Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland.
Curr Opin Allergy Clin Immunol. 2009 Dec;9(6):568-73. doi: 10.1097/ACI.0b013e3283310fdf.
The purpose of the present review is to describe recent approaches aimed at improving the treatment of allergic diseases through allergen-specific immunotherapy (SIT). Special emphasis will be given to the approach based on specific targeting of the major histocompatibility complex (MHC) class-II antigen-presentation pathway.
It is well recognized that IgE-mediated allergic diseases including rhinitis, atopic eczema and allergic asthma are increasing worldwide to a pandemic dimension. The only curative treatment remains allergen-SIT, which, however, requires a long treatment time of 3-5 years with up to 80 injections to confer protection. Recent findings strongly indicate that the treatment time and the number of injections could be drastically reduced by turning immunotherapy to a true vaccination. Direct injection of allergen extracts into the inguinal lymph nodes and targeting the MHC class-II antigen-presentation pathway by recombinant modular antigen-translocating vaccines have the potential to cure allergic diseases in a very short time.
The mechanisms of allergic inflammation can be divided into four distinct stages: T cell activation, organ-selective homing, survival/reactivation and effector functions. On the basis of this new knowledge several novel concepts aimed at treating allergic diseases have been developed. The area of allergen-SIT is experiencing exciting developments. Reciprocal regulation of effector and regulatory T cell subsets is being more and more used to develop novel strategies for immunomodulation.
本综述旨在描述通过过敏原特异性免疫疗法（SIT）改善过敏性疾病治疗的最新方法。特别强调基于主要组织相容性复合体（MHC）II 类抗原呈递途径的特定靶向方法。
众所周知，包括鼻炎、特应性皮炎和过敏性哮喘在内的 IgE 介导的过敏性疾病在全球范围内呈流行趋势。唯一的根治性治疗仍然是过敏原 SIT，但需要长达 3-5 年的治疗时间，最多需要 80 次注射才能提供保护。最近的发现强烈表明，通过将免疫疗法转变为真正的疫苗，可以大大缩短治疗时间和注射次数。将过敏原提取物直接注射到腹股沟淋巴结，并通过重组模块化抗原转运疫苗靶向 MHC Ⅱ类抗原呈递途径，有可能在很短的时间内治愈过敏性疾病。
过敏性炎症的机制可以分为四个不同的阶段：T 细胞激活、器官选择性归巢、存活/再激活和效应功能。基于这一新知识，已经开发出了几种旨在治疗过敏性疾病的新方法。过敏原 SIT 领域正在经历令人兴奋的发展。效应 T 细胞和调节性 T 细胞亚群的相互调节越来越多地被用于开发新的免疫调节策略。
