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Since it was introduced by Noon in 1911, allergen-specific immunotherapy or desensitization has been widely prescribed in the management of allergic diseases. Aimed at the etiology, it represents the only effective treatment for allergy. The basic mechanisms of immunotherapy are becoming better understood and allow us to improve this technique in the future. The sublingual immunotherapy as an alternative to subcutaneous route has been widely studied. Several clinical trials confirmed that sublingual immunotherapy is efficient in reducing allergic respiratory symptoms. The sublingual immunotherapy reduces the risk of developing serious side effects due to desensitization. We performed a literature review in order to remind the mechanisms of action and to demonstrate efficacy and tolerability of the sublingual immunotherapy in the treatment of allergic rhinoconjunctivitis and asthma and its impact on the quality of life.

Because the prevalence of allergic diseases has significantly increased in recent years, understanding the causes and mechanisms of these disorders is of high importance, and intense investigations are ongoing. Current knowledge pinpoints immune tolerance mechanisms as indispensable for healthy immune response to allergens in daily life. It is evident that development and maintenance of allergens-pecific T cell tolerance is of vital importance for a healthy immune response to allergens. Such tolerance can be gained spontaneously by dose-dependent exposures to allergens in nature or by allergen-specific immunotherapy. Allergen-specific immunotherapy induces regulatory T cells with the capacity to secrete interleukin-10 and transforming growth factor-β, limits activation of effector cells of allergic inflammation (such as mast cells and basophils), and switches antibody isotype from IgE to the noninflammatory type IgG4. Although allergen-specific immunotherapy is the only method of tolerance induction in allergic individuals, several factors, such as long duration of treatment, compliance problems, and life-threatening side effects, have limited widespread applicability of this immunomodulatory treatment. To overcome these limitations, current research focuses on the introduction of allergens in more efficient and safer ways. Defining the endotypes and phenotypes of allergic diseases might provide the ability to select ideal patients, and novel biomarkers might ensure new custom-tailored therapy modalities.

Allergy to hen’s (Gallus domesticus) egg white is one of the most common forms of food allergy. Allergy to hen’s yolk also exists however, to a lesser extent when compared to egg white allergy. Two minor allergens from the hen’s egg yolk known as α-livetin (Gal d 5) and YGP42 (Gal d 6) were discovered recently. In this study, we investigated whether sensitization to egg white is associated with reactivity to egg yolk as well. Sera obtained from 25 patients with allergy to egg white were tested for specific IgE binding for egg yolk proteins through western immunoblotting. 36% of patients were found with true IgE-sensitization against egg yolk proteins. It was found that most of the IgE reactive yolk proteins were fragments of major precursor proteins of hen; vitellogenin-1 (VTG-1), vitellogenin-2 (VTG-2) and apolipoprotein B (Apo B). The egg yolk allergen Gal d 6 is the C-terminal part of VTG-1 and was found to be allergenic in significant percentage of egg white allergy patients. These results highlight the significance of Gal d 6 as an important allergen of egg yolk. Therefore, the secondary aim of this study involved developing a recombinant version of YGP42 in an Escherichia coli expression system. Recombinant Gal d 6 (rGal d6) was expressed as a fusion peptide with a 6 × His tag and purified using metal chelating resin. The inhibition ELISA results showed that rYGP42 was IgE reactive and was able to inhibit IgE binding to crude egg yolk (CEY) by up to 30%. Traditionally, it was thought that allergy to egg yolk occurred independently from sensitization to egg white. This study underlies the importance of concomitant sensitization to egg yolk proteins in patients allergic to egg white. Evidence reported in this study strongly suggests that egg yolk has potentially undiscovered allergens and therefore warrants further investigation. Furthermore, IgE reactive Gal d 6 presented in this study has the potential to be used in diagnosis and immunotherapy to treat egg allergy. [ABSTRACT FROM AUTHOR]

There are many different treatment options for atopic dermatitis in the dog and cat. Unfortunately, many of the recommendations for therapy are based on anecdotal reports rather than on evidence-based decisions. This review considers the different treatment modalities that may be considered, together with the supporting scientific data for each of them. Therapies that are discussed include antihistamines, glucocorticoids, ciclosporine, Janus kinase inhibitors and allergen-specific immunotherapy. [ABSTRACT FROM AUTHOR]

Allergen specific immunotherapy (ASI) is a well-documented treatment for allergic asthma, rhinitis and allergy to bee venoms. Immunotherapy with subcutaneous injections of allergens extracts has proved beneficial in reducing symptoms of allergic rhinitis and asthma. Side effects due to specific immunotherapy in short term have been largely documented. These effects were various but were usually mild. Fatal reactions are less frequent. We reported a case of a woman, with a history of allergic asthma under specific desensitization protocol who developed an acute multi-organ failure (MOF) consecutive to administration of ASI (Alustal Stallergenes SA, France). This fatal reaction has never been described as adverse event of specific immunotherapy. We aimed to describe this dramatic reaction, expose the arguments to define the relationship between the administration of allergen extract and the occurrence of this fatal reaction.

