Year: 2006
Type: article
Abstract: Allergen immunotherapy (desensitisation) involves the repeated administration of allergen extracts to allergic individuals to induce a state of clinical and immunological tolerance. Traditionally, this has involved repeated subcutaneous injections of incremental doses of allergen over a period of 8‐16 weeks followed by monthly ‘maintenance’ injections for 3‐5 years. Modified approaches have included shorter and preseasonal regimens and alternative routes of administration, particularly the sublingual route. Immunotherapy is indicated in patients with immunoglobulin (Ig) E-dependent disease and is particularly effective in patients with insect venom anaphylaxis and in those with severe seasonal allergic rhinitis unresponsive to anti-allergic drugs. The risk/benefit should be assessed in every case. In view of the remote risk of systemic side effects, immunotherapy should be prescribed and given only by trained and experienced individuals with access to resuscitative measures. 1 Efficacy Immunotherapy is effective in seasonal allergic rhinitis due to grass, tree and weed pollens. Most hayfever sufferers respond to treatment with intranasal steroids and/or antihistamines (Fig 1). However, a primary care-based study in Southern England found that 40% of treated hayfever sufferers remain inadequately controlled, 2 a proportion of whom would benefit from immunotherapy. In a recent UK multicentre trial of immunotherapy in 410 participants with documented uncontrolled hayfever and IgE sensitivity to grass pollen there was a dose-dependent reduction in symptoms and rescue medication compared with placebo during the pollen season and a sustained improvement in quality of life. 3 Although direct comparative studies with pharmacological treatments are needed, the mean reduction in symptoms of about 30% over placebo compares favourably with documented effect sizes of nasal corticosteroids (18%), antihistamines (7%) and leukotriene modifiers (5%) compared with
Source: Clinical Medicine
Author: Stephen R Durham
Institutions: Royal Brompton Hospital, Imperial College London
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,500
OpenAlex ID: W2320775992