RESUMEN
Allergen immunotherapy has its roots in the immunologic treatment of contagious disease. The idea, beginning in the 18th century, that one could be protected against certain illnesses was successfully extended to the field of allergy in 1911. This review presents highlights of the advances by some of the individuals who have contributed to the science of allergen immunotherapy.
Asunto(s)
Desensibilización Inmunológica , Hipersensibilidad , Alérgenos , Humanos , Hipersensibilidad/terapiaAsunto(s)
Alergia e Inmunología , Asma , Hipersensibilidad , Escolaridad , Humanos , Estados Unidos/epidemiologíaRESUMEN
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
Asunto(s)
Rinitis/diagnóstico , Rinitis/terapia , Terapia Combinada , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Humanos , Fenotipo , Guías de Práctica Clínica como Asunto , Prevalencia , Pronóstico , Calidad de Vida , Rinitis/epidemiología , Rinitis/etiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Evaluación de Síntomas , Resultado del TratamientoAsunto(s)
Obstrucción Nasal/terapia , Guías de Práctica Clínica como Asunto , Rinitis Alérgica Estacional/terapia , Sesgo , Medicina Basada en la Evidencia , Humanos , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/epidemiología , Garantía de la Calidad de Atención de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Rinitis Alérgica Estacional/diagnóstico , Rinitis Alérgica Estacional/epidemiología , Riesgo , Estados Unidos/epidemiologíaAsunto(s)
Alérgenos/inmunología , Asma/terapia , Desensibilización Inmunológica/métodos , Hipersensibilidad a los Alimentos/terapia , Animales , Asma/inmunología , Niño , Exposición a Riesgos Ambientales/efectos adversos , Medicina Basada en la Evidencia , Femenino , Hipersensibilidad a los Alimentos/inmunología , Humanos , Inmunidad Innata , Guías de Práctica Clínica como Asunto , Medicina de Precisión , Embarazo , Efectos Tardíos de la Exposición PrenatalAsunto(s)
Alérgenos/clasificación , Mezclas Complejas/clasificación , Desensibilización Inmunológica , United States Food and Drug Administration , Alérgenos/uso terapéutico , Mezclas Complejas/uso terapéutico , Humanos , Hipersensibilidad/diagnóstico , Hipersensibilidad/terapia , Sociedades Médicas , Estados UnidosRESUMEN
Immunotherapy was a prominent part of the program at the Annual Meeting of the American College of Allergy, Asthma and Immunology in Boston, MA, USA, 3-8 November 2011. New advances in immunotherapy as well as mechanisms were featured. Recent updates of the immunotherapy practice parameters were discussed as well. The report on the safety of immunotherapy highlighted the data demonstrating that there have been no fatalities from this treatment during the past 4 years. The last speaker dealt with economic issues, presenting data that show that subcutaneous immunotherapy led to improved clinical outcomes and reduced costs in children and adults with allergic rhinitis.
Asunto(s)
Alérgenos/inmunología , Asma/inmunología , Asma/terapia , Desensibilización Inmunológica/tendencias , Hipersensibilidad/inmunología , Hipersensibilidad/terapia , Proteínas Recombinantes de Fusión/inmunología , Adyuvantes Inmunológicos/uso terapéutico , Animales , Asma/economía , Asma/epidemiología , Boston , Protocolos Clínicos , Análisis Costo-Beneficio , Humanos , Hipersensibilidad/economía , Hipersensibilidad/epidemiología , Evaluación de Resultado en la Atención de Salud/tendencias , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVE: The goal was to assess the effectiveness of specific immunotherapy (SIT) in reduction of symptoms and medication score in patients with immunoglobulin E (IgE) mediated extrinsic form of atopic dermatitis (AD); and to assess the effectiveness of oral immunotherapy (OIT) as "active" treatment to achieving tolerance for food(s) in patients with IgE mediated food allergy. DATA SOURCES: Computerized bibliographic searches of MEDLINE (1998-2010) were supplemented by hand searches of reference lists. Studies were included if they were double-blind randomized controlled trials comparing subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT) or OIT with placebo. However uncontrolled studies and case reports were also included. STUDY SELECTIONS: Thirty-two studies were analyzed. Because of the high heterogeneity of the AD studied only results of 2 placebo controlled studies 1-SCIT and 1-SLIT respectively were comparable. Among OIT studies: 4 carried out with control groups were analyzed. RESULTS: From 36% to 92% of patients treated with OIT reached tolerance to cow's milk or egg; a rate of 8% to 53% reached partial tolerance. The patients had either clinical history of severe systemic reactions to foods: anaphylaxis, or mild to moderate reactions. Regarding SIT for AD: 72% of patients treated with house dust mite SCIT and 54% treated with SLIT had a significant improvement of SCORAD-Index. CONCLUSIONS: This review found that OIT with cow's milk or egg is effective in achieving full tolerance or partial tolerance in the majority of patients with IgE mediated food allergy. SIT may represent an additional therapeutic tool for the treatment of extrinsic AD in properly selected patients.
