Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus.

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Presentation transcript:

Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report  A. Wesley Burks, MD, Moises A. Calderon, MD, PhD, Thomas Casale, MD, Linda Cox, MD, Pascal Demoly, MD, PhD, Marek Jutel, MD, Harold Nelson, MD, Cezmi A. Akdis, MD  Journal of Allergy and Clinical Immunology  Volume 131, Issue 5, Pages 1288-1296.e3 (May 2013) DOI: 10.1016/j.jaci.2013.01.049 Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Immunologic changes during the course of AIT. A, Although there is significant variation between subjects and protocols, an early decrease in mast cell and basophil degranulation and decreased tendency for systemic anaphylaxis is observed immediately after the first administration of allergens with a native-like structure. This is followed by generation of allergen-specific Treg cells and suppression of allergen-specific TH1 and TH2 cells and possibly other effector cells. B, An early increase and a very late decrease in specific IgE levels are observed. IgG4 levels show a relatively early increase that is dose dependent. In some studies allergen-specific IgG1 and IgA levels also increase. A significant decrease in the allergen-specific IgE/IgG4 ratio occurs after several months. A significant decrease in type I skin test reactivity is also observed relatively late in the course of specific immunotherapy. After a few months, a decrease in tissue mast cell and eosinophil numbers and release of their mediators is observed, as well as a decrease in the late-phase response. These effects are partially demonstrated in SLIT and are rather weak compared with those seen in SCIT. Novel AIT approaches might or might not show these effects, although they still can be effective. Journal of Allergy and Clinical Immunology 2013 131, 1288-1296.e3DOI: (10.1016/j.jaci.2013.01.049) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Novel approaches to AIT. Journal of Allergy and Clinical Immunology 2013 131, 1288-1296.e3DOI: (10.1016/j.jaci.2013.01.049) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions