REVIEWS   

Otorinolaringologia 2008 March;58(1):51-60

Copyright © 2008 EDIZIONI MINERVA MEDICA

language: English

Specific immunotherapy and allergic rhinitis

Ciprandi G.

Department of Internal Medicine University Hospital San Martino, Genoa, Italy

Allergic rhinitis (AR) is a high-prevalence disease, affecting 10% to 20% of the general population. AR is sustained by an IgE-mediated reaction, and by a complex inflammatory network of cells, mediators, and cytokines. It becomes chronic when exposure to allergen persists. Specific immunotherapy (SIT) is the only treatment able to modify the natural history of the allergic subjects. Several aspects of the immunopathological response modified by sublingual immunotherapy (SLIT) have been investigated; the first parameter historically studied was the production of allergen-specific antibodies. An increase of allergen-specific IgG4 and a decrease of IgE may appear after SLIT. A shift from Th2-polarized immune response toward Th1-oriented pattern has been reported after SLIT. More recently, a crucial role for a subpopulation of T cells has been evidenced: T regulatory cells (Treg). Allergic patients have a defect of Tregs. SLIT should be able of inducing a specific Treg response. SLIT is an alternative route of administration for SIT. Recent evidence shows that SLIT is also able of inducing a Treg response as detected by IL-10 production. In addition, SLIT significantly affects pharmaco-economy.