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Does Allergen Immunotherapy Alter the Natural Course of Allergic Disorders?

Drugs volume 61, pages 365–374 (2001)Cite this article

Abstract

Allergy in patients with atopy is caused by clinical adverse reactions to environmental antigen, which is often associated with allergen-specific immunoglobulin (Ig)E production. Since allergy reflects an inappropriate immunological reaction, a therapeutic approach related to immunology is likely to actively alter the natural course of allergic disorders. Allergen immunotherapy, known at various times as desensitisation or hyposensitisation, is very recently defined by the World Health Organization as therapeutic vaccines for allergic diseases.

At present, it has become a common clinical practice in selected patients for the treatment and prevention of the recurrence of allergic disorders caused by insect venoms and has proven to be effective in changing the course of allergic responses induced by grass and tree pollen, animal hair and dander, house dust mite and mold, as demonstrated by improvement in clinical symptoms, skin prick test and medication scores. Reported effects of allergen immunotherapy on the natural course of allergic disorders include (i) prevention of reaction following re-sting in insect venom allergy; (ii) prevention or decrease the rate of the natural progress of allergic rhinitis to asthma; and (iii) inhibition of new sensitisation in monosensitised children.

Many aspects of the immune responses associated with allergic disorders, including antibody production, cytokine secretion, T cell activation and local inflammatory reactions, are found to be significantly altered during and/or after immunotherapy. Specifically, the ratio of allergen-specific IgG4 to IgG1 correlates well with positive clinical outcome caused by allergen immunotherapy in patients with pollen-allergy. Allergen immunotherapy affects the cytokine profile of allergen-specific T cells and switches Th2 type immune responses in patients with atopy towards ThO or Th1 type responses. Although the changes in the absolute value of Th1 or Th2 cytokines appear quite variable, the increase in the ratio of Th1/Th2 cytokines is very consistent among published reports, especially in the late stage of treatment.

Accumulating evidence indicates that appropriate immunotherapy prevents the onset of new sensitisation and prevents the progress of allergic rhinitis to asthma. Although the changes in B cell and T cell responses, especially IgG antibodies and Th1/Th2 cytokine production, may be the major mechanism underlying the clinical efficacy of allergen immunotherapy and the prevention of the development of allergic phenotypic changes, multiple mechanisms may be involved in the outcome of alteration of the natural course of allergic disorders.

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Acknowledgements

This work was supported by a grant from the Medical Research Council of Canada (MRC) to Dr Yang (MT-14680). Dr Yang holds a salary (scholar) award from MRC.

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  1. Immune Regulation of Allergy Research Group, Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Manitoba, Room 523,730 William Avenue, Winnipeg, Manitoba, R3E OW3, Canada

    Xi Yang

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Yang, X. Does Allergen Immunotherapy Alter the Natural Course of Allergic Disorders?. Drugs 61, 365–374 (2001). https://doi.org/10.2165/00003495-200161030-00005

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Keywords

  • Asthma
  • Allergic Rhinitis
  • House Dust Mite
  • IgG4 Titre
  • Allergic Disorder