antigen desensitization; allergen immunotherapy
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Indications
- symptoms that occur after natural exposure to the allergen
- demonstrable IgE antibodies against the antigen
- antigen is not easily avoided
- trial of medical therapy has failed
- anaphylactic reaction to hymenoptera venom
Contraindications
- avoid on days where patient has symptoms of asthma
- use of beta-blockers relatively contraindicated
- beta-blocker reduce effectiveness of epinephrine in treatment of anaphylaxis[4]
Adverse effects
- anaphylaxis
- rare, but be prepared[4]
Principle
- prevents anaphylaxis by favoring formation of univalent haptens
- univalent haptens can bind IgE on surface of mast cells but do NOT cause cross-linking & degranulation
- similar in principle to homeotherapy
Clinical significance
Effects of immunotherapy on allergic reactions:
- production of IgG antibodies against allergen
- reduction in IgE response after allergen exposure
- increased allergen-specific IgG & IgA in respiratory secretions
- reduced release of mediators by allergen-challenged basophils (derived from peripheral blood)
- changes in cytokine production by T-helper lymphocytes
- induction of anergy in allergen-responsive T-helper lymphocytes
- certain fragments of allergens down-regulated T-helper activity but do not stimulate release of mediators by mast cells
- may evenually form new approach to allergen immunotherapy
Procedure
- subcutaneous & oral protocols
- subcutaneous protocols should be performed by experienced personelle in an intensive care unit (ICU) setting
- monitor for at least 30 minutes after injection[4]
- sublingual protocol FDA-approved for grass pollen[5][6]
- avoid premedication with antihistamines & glucocorticoids
- drug desensitization for sulfonamides may be performed on an outpatient basis
Notes
Specific agents:
- NSAIDs
- desensitization to aspirin produces cross-desensitization to all NSAIDs
- sensitization persists for 2-7 days after each dose
- interruption of NSAIDs for > 48 hours requires repeat desensitization
- pollens, grass[2][3]
More general terms
More specific terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 2.0 2.1 Lin SY et al Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma. A Systematic Review. JAMA. 2013;309(12):1278-1288. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23532243 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1672214
Nelson HS Is Sublingual Immunotherapy Ready for Use in the United States? JAMA. 2013;309(12):1297-1298. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23532248 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1672220 - ↑ 3.0 3.1 Didier A et al. Sustained 3-year efficacy of pre- and coseasonal 5-grass- sublingual immunotherapy tablets in patients with grass pollen-induced rhinoconjunctivitis. J Allergy Clin Immunol 2011 Sep; 128:559. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21802126
- ↑ 4.0 4.1 4.2 4.3 Epstein TG et al. AAAAI/ACAAI surveillance study of subcutaneous immunotherapy, years 2008-2012: An update on fatal and nonfatal systemic allergic reactions. J Allergy Clin Immunol Pract 2014 Mar/Apr; 2:161 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24607043
- ↑ 5.0 5.1 Creticos PS et al. Randomized, double-blind, placebo-controlled trial of standardized ragweed sublingual-liquid immunotherapy for allergic rhinoconjunctivitis. J Allergy Clin Immunol 2014 Mar; 133:751 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24332263 <Internet> http://www.jacionline.org/article/S0091-6749%2813%2901702-8/abstract
- ↑ 6.0 6.1 FDA News Release: April 2, 2014 FDA approves first sublingual allergen extract for the treatment of certain grass pollen allergies. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm391458.htm