Immunotherapies

In passive immunotherapy immune globulin (Ig) is an effective replacement in most forms of antibody deficiency (14). In the past, plasma was used instead of immune globulin, but plasma is rarely indicated in the 1990s because of the risk of disease, particularly AIDS, transmission. Because plasma contains many factors in addition to immunoglobulins (Igs), plasma is, however, of particular value in patients with protein-losing enteropathy, complement deficiencies, and refractory diarrhea. 

Hyposensitization is an empirically founded immunotherapy which is characterized by repeated exposure to the responsible (clearly defined) allergen. It can lead to a diminished Type I (IgE-dependent) allergic reaction. 

Tedesco SH Jr, Pinheiro MP, Rosso FC et al (2006) Immunotherapy for de novo renal transplantation what s in the pipeline Drugs 36 1665-1684... 

Metastatic renal cell carcinoma has a poor prognosis and resists conventional chemotherapy. Immunotherapy with IL-2 and/or IFN-a is currently regarded as the most effective therapy with, however, modest response rates of 15-20%. Similar results are also observed in patients with metastatic melanoma and the response to IFN-a and IL-2 correlates with the occurrence of tumor-infiltrating CD4+ T-lymphocytes identified in aspirates from melanoma metastases. Determination of these cells therefore seems to be a method to predict responders prior to the initiation of cytokine therapy. 

Molloy PE, Sewell AK, Jakobsen BK (2005) Soluble T cell receptors novel immunotherapies. Curr. Opin. Pharmacol 5 438-443... 

Berger J, Ring J Efficacy of antihistamine pretreat- 15 ment in the prevention of adverse reactions to Hymenoptera venom immunotherapy a prospective randomized placebo-controlled trial. J Allergy 16 Clin Immunol 1997 100 458-463. 

SC Fatalities from immunotherapy and skin testing. J Allergy Clin Immunol 1987 79 666-677. 

Larche M. Akdis CA. Valenta R Immunological 6 mechanisms of allergen-specific immunotherapy. 

K Role of interleukin-10 in specific immunotherapy. J Clin Invest 1998 102 98-106. 

Mechanisms of allergen-specific immunotherapy l20 T-regulatory cells and more. Immunol Allergy Chn North Am 2006 26 207-231. 

Francis JN, Till SJ, Durham SR Induction of 1L-10+CD4+CD25+ T cells by grass pollen immunotherapy. J Allergy Clin Immunol 2003 111 1255-1261. Jutel M, Akdis M, Budak F, Aebischer-Casaulta C. Wrzyszcz M, Blaser K, Akdis CA lL-10 and TGF-P cooperate in the regulatory T cell response to mucosal allergens in normal immunity and specific immunotherapy. Eur J Immunol 2003 33 1205-1214. 

Jutel M, Pichler WJ, Skrbic D, Urwyler A, Dahinden C, Muller UR Bee venom immunotherapy results in decrease of lL-4 and lL-5 and increase of IFN-y secretion in specific allergen-stimulated T cell cultures. J Immunol 1995 154 4187-4194. 

Pilette C. Nouri-Aria KT. Jacobson MR. Wilcock LK, Detry B. Walker SM. Francis JN. Durham SR Grass pollen immunotherapy induces an allergen-specific IgA2 antibody response associated with mucosal TGF-P expression. J Immunol 2007 178 4658-4666. 

Varney VA. Hamid QA. Gaga M. Ying S. Jacobson M, Frew AJ. Kay AB. Durham SR Influence of grass pollen immunotherapy on cellular infiltration and cytokine mRNA expression during allergen-induced late-phase cutaneous responses. J Clin Invest 1993 92 644-651. 

Radulovic S. Jacobson MR. Durham SR. Nouri-Aria KT Grass pollen immunotherapy induces Foxp3-expressing CD4+ CD25+ cells in the nasal mucosa. J AUergy Clin Immunol 2008 121 1467-1472. 1472 el461. 

