Rajakulendran Mohana, Tham Elizabeth Huiwen, Soh Jian Yi, Van Bever H P
Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore 119229.
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119229.
Asia Pac Allergy. 2018 Apr 9;8(2):e14. doi: 10.5415/apallergy.2018.8.e14. eCollection 2018 Apr.
Conventional immunotherapy (IT) for optimal control of respiratory and food allergies has been fraught with concerns of efficacy, safety, and tolerability. The development of adjuvants to conventional IT has potentially increased the effectiveness and safety of allergen IT, which may translate into improved clinical outcomes and sustained unresponsiveness even after cessation of therapy. Novel strategies incorporating the successful use of adjuvants such as allergoids, immunostimulatory DNA sequences, monoclonal antibodies, carriers, recombinant proteins, and probiotics have now been described in clinical and murine studies. Future approaches may include fungal compounds, parasitic molecules, vitamin D, and traditional Chinese herbs. More robust comparative clinical trials are needed to evaluate the safety, clinical efficacy, and cost effectiveness of various adjuvants in order to determine ideal candidates in disease-specific and allergen-specific models. Other suggested approaches to further optimize outcomes of IT include early introduction of IT during an optimal window period. Alternative routes of administration of IT to optimize delivery and yet minimize potential side effects require further evaluation for safety and efficacy before they can be recommended.
用于最佳控制呼吸道和食物过敏的传统免疫疗法一直存在疗效、安全性和耐受性方面的问题。传统免疫疗法佐剂的开发可能提高了变应原免疫疗法的有效性和安全性，这可能转化为更好的临床结果，甚至在治疗停止后仍能保持持续无反应状态。临床和小鼠研究现已描述了成功使用佐剂（如变应原疫苗、免疫刺激DNA序列、单克隆抗体、载体、重组蛋白和益生菌）的新策略。未来的方法可能包括真菌化合物、寄生虫分子、维生素D和传统中药。需要更有力的比较临床试验来评估各种佐剂的安全性、临床疗效和成本效益，以便在疾病特异性和变应原特异性模型中确定理想的候选佐剂。其他为进一步优化免疫疗法结果而建议的方法包括在最佳窗口期尽早引入免疫疗法。免疫疗法的替代给药途径以优化递送并同时尽量减少潜在副作用，在被推荐之前需要进一步评估其安全性和有效性。
