Schulten V, Tripple V, Aasbjerg K, Backer V, Lund G, Würtzen P A, Sette A, Peters B
La Jolla Institute for Allergy & Immunology, La Jolla, CA, USA.
Department of Cardiology and Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark.
Clin Exp Allergy. 2016 Mar;46(3):439-48. doi: 10.1111/cea.12653.
Allergen-specific immunotherapy is the only curative treatment for type I allergy. It can be administered subcutaneously (SCIT) or sublingually (SLIT). The clinical efficacy of these two treatment modalities appears to be similar, but potential differences in the immunological mechanisms involved have not been fully explored.
To compare changes in the allergen-specific T cell response induced by subcutaneous vs. sublingual administration of allergen-specific immunotherapy (AIT).
Grass pollen-allergic patients were randomized into groups receiving either SCIT injections or SLIT tablets or neither. PBMCs were tested for Timothy grass (TG)-specific cytokine production by ELISPOT after in vitro expansion with TG-peptide pools. Phenotypic characterization of cytokine-producing cells was performed by FACS.
In the SCIT group, decreased IL-5 production was observed starting 10 months after treatment commenced. At 24 months, T cell responses showed IL-5 levels significantly below the before-treatment baseline. No significant reduction of IL-5 was observed in the SLIT or untreated group. However, a significant transient increase in IL-10 production after 10 months of treatment compared to baseline was detected in both treatment groups. FACS analysis revealed that IL-10 production was associated with CD4(+) T cells that also produced IFNγ and therefore may be associated with an IL-10-secreting type 1 cell phenotype.
The most dominant immunological changes on a cellular level were a decrease in IL-5 in the SCIT group and a significant, transient increase of IL-10 observed after 10 months of treatment in both treated groups. The distinct routes of AIT administration may induce different immunomodulatory mechanisms at the cellular level.
变应原特异性免疫疗法是I型过敏的唯一治愈性治疗方法。它可以皮下注射（皮下免疫疗法，SCIT）或舌下含服（舌下免疫疗法，SLIT）给药。这两种治疗方式的临床疗效似乎相似，但所涉及的免疫机制的潜在差异尚未得到充分探索。
比较皮下注射与舌下含服变应原特异性免疫疗法（AIT）诱导的变应原特异性T细胞反应的变化。
对草花粉过敏的患者随机分组，分别接受皮下免疫疗法注射、舌下免疫疗法片剂治疗或不接受任何治疗。外周血单核细胞（PBMCs）在体外用梯牧草（TG）肽库扩增后，通过酶联免疫斑点法（ELISPOT）检测其产生的TG特异性细胞因子。通过荧光激活细胞分选术（FACS）对产生细胞因子的细胞进行表型鉴定。
在皮下免疫疗法组，治疗开始10个月后观察到白细胞介素-5（IL-5）产生减少。在24个月时，T细胞反应显示IL-5水平显著低于治疗前基线。在舌下免疫疗法组或未治疗组中未观察到IL-5的显著降低。然而，在两个治疗组中，与基线相比，治疗10个月后均检测到IL-10产生显著短暂增加。FACS分析显示，IL-10的产生与也产生γ干扰素（IFNγ）的CD4(+) T细胞相关，因此可能与分泌IL-10的1型细胞表型相关。
细胞水平上最主要的免疫学变化是皮下免疫疗法组中IL-5减少，以及两个治疗组在治疗10个月后均观察到IL-10显著短暂增加。AIT给药的不同途径可能在细胞水平上诱导不同的免疫调节机制。