Asunto(s)
Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/inmunología , Desensibilización Inmunológica , Hipersensibilidad a los Alimentos/tratamiento farmacológico , Hipersensibilidad a los Alimentos/inmunología , Alérgenos/administración & dosificación , Alérgenos/efectos adversos , Alérgenos/inmunología , Animales , Bovinos , Dermatitis Atópica/fisiopatología , Vías de Administración de Medicamentos , Proteínas del Huevo/administración & dosificación , Proteínas del Huevo/efectos adversos , Proteínas del Huevo/inmunología , Hipersensibilidad a los Alimentos/fisiopatología , Humanos , Tolerancia Inmunológica , Inmunoglobulina E/inmunología , Proteínas de la Leche/administración & dosificación , Proteínas de la Leche/efectos adversos , Proteínas de la Leche/inmunología , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
Alergia e Inmunología , Desensibilización Inmunológica/tendencias , Hipersensibilidad/tratamiento farmacológico , Hipersensibilidad/inmunología , Rol del Médico , Desensibilización Inmunológica/normas , Vías de Administración de Medicamentos , Humanos , Hipersensibilidad/diagnóstico , Hipersensibilidad/epidemiología , Guías de Práctica Clínica como Asunto , Estados UnidosAsunto(s)
Comités Consultivos , Anafilaxia/inducido químicamente , Anafilaxia/epidemiología , Anticuerpos Antiidiotipos/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Anticuerpos Monoclonales Humanizados , Asma/tratamiento farmacológico , Humanos , OmalizumabAsunto(s)
Hipersensibilidad a los Alimentos/terapia , Inmunoterapia/métodos , Rinitis Alérgica Estacional/terapia , Dermatitis Atópica/inmunología , Dermatitis Atópica/terapia , Hipersensibilidad a los Alimentos/inmunología , Humanos , Inmunoterapia/tendencias , Rinitis Alérgica Estacional/inmunología , Estados UnidosAsunto(s)
Desensibilización Inmunológica , Alérgenos/inmunología , Asma/terapia , Dermatitis Atópica/terapia , Desensibilización Inmunológica/efectos adversos , Desensibilización Inmunológica/métodos , Hipersensibilidad a los Alimentos/terapia , Humanos , Mordeduras y Picaduras de Insectos/terapia , Selección de Paciente , Guías de Práctica Clínica como Asunto , Rinitis Alérgica Estacional/terapiaRESUMEN
OBJECTIVE: To review major milestones in the development of subcutaneous allergen immunotherapy in 20-year segments. DATA SOURCES: Review of the literature available in textbooks and journals. STUDY SELECTION: Articles and books addressing major achievements in the development of subcutaneous allergy immunotherapy were selected for inclusion in this review. RESULTS: Immunotherapy administration has improved the lives of possibly millions of patients with hay fever. Asthmatic symptoms have been relieved if not ablated in millions as well. Insect venom hypersensitivity became treatable and highly effective. In the beginning years of immunotherapy, it was clear that immunotherapy worked; in the later years, the mechanisms for this efficacy were discovered. In this case, the therapy preceded its validation. Methods, materials, and safety have vastly improved. Postulated mechanisms explain much but not everything. CONCLUSIONS: There is still research to be accomplished, improvements to be made, and, of course, patients to be made well.
