5/6/2023 0 Comments Rf online skin palmas set![]() The need for up to 50–80 subcutaneous injections over 3–5 years and the associated risk of systemic allergic side-effects ( 7) limit broad patient acceptance of subcutaneous allergen-specific immunotherapy (SCIT) ( 8, 9). At first very minute doses were given…’ ( 5).Ĭonventional SIT still consists of subcutaneous administration of gradually increasing doses of allergen ( 7). These changes are accompanied by the suppression of mast cells, eosinophils and basophils ( 4, 6).ĭespite the paradigm change regarding the aetiological understanding of allergy – moving from a pollen-toxin-induced disease ( 5) to a IgE-mediated disease caused by an inappropriate Th2-biased immune response towards innocuous environmental antigens – the clinical practice of SIT has not substantially changed since its first application by Noon and Freeman: ‘Patients received subcutaneous injections of pollen extract. Additionally, successful treatment is associated with the increased production of allergen-specific antibodies, especially IgG4 and to lesser extent IgA. SIT favours the production of Th1 cytokines such as interferon-γ over Th2 cytokines and induces the secretion of IL-10 and transforming growth factor-β by functional regulatory T (Treg) cells. Nowadays, SIT is perceived as a treatment restoring normal immunity against allergens through redirection of inappropriate T-helper (Th) 2 responses ( 4, 6). Nevertheless, the original perception of SIT being a treatment conferring active immunity against pollen toxin ( 5) has changed. Introduced a century ago by Leonard Noon and John Freeman in 1911 ( 5), the immunological mechanisms leading to symptom amelioration are still a matter of debate. However, the only disease-modifying treatment is SIT ( 3, 4). Symptomatic treatment including antihistamines, corticosteroids and inhaled β2-adrenoreceptor agonists can efficiently ameliorate IgE-mediated symptoms ( 3). Reaching a prevalence of up to 30% in industrialized countries, IgE-mediated allergies have become ‘the new epidemics of advanced civilization’. The prevalence of allergic diseases, first described by John Bostock at the beginning of the 19th century as ‘ catarrhus aestivus’ ( 1), has been continuously increasing ( 2). transcutaneous allergen-specific immunotherapy.sublingual allergen-specific immunotherapy.subcutaneous allergen-specific immunotherapy.intralymphatic allergen-specific immunotherapy.epicutaneous allergen-specific immunotherapy.The present review will discuss the immunological rational, history and actual clinical experience with epicutaneous allergen-specific immunotherapy. The epidermis, a nonvascularized multilayer epithelium, that contains high numbers of potent antigen-presenting Langerhans cells (LC) could therefore be an interesting administration route. Secondly, it should be nonvascularized in order to minimize inadvertent systemic distribution of the allergen and therefore systemic allergic side-effects. First, it should contain a high number of potent antigen-presenting cells to enhance efficacy and shorten treatment duration. In order to resolve these two major drawbacks, the ideal application site of SIT should have two characteristics. Allergen-specific immunotherapy (SIT) either subcutaneously or via the sublingual route is effective, but only few patients (<5%) choose immunotherapy, as treatment takes several years and because allergen administrations are associated with local and, in some cases, even systemic allergic side-effects because of allergen accidentally reaching the circulation. IgE-mediated allergies, such as allergic rhinoconjunctivitis and asthma, have become highly prevalent, today affecting up to 30% of the population in industrialized countries. Epicutaneous allergen administration: is this the future of allergen-specific immunotherapy? Allergy 2011 66: 798–809. To cite this article: Senti G, von Moos S, Kündig TM.
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