Jhamnani Rekha D, Frischmeyer-Guerrerio Pamela
National Institutes of Health, 10 Clinical Center Drive, Bethesda, MD, 20892, USA.
National Institutes of Health, 4 Memorial Drive, Building 4, Room 228, Bethesda, MD, 20892, USA.
Curr Treat Options Allergy. 2016 Sep;3(3):282-291. doi: 10.1007/s40521-016-0091-3. Epub 2016 Jul 21.
Immunotherapy for peanut allergy has been an exploding topic of study within the last few years. Sublingual, epicutaneous, and oral immunotherapy are being investigated and show promise in the treatment of peanut allergy. Oral immunotherapy has shown the most clinical benefit; however, sublingual and epicutaneous immunotherapy appear to have the most favorable safety profiles. Most studies to date suggest that only a minority of subjects achieve sustained unresponsiveness to peanut after discontinuation of immunotherapy. Recent efforts have been focused on identifying adjunct therapies, such as omalizumab, that may assist patients in achieving peanut desensitization more quickly and with greater success. Several underlying immunologic mechanisms, including a switch from IgE to IgG4 production and induction of T regulatory cells, have been studied although more research is needed to identify reliable biomarkers. This article will describe the immunotherapy approaches that are being investigated to induce peanut desensitization, and highlight the benefits and risks of these therapies that need to be considered before they are ready for routine clinical practice.
在过去几年里，花生过敏的免疫疗法一直是一个热门研究课题。舌下免疫疗法、经皮免疫疗法和口服免疫疗法正在接受研究，并且在治疗花生过敏方面显示出前景。口服免疫疗法已显示出最大的临床益处；然而，舌下免疫疗法和经皮免疫疗法似乎具有最良好的安全性。迄今为止的大多数研究表明，在免疫疗法停止后，只有少数受试者对花生实现持续无反应。最近的努力集中在确定辅助疗法，如奥马珠单抗，其可能有助于患者更快且更成功地实现花生脱敏。尽管需要更多研究来确定可靠的生物标志物，但已经对几种潜在的免疫机制进行了研究，包括从产生IgE转变为产生IgG4以及诱导调节性T细胞。本文将描述正在研究的诱导花生脱敏的免疫疗法方法，并强调在这些疗法准备好用于常规临床实践之前需要考虑的这些疗法的益处和风险。
