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Long-term clinical and immunological effects of allergen immunotherapy

Eifan, Aarif O.; Shamji, Mohamed H.; Durham, Stephen R.

Current Opinion in Allergy & Clinical Immunology: December 2011 - Volume 11 - Issue 6 - p 586–593
doi: 10.1097/ACI.0b013e32834cb994
Immunotherapy and new treatments: Edited by Giovanni Passalacqua and Robert Bush

Purpose of review: The present review updates current findings on long-term clinical and immunological outcomes after cessation of allergen immunotherapy for allergic respiratory disease.

Recent findings: Recent studies have shown that allergen immunotherapy has sustained disease-modifying effects that persist for years after discontinuation. This is in contrast to the effects of antiallergic drugs that do not induce tolerance to offending allergens. Long-term effects of immunotherapy include a reduction in nasal symptoms, a decrease in the use of rescue medication and improvement in quality of life. These benefits are accompanied by immunological changes such as the induction of allergen-specific IgG antibodies with inhibitory activity for IgE-facilitated binding of allergen–IgE complexes to B cells. One study reported a reduction in the development of asthma in children with seasonal pollen-induced rhinitis.

Summary: Allergen immunotherapy induces clinical and immunological tolerance as defined by persistence of clinical benefit and associated long-term immunological parameters after discontinuation of treatment. These findings are largely confined to studies of subcutaneous and sublingual immunotherapy for seasonal pollinosis. Further studies are needed to address potential long-term clinical effects for other seasonal and perennial inhaled allergens in both children and adults, and to identify potential biomarkers of tolerance.

Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK

Correspondence to Aarif O. Eifan, MD, Allergy and Clinical Immunology Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Dovehouse Street, London, SW3 6LY, UK E-mail: a.eifan@imperial.ac.uk

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.