million injections. Conventional subcutaneous immunotherapy build-up schedules involve administration of a single-dose increase each visit and it may take several months before a patient achieves the therapeutic maintenance dose. Accelerated schedules, such as rush and cluster, will allow the patient to achieve the maintenance dose sooner but there may be a greater risk of a systemic reaction. The current focus of immunotherapy research is to develop safer and more effective vaccines. Another approach to enhancing immunotherapy safety is through an alternative delivery method. Sublingual immunotherapy is clearly safer than subcutaneous immunotherapy, but further investigation is needed to determine optimal dose and appropriate patient selection.