Division of Allergy/Immunology, Creighton University, Omaha, Neb. 68131, USA.
J Allergy Clin Immunol. 2011 Jan;127(1):8-15; quiz 16-7. doi: 10.1016/j.jaci.2010.10.034. Epub 2010 Nov 20.
Allergic respiratory diseases affect approximately 15% of the US population. Allergen immunotherapy has been a treatment option for diseases such as allergic rhinitis, allergic asthma, and venom allergy for the last 100 years. During the first 75 years, conventional subcutaneous immunotherapy did not change much. However, the last 25 years has seen substantial growth in the development of alternatives to conventional subcutaneous immunotherapy. The addition of omalizumab, an anti-IgE mAb, to immunotherapy offers the potential for increased safety and efficacy. Activation of the innate immune system through Toll-like receptor agonists with and without specific allergens appears to improve the immunologic responses and clinical outcomes in patients with allergic diseases. The use of chemically altered allergens, allergoids, recombinant allergens, and relevant T-cell epitope peptides are all approaches that have yielded positive results. Finally, alternative modes of delivery hold promise, with sublingual immunotherapy rapidly approaching mainstream use in many countries. One thing is clear: the next century of immunotherapy will be vastly different from today's current standard of care.
过敏性呼吸系统疾病影响了大约 15%的美国人口。过敏原免疫疗法是治疗过敏性鼻炎、过敏性哮喘和毒液过敏等疾病的一种选择，已有 100 年的历史。在最初的 75 年中，传统的皮下免疫疗法并没有太大变化。然而，在过去的 25 年中，传统皮下免疫疗法的替代品得到了极大的发展。奥马珠单抗（一种抗 IgE mAb）的加入为免疫疗法提供了提高安全性和疗效的潜力。通过 Toll 样受体激动剂（有和没有特定过敏原）激活先天免疫系统，似乎可以改善过敏性疾病患者的免疫反应和临床结果。使用化学修饰的过敏原、类毒素、重组过敏原和相关 T 细胞表位肽都是取得积极成果的方法。最后，替代给药方式也有希望，舌下免疫疗法在许多国家迅速成为主流应用。有一点是明确的：免疫疗法的下个世纪将与今天的标准治疗有很大的不同。
