Specific immunotherapy

Clinical tolerance to allergens may be achieved by the administration of allergen extracts, which is called specific immunotherapy. In addition to its therapeutic value, it has been suggested that this treatment may also alter the progression of disease. Specific allergen immunotherapy (SIT) is used to alleviate the condition associated 

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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, 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. 

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. 

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. 

While in anaphylaxis caused by other frequent elicitors like food and drugs, allergen-specific immunotherapy is not established, immimotherapy with Hymenoptera venoms has been shown to be effective in three prospective controlled trials (table 4) [38-40] and also in a number of studies where patients were submitted to a sting challenge with the responsible insect during venom immimotherapy (table 5) [44]. While over 90% of vespid venom-allergic patients are fully protected and do not develop any... 

If possible, refer patient to allergen-specific immunotherapy (e.g. insect venom anaphylaxis)... 

Diagnosis Be suspicious if an aerosol attack occurs in the form of yellow rain with droplets of yellow fluid contaminating clothing and the environment. Confirmation requires testing of blood, tissue and environmental samples. As for treatment, there is no specific antidote however, super-activated charcoal should be given orally if the toxin is swallowed. The only defense is to wear a protective mask and clothing during an attack. No specific immunotherapy or chemotherapy is available for use in the field. 

Jarisch R, Goetz M, Aberer W, Sidl R, Stabel A, Zajc J, Fordos A Reduction of side effects of specific immunotherapy by premedication with antihistamines and reduction of maximal dosage to 50,000 SQ-U/ml. Arbeiten aus dem Paul-Ehrlich Institut 1988 82 163-175. 

Specific immunotherapy (SIT) with aeroallergens directly addresses adaptive mechanism in hypersensitivity reactions. A meta-analysis of SIT studies revealed positive effects of subcutaneous... 

Bussmann C, Bockenhoff A, Henke H, Werfel T, Novak N Does allergen-specific immunotherapy represent a therapeutic option for patients with atopic dermatitis J Allergy Chn Immunol 2006 118 1292-1298. 

Werfel T, Breuer K, Rueff F, Przybilla B, Worm M, Grewe M, Ruzicka T, Brehler R, Wolf H, Schnitker J, Kapp A Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites a multicentre, randomized, dose-response study. Allergy 2006 61 202-205. 

Jutel M. Akdis M, Budak F, et al IL-10 and TGF-3 cooperate in the regulatory T cell response to mucosal allergens in normal immunity and specific immunotherapy. Eur J Immunol 2003 33 1205-1214. 

Peripheral T-Cell Tolerance in Allergen-Specific Immunotherapy... 

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