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Scientific Foundations of Allergen-Specific Immunotherapy for Allergic DiseaseAllergen-Specific Immunotherapy for Allergies

Michael B. Soyka, MD; Willem van de Veen, PhD; David Holzmann, MD; Mübeccel Akdis, MD, PhD; Cezmi A. Akdis, MD
Author and Funding Information

From the Swiss Institute of Allergy and Asthma Research Davos (Drs Soyka, van de Veen, M. Akdis, and C. A. Akdis), University of Zurich, Davos; Department of Otorhinolaryngology Head and Neck Surgery (Drs Soyka and Holzmann), University Hospital Zurich, Zurich; and Christine Kühne-Center for Allergy Research and Education (Dr C. A. Akdis), Davos, Switzerland.

CORRESPONDENCE TO: Cezmi A. Akdis, MD, Swiss Institute of Allergy and Asthma Research, Obere Str 22, 7270 Davos Platz, Switzerland; e-mail: akdisac@siaf.uzh.ch


FUNDING/SUPPORT: The authors’ laboratories are supported by Swiss National Foundation [Grant 320030_140772] and the Christine Kühne-Center for Allergy Research and Education, European Seventh Framework Programme projects MeDALL: Mechanisms of the Development of Allergy [261357] and PREDICTA: Post-Infectious Immune Reprogramming and Its Association with Persistence and Chronicity of Respiratory Allergic Diseases [260895].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1347-1357. doi:10.1378/chest.14-0049
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Allergen-specific immunotherapy (AIT) was described as a therapeutic option for the treatment of allergies > 100 years ago. It is based on administration of allergen extracts and leads to the development of clinical allergen tolerance in selected patients. According to current knowledge, AIT results in the restoration of immune tolerance toward the allergen of interest. It is mainly accompanied by the induction of regulatory and suppressive subsets of T and B cells, the production of IgG4 isotype allergen-specific blocking antibodies, and decreased inflammatory responses to allergens by effector cells in inflamed tissues. Currently, AIT is mainly applied subcutaneously or sublingually and is suitable for both children and adults for pollen, pet dander, house dust mite, and venom allergies. It not only affects rhinoconjunctival symptoms but also has documented short- and long-term benefits in asthma treatment. Clinically, a fast onset of tolerance is achieved during desensitization, with a tolerable amount of side effects. The disease modification effect leads to decreased disease severity, less drug usage, prevention of future allergen sensitizations, and a long-term curative effect. Increasing safety while maintaining or even augmenting efficiency is the main goal of research for novel vaccine development and improvement of treatment schemes in AIT. This article reviews the principles of allergen-specific immune tolerance development and the effects of AIT in the clinical context.

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