L'immunoterapia specifica con allergeni inalanti

Allergen specific immunotherapy is the only treatment acting on the causes and not only on the symptoms of respiratory allergy, including rhinitis and asthma. Currently, this therapy can be performed by two routes of administration, that is, subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Both forms have sound demonstration of clinical efficacy, based on several meta-analyses, but SCIT is partially limited by the problem of safety, because, though rarely, severe systemic reactions may occur, while SLIT has a very satisfactory safety profile. The mechanim of action is similar in both forms, consisting in modifications, through allergen presentation by antigen presenting cells, of the T lymphocytes response and their cytokine pattern. In fact, from the Th2 prevalence typical of allergic inflammation the subjects treated with immunotherapy show a Th1 prevalence and an influence by T-regulatory cells. The future developments are likely to be based on new materials as well as on new routes of administration, such as the epicutaneous route and the intra-lymphonodal route, that in preliminary studies appeared promising.