Asunto(s)
Alérgenos/uso terapéutico , Venenos de Artrópodos/efectos adversos , Desensibilización Inmunológica , Mordeduras y Picaduras de Insectos/tratamiento farmacológico , Hipersensibilidad Respiratoria/tratamiento farmacológico , Alérgenos/inmunología , Animales , Venenos de Artrópodos/administración & dosificación , Venenos de Artrópodos/inmunología , Desensibilización Inmunológica/tendencias , Humanos , Inyecciones Subcutáneas , Mordeduras y Picaduras de Insectos/inmunología , Insectos , Guías de Práctica Clínica como Asunto , Hipersensibilidad Respiratoria/inmunologíaAsunto(s)
Alérgenos/uso terapéutico , Hipersensibilidad/tratamiento farmacológico , Hipersensibilidad/inmunología , Inmunoterapia/tendencias , Proteínas Recombinantes de Fusión/uso terapéutico , Adyuvantes Inmunológicos/uso terapéutico , Alérgenos/genética , Alérgenos/metabolismo , Animales , Protocolos Clínicos , Ensayos Clínicos como Asunto , Humanos , Tolerancia Inmunológica , Inmunoterapia/métodos , Proteínas Recombinantes de Fusión/genética , Proteínas Recombinantes de Fusión/metabolismoRESUMEN
PURPOSE OF REVIEW: The treatment of insect allergy by desensitization still continues to present with some unanswered questions. This review will focus mainly on articles that have dealt with these issues in the past 2 years. RECENT FINDINGS: With the publication in 2007 of Allergen Immunotherapy: a practice parameter second update, many of the key issues were reviewed and summarized. Other recent studies deal with omalizumab pretreatment of patients with systemic mastocytosis and very severe allergic reactions to immunotherapy. It would appear that venom immunotherapy is somewhat unique compared to inhalant allergen immunotherapy in that premedication prior to rush protocols may not be necessary and that intervals of therapy may be longer than with allergen immunotherapy. The use of concomitant medications such as beta-blockers may be indicated in special situations. Angiotensin-converting enzyme inhibitors can be stopped temporarily before venom injections to prevent reactions. The issue of when to discontinue immunotherapy remains unsettled and should be individualized to patient requirements. SUMMARY: The newest revision of the Immunotherapy Parameters provides much needed information concerning successful treatment with immunotherapy of Hymenoptera-sensitive patients.
Asunto(s)
Alérgenos/efectos adversos , Venenos de Artrópodos/uso terapéutico , Desensibilización Inmunológica , Himenópteros , Hipersensibilidad Inmediata/terapia , Mordeduras y Picaduras de Insectos/inmunología , Alérgenos/inmunología , Alérgenos/uso terapéutico , Animales , Anticuerpos Antiidiotipos , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Venenos de Artrópodos/efectos adversos , Venenos de Artrópodos/inmunología , Contraindicaciones , Desensibilización Inmunológica/efectos adversos , Desensibilización Inmunológica/normas , Esquema de Medicación , Sinergismo Farmacológico , Humanos , Hipersensibilidad Inmediata/inducido químicamente , Hipersensibilidad Inmediata/inmunología , Inyecciones Subcutáneas , Proteínas de Insectos/efectos adversos , Proteínas de Insectos/inmunología , Mastocitosis Sistémica/tratamiento farmacológico , Omalizumab , Privación de TratamientoRESUMEN
Patients presenting with chronic coughs are seen frequently by allergists/immunologists. When the usual diagnostic and therapeutic maneuvers do not control symptoms, it is worthwhile to consider whether a non-tuberculous mycobacterial (NTM) infection might be playing a role in the pathogenesis of the coughing. Sputum culture should be considered along with a pulmonary computerized axial tomography scan. NTM infection should be added to the differential diagnosis list for patients with chronic coughs unresponsive to conventional therapy.
