Immunotherapy in allergic rhinitis

D Amato G, Lobefalo G, Liccardi G, Cazzola M A double-blind placebo-controlled trial of local nasal immunotherapy in allergic rhinitis to Parietaria pollen. Clin Exp Allergy 1995 25 141-148. 

Andri L, Senna GE, Betteli C, Givanni S, Andri G, Falagiani P, Lugo G Local nasal immunotherapy in allergic rhinitis to Parietaria. A double-blind controlled study. Allergy 1992 47 318-323. 

La Rosa M, Ranno C, Andre C, Carat F, Tosca MA, Canonica GW Double-blind placebo-controlled evaluation of sublingual swallow immunotherapy with standardized Parietaria judaica extract in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol 1999 104 425 432. Guez S, Vatrinet C, Fadel R, Andre C House dust mite sublingual swallow immunotherapy in perennial rhinitis A double-blind placebo-controlled study. Allergy 2000 55 369-375. 

The efficacy of subcutaneous SIT has been clearly shown in a metaanalysis of 43 double-blind placebo-controlled trials in allergic rhinitis as well as another meta-analysis of 16 double-blind placebo-controlled studies in asthma patients [13]. The mean clinical improvement was 45% reduction in symptoms and medication compared with placebo in rhinitis and 40% in asthma patients, which exceeds the effects of drug therapy. A recent meta-analysis also confirmed that asthma responds favorably to SIT [14], However, recently it could also be demonstrated that SIT is effective in patients with house dust mite allergy, allergic rhinitis and asthma [15]. Immunotherapy in these patients not only reduced rhinitis and asthma symptoms as well as rescue medication, but also had an impact on bronchial hyperreactivity over the 3-year follow-up period. 

In allergen immunotherapy, specific allergen extracts (also called allergen vaccines) are administered in order to modify or eliminate allergic rhinitis symptoms. 

The World Health Organization position paper [31] published in 1998 found that properly conducted double-blind, placebo-controlled trials have shown the effectiveness of sublingual-swallow immunotherapy with grass, Parietaria and mite vaccines. The ARIA (Allergic Rhinitis and Impact on Asthma) [32] guidelines published in 2001 gave specific indications for usage. 

Marcucci F, Sensi LG, Caffarelli C, Cavagni G, Bernardini R, Tiri A, Riva G, Novembre E Low-dose local nasal immunotherapy in children with perennial allergic rhinitis due to Dermatophagoides. Allergy 2002 57/l 23—28. 

Andri L, Senna GE, Andri G Local nasal immunotherapy for birch allergic rhinitis with extract in powder form. Clin Exp Allergy 1995 25 1092-1099. 

Cirla A, Sfoiza N, Roffi G Preseasonal intranasal immunotherapy in birch-alder allergic rhinitis. A double-blind study. Allergy 1996 51 299-306. 

Ariano R, Panzani RC, Chiapella M, Augeri G, Falagiani P Local immunotherapy of seasonal allergic rhinitis in children due to Parietaria officinalis pollen. A preliminary report. Pediatr Asthma Allergy Immunol 1993 7/4 227-237. 

Ohashi Y, Nakai Y, Sakamoto H, Ohno Y, Sugiura Y, Okamoto H, Tanaka A, Kakinoki Y, Kishimoto K, Hayashi M Serum levels of soluble interleukin-2 receptor in patients with perennial allergic rhinitis before and after immunotherapy. Ann Allergy Asthma Immunol 1996 77 203-208. Ohashi Y, Nakai Y, Tanaka A, Kakinoki Y, Washio Y, Kato A, Masamoto T, Sakamoto H, Yamada K Ten-year follow-up study of allergen-specific immunoglobulin E and immunoglobulin G4, soluble interleukin-2 receptor, interleukin-4, soluble intercellular adhesion molecule-1 and soluble vascular cell adhesion molecule-1 in serum of patients on immunotherapy for perennial allergic rhinitis. Scand J Immunol 1998 47 167-178. 

The first report of the successful use of grass pollen extract injections to treat allergic rhinitis was published in 1911 by Noon." The therapy was first called desensitization however, this did not seem appropriate because skin reactivity sometimes remained. The name was later changed to hyposensitization. While this term is still used today, immunotherapy is used more commonly and is less confusing. 

The effectiveness of immunotherapy for seasonal allergic rhinitis appears to be better than that seen with perennial rhinitis, in part because it is more difficult to determine which allergen is responsible for perennial symptoms, and it is more due to multiple sensitizations. Effectiveness has been shown in a number of clinical studies using a variety of pollen extracts, even in patients with severe disease resistant to pharmacotherapy." " Specific immunotherapy for house dust mites has had good results in appropriately selected patients, while several studies have described marked improvement in patients with allergy to cats. Data indicate that in some patients 3 years of immunotherapy may be sufficient to give lasting benefit." ... 

Kuehr J, Brauburger J, Zielen S, et al. Efficacy of combination treatment with anti-IgE plus immunotherapy in polysensitized children and adolescents with seasonal allergic rhinitis. J Allergy Qin Immunol 2002 109 274-280. 

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