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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2004 March;54(1):15-23
Allergen specific immunotherapy in allergic rhinitis
Calderon-Zapata M. A., Durham S. R.
Upper Respiratory Medicine National Heart and Lung Institute Imperial College School of Medicine, London, UK
Allergen immunotherapy is highly effective in selected patients with IgE mediated disease with a limited spectrum of allergies who fail to respond to usual therapies. The mechanism is likely to involve modification of the T lymphocyte response to subsequent allergen exposure with a shift in the Th2/Th1 lymphocyte balance, either by immune deviation Th2>Th1 responses or down-regulation of Th0/Th2 responses. Allergen immunotherapy has been shown to be effective in patients with severe summer hay fever. Treatment for 3-4 years may result in long-term benefit for at least 3 years following discontinuation. In children, immunotherapy has been shown to prevent the onset of new sensitisations. Immunotherapy for seasonal hay fever in children, when continued for 3 years, resulted in a two-threefold reduction in the risk of developing physician-diagnosed asthma at 5 years, 2 years following discontinuation. Although highly effective, allergen injection immunotherapy may be associated with side effects, including a remote risk of anaphylaxis. Therefore, the risk/benefit of immunotherapy should be considered in every case, and the treatment confined to specialist clinics with access to resuscitation with a waiting period of at least 30 minutes after injections (60 minutes within the UK).