Asunto(s)
Tos/etiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/fisiopatología , Complejo Mycobacterium avium , Micobacterias no Tuberculosas , Rinitis Alérgica Perenne/fisiopatología , Anciano , Enfermedad Crónica , Tos/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Inmunoglobulinas/sangre , Infecciones por Mycobacterium no Tuberculosas/sangre , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/microbiología , Paraproteinemias/complicaciones , Paraproteinemias/microbiología , Rinitis Alérgica Perenne/sangre , Rinitis Alérgica Perenne/complicaciones , Esputo/microbiología , Tomografía Computarizada por Rayos X , Insuficiencia del TratamientoRESUMEN
The American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma and Immunology Executive Committees formed the Omalizumab Joint Task Force with the purpose of reviewing the Genentech Xolair (omalizumab) clinical trials and postmarketing surveillance data on anaphylaxis and anaphylactoid reactions. Using the definition of anaphylaxis proposed at a 2005 multidisciplinary symposia, the Omalizumab Joint Task Force concluded that 35 patients had 41 episodes of anaphylaxis associated with Xolair (omalizumab) administration between June 1, 2003, and December 31, 2005. With 39,510 patients receiving Xolair (omalizumab) during the same period of time, this would correspond to an anaphylaxis-reporting rate of 0.09% of patients. Of those 36 events for which the time of reaction was known, 22 (61%) reactions occurred in the first 2 hours after one of the first 3 doses. Five (14%) of the events after the fourth or later doses occurred within 30 minutes. Considering the timing of these 36 events, an observation period of 2 hours for the first 3 injections and 30 minutes for subsequent injections would have captured 75% of the anaphylactic reactions. The OJTF report provides recommendations for physicians who prescribe Xolair (omalizumab) on (1) the suggested wait periods after administration and (2) patient education regarding anaphylaxis.
Asunto(s)
Academias e Institutos , Comités Consultivos , Alergia e Inmunología , Anafilaxia/inmunología , Antialérgicos/efectos adversos , Antiasmáticos/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Asma/terapia , Academias e Institutos/normas , Comités Consultivos/normas , Alergia e Inmunología/normas , Anafilaxia/prevención & control , Anticuerpos Antiidiotipos , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Asma/complicaciones , Asma/inmunología , Humanos , Omalizumab , Estados UnidosRESUMEN
In this article the present and future of immunotherapy is discussed under four general headings: (1) present understanding of mechanisms of immunotherapy, (2) present status of clinical efficacy of immunotherapy, (3) changes/challenges of immunotherapy on the horizon, and (4) future of immunotherapy. The mechanisms of immunotherapy are well delineated and show that immunotherapy alters the natural course of allergic disease. There is a reduction in inflammation, nonspecific hyperresponsiveness, prevention of new sensitivities, and progression of allergic rhinitis to asthma. Further efficacy continues after cessation of immunotherapy. Complete asthma control does not occur with pharmacotherapy. There is a need to recognize that adding treatment for asthma's allergic component with immunotherapy may be the solution to achieving the unmet goals of asthma therapy. There are new developments and challenges to the role of immunotherapy on the horizon but, at present, subcutaneous immunotherapy is the specific allergen treatment of choice in the United States.
Asunto(s)
Alérgenos/administración & dosificación , Desensibilización Inmunológica/métodos , Hipersensibilidad Respiratoria/terapia , Administración Sublingual , Alérgenos/inmunología , Animales , Asma/terapia , Desensibilización Inmunológica/tendencias , Humanos , Inmunoglobulina E/inmunología , Hipersensibilidad Respiratoria/inmunología , Rinitis Alérgica Perenne/terapia , Rinitis Alérgica Estacional/terapia , Resultado del TratamientoRESUMEN
Although immunotherapy has documented short- and long-term benefits with regard to treatment of allergies and asthma as well as reducing development of new allergies and preventing progression of allergic rhinitis to asthma, the age to begin subcutaneous allergen immunotherapy appears established at the age of 5 years by published guidelines for treatment. The rationale for this age limit was examined and found to not reflect actual immunotherapy practice. Reasons for considering a downward revision are explored in this article. The conclusions from this review of past data and some recent studies with young children, especially with asthma, suggest that there is a need to consider beginning allergen immunotherapy earlier than the age of 5 years in more children.