Update on Allergy Immunotherapy 英文参考文献.docVIP

Review Update on Allergy Immunotherapy William Davidson, MD; Sean Lucas, MD; Larry Borish, MD Abstract This article summarizes and provides commentary regarding guidelines on the administration of immunotherapy (IT) for allergic airway disease. Recent investigations have provided important insights into the immunologic mechanism of IT and the prominent role of interleukin-10–producing regulatory T lymphocytes. The most important aspect of successful IT is the administration of an appropriate dose of an extract containing a sufficient concentration of the relevant allergen. This is largely possible now only with standardized extracts. When the major allergen content of successful IT extracts was quanti- fied, efficacy was demonstrated across a surprisingly narrow concentration range (approximately 5–24 μg per injection), irrespective of the extract. This presumably reflects the concentration of an anti- gen that drives an immune response toward tolerance. It may be predicted that as major allergen con- tent is quantified in currently nonstandardized extracts, effective IT will also be achieved by administer- ing a dose in this range, in contrast to current practices involving fairly arbitrary dosing decisions. With the availability of nonsedating antihistamines, intranasal corticosteroids, and the leukotriene modifiers, inadequate pharmacologic response or intolerable side effects are less commonly the major indications for starting IT for allergic rhinitis (AR). However, with the recognition that a relatively short course (3–5 years) of IT can provide long-term immunomodulation and clinical benefit, a desire to avoid long- term pharmacotherapy and the associated high costs may be the primary indication for IT in AR cases. While evidence overwhelmingly supports the beneficial influences of IT in asthma cases, the position- ing of IT for this disorder is not established. The observed prevention of asthma in children who have AR is intr