Mechanisms of Allergen Immunotherapy in Allergic Rhinitis
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RHINITIS, CONJUNCTIVITIS, AND SINUSITIS (JJ OPPENHEIMER AND J CORREN, SECTION EDITORS)
Mechanisms of Allergen Immunotherapy in Allergic Rhinitis Gabija Drazdauskaitė 1 & Janice A. Layhadi 1 & Mohamed H. Shamji 1 Accepted: 24 October 2020 # The Author(s) 2020
Abstract Purpose of Review Allergic rhinitis (AR) is a chronic inflammatory immunoglobulin (Ig) E-mediated disease of the nasal mucosa that can be triggered by the inhalation of seasonal or perennial allergens. Typical symptoms include sneezing, rhinorrhea, nasal itching, nasal congestion and symptoms of allergic conjunctivitis. AR affects a quarter of the population in the United States of America and Europe. Recent Findings AR has been shown to reduce work productivity in 36–59% of the patients with 20% reporting deteriorated job attendance. Moreover, 42% of children with AR report reduced at-school productivity and lower grades. Most importantly, AR impacts the patient’s quality of life, due to sleep deprivation. However, a proportion of patients fails to respond to conventional medication and opts for the allergen immunotherapy (AIT), which currently is the only disease-modifying therapeutic option. AIT can be administered by either subcutaneous (SCIT) or sublingual (SLIT) route. Both routes of administration are safe, effective, and can lead to tolerance lasting years after treatment cessation. Both innate and adaptive immune responses that contribute to allergic inflammation are suppressed by AIT. Innate responses are ameliorated by reducing local mast cell, basophil, eosinophil, and circulating group 2 innate lymphoid cell frequencies which is accompanied by decreased basophil sensitivity. Induction of allergen-specific blocking antibodies, immunosuppressive cytokines, and regulatory T and B cell phenotypes are key pro-tolerogenic adaptive immune responses. Conclusion A comprehensive understanding of these mechanisms is necessary for optimal selection of AIT-responsive patients and monitoring treatment efficacy. Moreover, it could inspire novel and more efficient AIT approaches. Keywords Allergen immunotherapy . Allergic rhinitis . Innate and adaptive immune response . T cells . B cell . Innate lymphoid cells . Dendritic cells
Abbreviations AIT Allergen immunotherapy AR Allergic rhinitis Breg B regulatory cell CP Cedar pollen DAO Diamine oxidase
This article is part of the Topical Collection on Rhinitis, Conjunctivitis, and Sinusitis * Mohamed H. Shamji [email protected] 1
Immunomodulation and Tolerance Group, Allergy & Clinical Immunology, Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, 1st Floor, Room 111, Sir Alexander Fleming Building, South Kensington Campus, London SW7 2AZ, UK
DC DP EC ECP FOXP3+ GP HDM IgE-FAB ILC2 NAC PAR PBMC PNIF SAR SATB1 SCIT SLIT
Dendritic cell Dermatophagoides pteronyssinus (en. house dust mite) Epithelial cell Eosinophil cationic protein Forkhead box protein P3 Grass pollen House dust mite IgE-facilitated antigen binding Group 2 innate lymphoid cell Nasal allerge
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