immunotherapy - INVESTIGATIONS & PROCEDURES IN...

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INVESTIGATIONS & PROCEDURES IN PULMONOLOGY Immunotherapy in Asthma Dr. Zia Hashim
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Definition Involves • Administration of gradually increasing quantities of specific allergens to patients with IgE-mediated conditions till a dose is reached which is effective in reducing disease severity from natural exposure
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Objectives • To reduce responses to allergic triggers that precipitate symptoms in the short term • Decrease inflammatory response • Prevent development of persistent disease in long term
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IT in Other diseases Efficacy demonstrated in • Stinging-insect hypersensitivity • Allergic rhinitis or conjunctivitis • Allergic asthma. Not effective • Atopic dermatitis • Urticaria • Potentially dangerous if used for food or antibiotic allergies
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Indications in asthma • Demonstration that disease is due to IgE mediated allergy • Insufficient response to environmental control or pharmacotherapy • Environmental control not feasible • Significant side effects of pharmacotherapy • Poor compliance to therapy •FEV 1 > 70% after adequate pharmacological treatment • Both nasal and bronchial symptoms
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Relative Contraindications • Severe asthma uncontrolled by pharmacotherapy and/or irreversible obstruction (FEV 1 < 70% after adequate pharmacological treatment) • Treatment with β -blockers even when administered topically • Significant cardiovascular disease • Serious immunodeficiency diseases • Malignancy • Psychological illness • Pregnancy: should not be started
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Role of Immunotherapy • Allergen avoidance & IT have the potential to modify the natural course of disease • Prevents sensitization to new allergens in monosensitized patients • Prevents progression of rhinoconjunctivitis to asthma • Effects of IT for grass, tree or ragweed pollen allergy last several years after discontinuation • If relapse occurs the immunologic memory persists & there may be good response to new IT regimen
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Mechanism of immunotherapy • Allergen Th 2 stimulation IgE • Later exposure immediate mediator release eosinophilic & basophilic inflammation • IT Allergens T regulatory cells (CD 4 + CD 25 + ) IL-10 Th 1 Th 2 IFN- γ 
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Blocking Antibody Natural allergen exposure after IT IgG4 instead of IgE blocks Ag Immediate mediators late phase Less mast cells altered TH1/TH2 ratio
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Preparation of Allergen Vaccines Allergenic extract: preparation of allergen from extraction of active component of animal/vegetable substances Allergenic product: biologic product including allergenic extract administered to pts for diagnosis or treatment • Standardization is based on detection of IgE Ab to allergen
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Recombinant Antigens • Newer method is by production of human recombinant proteins • Cloning of cross-reactive major allergenic
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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immunotherapy - INVESTIGATIONS &amp; PROCEDURES IN...

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