Because the prevalence of allergic diseases has significantly increased in recent years, understandingthe causes and mechanisms of these disorders is of high importance, and intense investigations areongoing. Current knowledge pinpoints immune tolerance mechanisms as indispensable for healthyimmune response to allergens in daily life. It is evident that development and maintenance of allergenspecificT cell tolerance is of vital importance for a healthy immune response to allergens. Suchtolerance can be gained spontaneously by dose-dependent exposures to allergens in nature or byallergen-specific immunotherapy. Allergen-specific immunotherapy induces regulatory T cells withthe capacity to secrete interleukin-10 and transforming growth factor-ß, limits activation of effectorcells of allergic inflammation (such as mast cells and basophils), and switches antibody isotype fromIgE to the noninflammatory type IgG4. Although allergen-specific immunotherapy is the only methodof tolerance induction in allergic individuals, several factors, such as long duration of treatment,compliance problems, and life-threatening side effects, have limited widespread applicability ofthis immunomodulatory treatment. To overcome these limitations, current research focuses on theintroduction of allergens in more efficient and safer ways. Defining the endotypes and phenotypes ofallergic diseases might provide the ability to select ideal patients, and novel biomarkers might ensurenew custom-tailored therapy modalities. [ABSTRACT FROM AUTHOR]

Résumé Les réactions allergiques aux piqûres de moustiques se présentent sous forme de réactions locales ou loco-régionales et les réactions systémiques sont rares. En cas de réactions systémiques, il est important de rechercher une éventuelle mastocytose qui semble constituer un facteur de risque de ces réactions systémiques. Allergic reactions to mosquito bites are most often local or loco-regional reactions, whereas systemic reactions are rare. In cases of systemic reactions, it is important to look for a possible mastocytosis, which is known to be a risk factor for such systemic reactions. [ABSTRACT FROM AUTHOR]

House dust mite (HDM) allergens are perennial indoor allergens, which may play a role as allergic trigger factors in atopic dermatitis (AD). Facilitated by their high enzymatic activity, HDM allergens are capable of penetrating the impaired epidermal skin barrier in patients with AD, gaining access to immune cells. In this way, HDM allergens induce both allergic reactions of the immediate type and allergic reactions of the delayed type, which contribute to impairment of AD. Because allergen reduction achieved by encasing strategies does not always lead to significant improvement of clinical symptoms, specific immunotherapy (SIT) might represent an attractive therapeutic option for long-time treatment of this subgroup of patients with AD. However, systematic studies on the effectiveness of SIT in patients with AD are rare. Furthermore, data on the immunologic changes induced by SIT in patients with AD are not well studied. In this review, we provide an overview of the pathogenic impact of HDM allergens as an example for aeroallergens on the course of AD. In addition, we discuss prophylactic and therapeutic options for the treatment of HDM allergy in patients with AD, including a summary of the current data available on SIT as a potential therapeutic option for patients with AD. [Copyright &y& Elsevier]

Allergen-specific immunotherapy (SIT) is associated with increased levels of allergen-specific IgG in serum. However, it is not clear to what extent qualitative changes in the allergen binding capacity of IgG may be induced as well.The purpose of this study was to investigate the influences of SIT on antibody affinity.The binding affinity of purified serum IgG1, IgG4 and IgE to the major allergen in birch (Betula verrucosa) pollen, Bet v 1, was analysed by surface plasmon resonance. The antibodies were obtained from 10 birch pollen-allergic patients receiving SIT and from 10 patients with no SIT.The patients having received SIT have a significant higher titre of anti-Bet v 1 antibodies in their blood, but the affinity to Bet v 1 of allergen-specific IgE, IgG1 and IgG4 does not differ between the two groups. For IgG1 and IgG4, correlations between less allergic symptoms and affinity of the antibodies were observed both in the SIT group and to a smaller extent in the non-SIT group.SIT has no effect on antibody affinity of allergen-specific IgE, IgG1 or IgG4. Allergic patients with high-affinity IgG1 and IgG4 antibodies report less symptoms than patients with low-affinity antibodies. [ABSTRACT FROM AUTHOR]

Allergen specific immunotherapy (ASI) is a well-documented treatment for allergic asthma, rhinitis and allergy to bee venoms. Immunotherapy with subcutaneous injections of allergens extracts has proved beneficial in reducing symptoms of allergic rhinitis and asthma. Side effects due to specific immunotherapy in short term have been largely documented. These effects were various but were usually mild. Fatal reactions are less frequent. We reported a case of a woman, with a history of allergic asthma under specific desensitization protocol who developed an acute multiorgan failure (MOF) consecutive to administration of ASI (Alustal® Stallergenes SA, France). This fatal reaction has never been described as adverse event of specific immunotherapy. We aimed to describe this dramatic reaction, expose the arguments to define the relationship between the administration of allergen extract and the occurrence of this fatal reaction. [ABSTRACT FROM AUTHOR]

The role of environmental allergens in equine atopic dermatitis as the cause of pruritus in horses is becoming better appreciated. Atopic dermatitis presents as either seasonal or nonseasonal pruritus, sometimes complicated by concurrent insect-bite hypersensitivity and/or secondary superficial bacterial infection (most often staphylococcal in origin). Diagnosis is based on history and clinical presentation, as well as elimination of other causes of pruritus. Detection of presumed allergens may be performed using either intradermal or serologic testing. Treatment may be symptomatic using antipruritic drugs, and/or allergen-specific immunotherapy. The success rate of the latter currently approaches 70%. [Copyright &y& Elsevier]