MRC Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK.
Clin Transl Allergy. 2011 Nov 7;1(1):13. doi: 10.1186/2045-7022-1-13.
Allergic sensitisation usually begins early in life. The number of allergens a patient is sensitised to can increase over time and the development of additional allergic conditions is increasingly recognised. Targeting allergic disease in childhood is thus likely to be the most efficacious means of reducing the overall burden of allergic disease. Specific immunotherapy involves administering protein allergen to tolerise allergen reactive CD4+ T cells, thought key in driving allergic responses. Yet specific immunotherapy risks allergic reactions including anaphylaxis as a consequence of preformed allergen-specific IgE antibodies binding to the protein, subsequent cross-linking and mast cell degranulation. CD4+ T cells direct their responses to short "immunodominant" peptides within the allergen. Such peptides can be given therapeutically to induce T cell tolerance without facilitating IgE cross-linking. Peptide immunotherapy (PIT) offers attractive treatment potential for allergic disease. However, PIT has not yet been shown to be effective in children. This review discusses the immunological mechanisms implicated in PIT and briefly covers outcomes from adult PIT trials. This provides a context for discussion of the challenges for the application of PIT, both generally and more specifically in relation to children.
过敏致敏通常始于生命早期。随着时间的推移，患者致敏的过敏原数量可能会增加，并且越来越多的人认识到会出现额外的过敏病症。因此，针对儿童时期的过敏性疾病可能是减轻过敏疾病总体负担的最有效方法。特异性免疫疗法涉及给予蛋白过敏原以耐受过敏原反应性 CD4+T 细胞，这被认为是驱动过敏反应的关键。然而，特异性免疫疗法会带来过敏反应的风险，包括由于预先形成的过敏原特异性 IgE 抗体与蛋白结合、随后的交联和肥大细胞脱颗粒而导致的过敏反应，包括过敏反应。CD4+T 细胞将其反应导向过敏原内的短“免疫优势”肽。可以给予此类肽进行治疗以诱导 T 细胞耐受，而不会促进 IgE 交联。肽免疫疗法（PIT）为过敏疾病提供了有吸引力的治疗潜力。然而，尚未证明 PIT 在儿童中有效。本文综述了 PIT 中涉及的免疫机制，并简要介绍了成人 PIT 试验的结果。这为讨论 PIT 的应用挑战提供了背景，包括一般情况下以及更具体地针对儿童的情况。
