Senti Gabriela, von Moos Seraina, Kündig Thomas M
Clinical Trials Center, University Hospital Zürich, Zürich, Switzerland.
Department of Internal Medicine, University Hospital Zürich, Zürich, Switzerland.
Curr Treat Options Allergy. 2013 Dec 17;1(1):68-78. doi: 10.1007/s40521-013-0003-8. eCollection 2014.
IgE-mediated allergies today affect up to 30 % of the population in industrialized countries. Allergen immunotherapy is the only disease-modifying treatment option with a long-term effect. However, very few patients (<5 %) choose immunotherapy, due to the long treatment duration (between 3-5 years) and possible local and systemic allergic side effects of the allergen administrations. The latter occur when an allergen accidentally reaches the blood circulation. Therefore, the ideal application route for allergen immunotherapy should be characterized by two hallmarks: firstly, by a high number of potent antigen-presenting cells, which enhance efficacy and thus shorten treatment duration. Secondly, the allergen administration site is ideally non-vascularized, so that inadvertent systemic distribution of the allergen and consequent systemic allergic side effects are minimized. The epidermis contains high numbers of potent antigen-presenting Langerhans cells and, as an epithelium, is non-vascularized. Therefore, the epidermis represents an interesting administration route. Historical evidence for the clinical efficacy of epicutaneous allergy immunotherapy (EPIT) has now been strengthened by a number of recent double-blinded placebo-controlled clinical trials performed by independent groups. We review the immunological rationale, history and clinical experience with epicutaneous allergy immunotherapy.
如今，在工业化国家，IgE介导的过敏影响着高达30%的人口。变应原免疫疗法是唯一具有长期疗效的疾病改善治疗选择。然而，由于治疗持续时间长（3至5年）以及变应原给药可能产生的局部和全身过敏副作用，很少有患者（<5%）选择免疫疗法。当变应原意外进入血液循环时，就会出现后者这种情况。因此，变应原免疫疗法的理想给药途径应具备两个特点：其一，要有大量高效的抗原呈递细胞，这能提高疗效，从而缩短治疗时间。其二，变应原给药部位理想情况下应无血管，这样可将变应原意外的全身分布及随之而来的全身过敏副作用降至最低。表皮含有大量高效的抗原呈递朗格汉斯细胞，并且作为上皮组织，是无血管的。因此，表皮是一种有趣的给药途径。近期多个独立小组进行的多项双盲安慰剂对照临床试验，强化了经皮过敏免疫疗法（EPIT）临床疗效的历史证据。我们回顾经皮过敏免疫疗法的免疫学原理、历史及临床经验。
