Klimek Ludger, Pfaar Oliver, Bousquet Jean, Senti Gabriela, Kündig Thomas
a Department of Otorhinolaryngology , Allergy Center , Wiesbaden , Germany.
b Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim , Heidelberg University , Mannheim , Germany.
Expert Rev Clin Immunol. 2017 Sep;13(9):897-906. doi: 10.1080/1744666X.2017.1333423. Epub 2017 Jun 15.
Type-1 allergies are among the most chronic common diseases of humans. Allergen immunotherapy (AIT) is the only causative and disease-modifying treatment option besides allergen avoidance. Severe systemic adverse allergic reactions may be induced by every AIT treatment. Different approaches have been used to provide safer AIT preparations to lower or even totally overcome this risk. Areas covered: A structured literature recherche in Medline and Pubmed under inclusion of national and international guidelines and Cochrane meta-analyses has been performed aiming at reviewing clinical use of such approaches in AIT. New allergen preparations may include allergoids, recombinant allergens (recA) and modified recombinant allergens (recA) in subcutaneous as well as in mucosal immunotherapies (application e.g. using bronchial, nasal, oral and sublingual application) with sublingual being the established mucosal application route and new ways of application like intralymphatic and epicutaneous immunotherapy. Expert commentary: Immune-modifying agents like Virus-like particles and CpG-motifs, adjuvants like MPL and aluminum hydroxide are evaluated and found to increase and direct the immunological response toward immunological tolerance. New forms of allergen extracts can improve safety and efficacy of AIT and may change our way of performing allergen immunotherapy in the future.
1型过敏是人类最常见的慢性疾病之一。除了避免接触变应原外，变应原免疫疗法（AIT）是唯一一种具有病因学作用且能改变疾病进程的治疗选择。每次AIT治疗都可能诱发严重的全身性过敏不良反应。人们采用了不同方法来提供更安全的AIT制剂，以降低甚至完全消除这种风险。涵盖领域：在纳入国家和国际指南以及Cochrane荟萃分析的情况下，对Medline和Pubmed进行了结构化文献检索，旨在综述此类方法在AIT中的临床应用。新的变应原制剂可能包括变应原衍生肽、重组变应原（recA）和修饰的重组变应原（recA），可用于皮下免疫疗法以及黏膜免疫疗法（例如通过支气管、鼻腔、口服和舌下应用），其中舌下是既定的黏膜应用途径，还有诸如淋巴内免疫疗法和皮内免疫疗法等新的应用方式。专家评论：诸如病毒样颗粒和CpG基序等免疫调节剂，以及诸如MPL和氢氧化铝等佐剂正在接受评估，并发现它们可增强免疫反应并使其朝着免疫耐受的方向发展。新形式的变应原提取物可提高AIT的安全性和有效性，并可能在未来改变我们进行变应原免疫疗法的方式。
