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Efficacy of Subcutaneous and Sublingual-swallow Allergen-Specific Immunotherapy in the Prevention and in the Causal Treatmentof Allergic Rhinitis and Asthma
Alireza Ranjbar, MD
Pediatric Clinical Immunology and Allergy
Cologne , Germany
Allergic diseases are the most common chronic diseases in children. In allergic subjects the activity of T helper cells type 2 (Th2) predominates over that of T- helper cells type 1 (Th1). T-helper cells type 2 (Th2) with their cytokines such as IL-4, IL-5 and IL-13 are responsible for increased synthesis of IgE, the activation and degranulation of mast cells and basophiles, the differentiation and activation of eosinophils and their migration into the target organs and the enhanced expression of IgE receptors and adhesion molecules on various cell types. Allergen-specific Immunotherapy (SIT) is recognized as a biological modifier which alters the natural course of the allergic diseases.
The mechanisms of SIT are complex and may involve a reorientation of the Th2 dominated response toward the Th1 cells Subcutaneous and sublingual-swallow allergen-specific immunotherapy have been recognized in 1998 by WHO and in 2000 by ARIA as an only effective therapeutically procedure for the causal treatment of allergic rhinitis and asthma and for the prevention of the development of new sensitization. SIT is also capable to prevent the switch of allergic rhinitis to asthma. Long-term efficacy of allergen-specific immunotherapy after it has been stopped has been shown at least for 3-6 years. Children and young patients respond better than adults, especially for asthma. This is probably due to the duration of the disease and implies that the immunological intervention to alter the natural course of the disease should be introduced at the early age and at a time where the patient has not shown the remodeling of the airway tissues and is able to respond