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ECPB 2014, 67(3): 77–85
Assisting a doctor

Allergen – specific immunotherapy and its role in treatment of the bronchial asthma: current state of art

Besh O., Radchenko O.
Abstract

The article presents analytical overview of the literature dedicated to the history of application of the allergen-specific immunotherapy, its influence on the allergic inflammation and its efficiency in the bronchial asthma treatment. It is highlighted that insufficient application of this treatment method comprises one of the reasons of lack of the control over the bronchial asthma in certain cases. It demonstrates the elements of discussion regarding appropriateness and ways of its performance. On the one hand, many guidelines recommend application of the allergen-specific immunotherapy only in case of non– efficiency of the conservative medication. However, on the other hand, there exist other persuasive examinations proving the fact that its efficiency increases in case of application in first years after the diagnosis of the bronchial asthma is determined.

The article also comprises discussion regarding possibilities of realization and efficiency of the traditional parenteral and sublingual allergen-specific immunotherapy. It defines that sublingual allergen-specific immunotherapy constitutes the effective alternative to subcutaneous introduction of the allergens. The article also demonstrates diversified mechanisms for achievement of the treatment goal in case of application of this treatment method as well as ways for dynamic improvement of the allergens for carrying out the allergen-specific immunotherapy. For a long time leading scientists acknowledged that the main mechanism of action antigen-specific immunotherapy (ASIT) is the formation of the so-called “blocking” of IgG antibodies. During recent years, knowledge about immune mechanisms ASIT has been expanded; particularly the role of autoantibodies against IgE (anti-IgE) has been under study. The last one belong to IgG class and may block the immune mechanisms of allergy. Nowadays it is proved that the ASIT medications interact with antigen presenting cells, mainly with dendritic cells, at the injection site and in regional lymphatic nodes. Dendritic cells induce T-regulatory cells and Th1. T-regulatory cells and the cytokines that are produced (e.g., interleukin-10 – IL-10 and transforming growth factor-β – TGF-b) play a crucial role in the regulation of the immune response in ASIT.

Both IL-10 and TGF-b suppress IgE synthesis, and IL-10 induces the synthesis of IgG4 isotype. These two cytokines were proved to directly inhibit allergic inflammation. The article presents the results of a Cochrane review, which analyzes results of 54 multicenter randomized placebo-controlled trials about the use of allergen-specific immunotherapy.

There are analysed results of numerous publication on the changes of the immune indices as a result of this treatment way. It provides the research describing results of combination of the background medication and allergen-specific immunotherapy.

Particularly, testing of combination of steroid therapy with fluticasone propionate and allergen-specific immunotherapy for patients with bronchial asthma have confirmed the correctness of the opinion of several scientists and practices stating that the efficiency of the allergen-specific immunotherapy increases if applied immediately in first years after the diagnosis is determined.

This publication represents the steps of dynamic improvement of allergens for allergen-specific immunotherapy and current perspectives of further improvement of this method of treatment.

Keywords: parenteral, sublingual allergen-specific immunotherapy, bronchial asthma

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