Durham S R
Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, UK.
Eur Arch Otorhinolaryngol. 1995;252 Suppl 1:S64-7. doi: 10.1007/BF02484438.
Allergen-specific immunotherapy retains a place in treatment in patients with allergic rhinitis who fail to respond to conventional treatment with antihistamines and topical corticosteroids. Studies on mechanisms of immunotherapy have previously focussed on changes in serum antibodies, including blunting of seasonal rises in specific IgE and increase in "blocking" specific IgG antibodies. Immunotherapy in patients with rhinitis has also been shown to inhibit effector cells with a decrease in nasal mucosal eosinophils and epithelial mast cells. Recent evidence suggests that these events may be orchestrated by an effect of immunotherapy on T lymphocytes with alteration from a predominant "Th2" response (interleukin 4 and 5) in favour of an additional "Th1" response (gamma interferon) which may decrease tissue eosinophilia and local IgE production. Novel therapeutic approaches to allergic diseases might include use of topical gamma interferon, immunosuppressive agents, anti-CD4 antibodies or strategies directed specifically against IL-4 or IL-5.
对于使用抗组胺药和局部用皮质类固醇进行常规治疗无效的变应性鼻炎患者，变应原特异性免疫疗法在治疗中仍占有一席之地。此前，免疫疗法的作用机制研究主要集中在血清抗体的变化上，包括特定IgE季节性升高的减弱以及“阻断”性特异性IgG抗体的增加。鼻炎患者的免疫疗法还显示可抑制效应细胞，使鼻黏膜嗜酸性粒细胞和上皮肥大细胞减少。最近的证据表明，这些情况可能是由免疫疗法对T淋巴细胞的作用精心安排的，导致从主要的“Th2”反应（白细胞介素4和5）转变为额外的“Th1”反应（γ干扰素），这可能会减少组织嗜酸性粒细胞增多和局部IgE的产生。变应性疾病的新型治疗方法可能包括使用局部γ干扰素、免疫抑制剂、抗CD4抗体或专门针对IL-4或IL-5的策略。
