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REVIEW ARTICLE
Year : 2012  |  Volume : 26  |  Issue : 2  |  Page : 50-60

Respiratory allergic diseases and therapeutic intervention using allergen-specific immunotherapy


Department of Pulmonary Medicine, V. P. Chest Institute, University of Delhi, Delhi, India

Correspondence Address:
Shailendra N Gaur
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi - 110 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6691.112548

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Bronchial asthma and allergic rhinitis are the most common respiratory allergic disease mediated through type-1 immune reaction. The imbalance of TH1 and TH2 cells is responsible for increased immunoglobulin E (IgE) level and release of immune mediators, producing symptoms in the particular genetically predetermined target organ. Pharmacotherapy is effective in controlling the symptoms of allergic diseases, but withdrawal of medication leads to reappearance of symptoms in a short span of time. The therapeutic modality, namely allergen-specific immunotherapy, corrects the TH1 and TH2 imbalance and thus effects the natural course of allergic disease prescribed in addition to the pharmacotherapy. Immunotherapy has also been found to prevent development of newer allergies and progression of rhinitis to asthma. The subcutaneous immunotherapy with perennial subcutaneous injections and stepwise procedure is the standard and established method. Here, the injections are started with a very high dilution of antigen and then slowly increased to the optimal maintenance dose. However, precautions should be taken to take care of the related side-effects, including anaphylaxis. Patient education and use of this therapy only by trained physicians is mandatory, and it should be practiced at a center having facilities for the management of anaphylaxis. There are various trials in the literature to support improvement by immunotherapy. In Indian studies, favourable results were noted in symptom score, skin sensitivity, airway reactivity (PC20), specific immunoglobulin (Ig) E, Ig G1 and Ig G4. Researches are aimed on a safer and more acceptable route of administration of the allergen. The sublingual route for immunotherapy has been used from 1986 and, till today, has been found to be equally effective and safe. Considering the difference in geo-environmental variation in India from the western world, an Indian guideline for practice of allergen immunotherapy was published in 2009, where consideration was given to the Indian environment, pattern of seasons, presence of different/newer allergens, affordability and feasibility of certain tests in the Indian context.


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