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REVIEWS ALLERGIC RHINITIS
Otorinolaringologia 2006 March;56(1):1-8
Copyright © 2006 EDIZIONI MINERVA MEDICA
language: English
Specific immunotherapy for treating allergic rhinitis
Incorvaia C. 1, Riario-Sforza G. C. 1, Pravettoni C. 1, Di Cicco M. 2, Frati F. 3, 4, Marcucci F. 3
1 Allergy/Pulmonary Rehabilitation Istituti Clinici di Perfezionamento, Milan, Italy 2 Department of Otorhinolaryngology Clinical Institutes of Improvement, Milan, Italy 3 University Department of Obstetric Gynecologic and Pediatric Sciences, Perugia, Italy 4 Scientific Department, Stallergenes Italia, Milan, Italy
Specific immunotherapy (SIT) is the practice of reducing the clinical reactivity of allergic subjects by administering gradually increasing doses of the specific allergen. Subcutaneous immunotherapy has strong evidence of efficacy for allergic rhinitis caused by pollens, house dust mites, moulds, and animal hair and danders. Its clear dose dependence requires high doses, in the range of 5-20 mg of single major allergens as maintenance treatment, but this exposes the patients to possible adverse reactions and makes essential to accurately consider the risk/benefit ratio. The search for safer ways of administration lead to the development of sublingual immunotherapy, which meta-analysis studies stated as effective and safe in allergic rhinitis. It is essential that practical application of SIT fulfils the requirements indicated by controlled studies concerning the selection of patients, the use of adequate quality allergen extracts, the administration of sufficiently high doses and the appropriate duration of treatment. Such application makes possible to SIT to carry out its mechanisms of action, which mainly consist in the induction in T cells of a tolerant state to the specific allergen, with a particular role for T regulatory cells and for the inhibition of a Th2 cytokine pattern, with a consequent decrease of the production and activation of effector cells, such as mast cells, eosinophils and basophils, and of the IgE synthesis.