Subcutaneous Versus Sublingual Immunotherapy for Allergic Rhinitis and/or Asthma

Nerin Nadir Bahceciler; Nazan Cobanoglu

Disclosures

Immunotherapy. 2011;3(6):747-756. 

In This Article

T-cell Responses

Successful SCIT in patients with grass pollen[86] and with mite[73] allergy has been shown to be accompanied by increased production of IL-10 in allergen-stimulated peripheral T-cell cultures. In one study, this was accompanied by suppression of allergen-induced T-cell proliferation, possibly mediated by CD4+CD25+ T cells and inhibited by strategies that blocked IL-10 or TGF-β.[73] In addition, SCIT has been associated with alterations in peripheral T-cell responses, with immune deviation in favor of Th1 responses.[87] However, changes in T-cell responses to allergen have not been universally observed in cells derived from peripheral blood.[88,89]

Studies demonstrating that SLIT is able to induce Tregs in clinical practice are emerging in recent years. Nevertheless, a preliminary study demonstrated that compared with untreated controls, SLIT increased IL-10 production in peripheral blood mononuclear cells from patients with HDM allergy following in vitro stimulation with Dermatophagoides antigens, as well as recall antigens such as Candida albicans or phytohemaglutinin.[69] In another study in childhood asthma with HDM allergy, 6 and 12 months of SLIT downregulated specific IgE response, while slightly increasing specific IgA.[72]

A 12-month DBPC study of HDM-SLIT was performed demonstrating decreased CD4+ T-cell proliferation and IL-5 production along with increased IL-10 secretion and specific IgG4 in the active group. Treg (CD4+CD25+CD127lo/Foxp3+) function was demonstrated by suppression of allergen-specific effector T-cell proliferation and cytokine production. This was the first study demonstrating TGF-β-mediated immunological suppression of SLIT.[90]

Local changes in the nasal mucosa have been measured after SCIT. These include skewing of cytokine profiles in favor of Th1 responses[91,92] and the local induction of Tregs with increases in IL-10[82] and TGF-β.[84] Using triple immunofluorescence microscopy, increases in CD3+CD25+Foxp3+ phenotypic Tregs have been demonstrated in the nasal mucosa after successful grass pollen immunotherapy, with further increases after immunotherapy detected during natural allergen exposure during the pollen season.[93]

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....