Muller U, Helbling A, Bischof M Predictive value of venom-specific IgE, IgG and IgG subclass antibodies in patients on immunotherapy with honey bee venom. Allergy 1989 44 412-418. 

Jutel M, Jaeger L, Suck R, Meyer H, Fiebig H, Cromwell O Allergen-specific immunotherapy with recombinant grass pollen allergens. J Allergy Clin Immunol 2005 116 608-613. 

Shim JY, Kim BS, Cho SH, Min KU, Hong SJ Allergen-specific conventional immunotherapy decreases immunoglobulin E-mediated basophil histamine releasability. Clin Exp Allergy 2003 33 52-57. 

MH, Townley RG. Mokhtarani M. Seyfert-Margohs V, Asare A. Bateman K. Deniz Y Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis. J Allergy Clin Immunol 2006 117 134-140. 

Rak S. Lowhagen O, Venge P The effect of immunotherapy on bronchial hyperresponsiveness and eosinophil cationic protein in pollen-allergic patients. J Allergy Chn Immunol 1988 82 470-480. 

Diet should be modified only in cases where foods have been proven to elicit symptoms. Patients with mastocytosis and Hymenoptera venom exposure are at risk for severe anaphylaxis. Thus, specific immunotherapy should be considered in patients with Hymenoptera venom allergy and then administered under close supervision [31]. The majority of patients with mastocytosis reportedly tolerate immunotherapy without significant side effects and appear protected following this approach [33,40]. However, there does appear to be some increased risk for adverse reactions during initiation of immunotherapy, as well as for therapy failures [31, 33]. An increased maintenance dose of insect venom has been reported to carry better success rates by sting provocation [41]. Also, in the light of 2 fatal cases of anaphylaxis after discontinuation of SIT in patients with mastocytosis [30], lifelong immunotherapy should be considered [26]. 

In rare cases, initiation of specific immunotherapy with insect venom leads to recurrent anaphylaxis, even with antihistamine premedication. In those cases, comedication with omalizumab (anti-IgE) has been reported to induce tolerance. In a case of recurrent anaphylaxis to induction of specific immunotherapy, the injection of 300 mg of omalizumab between 4 days and 1 h reportedly led to tolerance [42]. This approach also appears worthy of consideration in patients with both idiopathic recurrent anaphylaxis and mastocytosis who do not respond to standard antimediator therapy, as has been described in 2 atopic patients with ISM [43]. Most patients with mastocytosis and idiopathic anaphylaxis, however, are sufficiently controlled by standard antimediator therapy with antihistamines with or without low-dose corticosteroids. 

Fatal anaphylaxis after ayellow jacket sting, despite 41 venom immunotherapy, in two patients with mastocytosis. J Allergy Clin Immunol 1997 99 153-154. 

Gonzalez de Olano D, Alvarez-Xwose I, Esteban-Lopez MI, et al Safety and effectiveness of immunotherapy in patients with indolent systemic mastocytosis present- 44 ing with Hymenoptera venom anaphylaxis. J Allergy Clin Immunol 2008 121 519-526. 

Carter MC, Uzzaman A, Scott LM, et al Pediatric mastocytosis routine anesthetic management for a complex disease. Anesth Analg 2008 107 422-427. Bonadonna R Zanotti R, Caruso B, et al Allergen-specific immunotherapy is safe and effective in patients with systemic mastocytosis and Hymenoptera allergy. J Allergy Clin Immunol 2008 121 256-257. 

Rueff F, Wenderoth A, Przybilla B Patients still reacting to a sting challenge while receiving conventional Hymenoptera venom immunotherapy are protected by increased venom doses. J Allergy Clin Immunol 2001 108 1027-1032. 

One limitation of serum-specific IgE is that given the cross-reactivity between different Hymenoptera venoms, and also due to the presence of anti-carbohydrate antibodies, it is frequent to find several simultaneous positive results in patients with non-identified insect stings, a situation which makes diagnosis of the same difficult. In these cases, RAST inhibition and the release of histamine occasionally provide data on the venom involved and when this is not the case, it is advisable to administer immunotherapy against both [44]. 

---