Allergen immunotherapy for allergic diseases

Prof Ariyanto Harsono MD PhD SpA(K)

Prof Ariyanto Harsono MD, PhD, SpA(K)

First developed at St Mary Hospital

London at the end of 19th century.

Basic Principle: Noon and Freeman

Cornerstone in the management of asthma and allergic rhinitis

Tree polen

Bee sting

Dermatophagoides pterisynus

Dermatophagoides farinai

9The main allergen is the feces of mite

10Transepithelial

deliveryof allergen

Indirect proteolysisof TJ protein

Direct proteolysisof TJ protein

Der p1/Der f1 Der p1/Der f1 Der p1/Der f1

allergen

2004: 3:234-237

Allergy AllergyGrow out

AllergenExposure

Allergen IT

TLR 1,2,6,7,8,11

Respon imun melawan infeksi faktor-faktor yang mempengaruhi respon

Subset Dendritic Cell

Subset DC1

Nat Rev Immunol, 2003,3:984-93Prof Ariyanto Harsono MD PhD

SpA(K)

Respon imun melawan infeksi faktor-faktor yang mempengaruhi respon

Subset Dendritic Cell

Subset DC2

TLR 1,4,7,9,10

Nat Rev Immunol, 2003,3:984-93Prof Ariyanto Harsono MD PhD

SpA(K)

152004: 3:234-237

Allergen exposureAllergen IT

Pre Immunotherapy Post Immunotherapy

J Allergy Clin Immunol 2004 • Volume 113 • Number 6 :1234-1237

17Prof Ariyanto Harsono MD PhD

SpA(K)

Allergen exposure

IL-4, IL-5

Th-2 CellIL-13

B Cell

Allergen IT

Th-1 CellIL-12 IFN-IL-2

B Cell

Pre Immunotherapy Post Immunotherapy

: Pre Immunotherapy

Post Immunotherapy

Pre Immunotherapy

Post Immunotherapy

Other study…

Durham 1998, reported reduce of IL-4 and IL-5; increase of IFN- and IL-2 as well as reduce of IgE and increase IgG resulted in the diminish late phase reaction

(JACI 1998;102:157-64)

242004: 3:234-237

2004: 3:234-237Prof Ariyanto Harsono MD PhD

SpA(K)

Th-2 Th-2

Th-1 Th-1

Atopic PatientAllergen IT treated

Atopic Patient

(Guerra. JACI 2001;107:647-53)

(Akdis, J Clin Invest 1998;102:98-106)

Allergen extract:-Whole body extract -Pure venom extract

10% residual risk

•Effective in Seasonal allergic rhinitis

•Less effective in perennial allergic rhinitis

•Mark improvement in tolerance of cat exposure

•Common indication in North America and Europe•Meta analysis 1954-1998: beneficial effect•DBPC: 60-75% reduce of symptom score in patients with grass pollen allergy•Economic analysis: less cost than pharmaco- therapy

ControlSub-cutan ITSub-lingual IT

PEFR Variability Pre

PEFR Variability Pos

Study from Surabaya

(Harsono. Fol Med Indones 2003;39:223-7)

IL-5IL-4

Immunotherapy

IgE IgG

Asthma symptom(Rev FEV-1)

Cortikosteroid

IFN- IL-2

Group A

Group B

Group C

Study from Surabaya

(Harsono, Dissertation 2004)Prof Ariyanto Harsono MD PhD

SpA(K)

Group A Group B Group C

Reduced of IL-5 correlate with significant increased of IL-2

Analysis of discriminant

The improvement of FEV-1 reversibility is a cumulative result of 4 factors

• decreased IL-4, enhances inhibition of IgE production.• decreased IL-5, enhances inhibition of eosinophil

maturation in the stem cell, chemo taxis, and prolonged life span.

• increased IFN- enhances isotype switching of immunoglobuline production in favor of IgG subclass instead of IgE.

• increased IL-2 enhances the affinity maturation and differentiation of B cells giving rise to the generation of B memory cells and antibody secreting plasma cells producing IgG.

Conclusion

Immunotherapy in asthmatic children results in elevation of IFN- and IL-2, diminish IL-4 and IL-5.

Addition of inhaled corticosteroid to immunotherapy results in marked attenuation of IL-5 correlates with greater elevation of IL-2 and play an important role in the modulation of immune response resulting in the improvement of FEV-1 reversibility.

•Reduce development of Rhinitis to asthma•Reduce developing new sensitization•Prevent allergic children from going on to develop asthma•Rhinitis symptom seem to show more sustain relief

UK 1957-1986: 26 fatal cases 17 for asthma5-35% systemic reactions for asthma

Contra indications:•Auto-immune disease•Malignancy•Cardiac disease•Patients receiving beta blocker

1. The primary mechanism of action is a shift in the balance of Th-1 and Th-2 cytokine expression in the allergen-challenged site.

2. Allergen IT is highly form of treatment of IgE mediated diseases.

3. Highly effective for allergic rhinitis and hypersensitivity to wasp and bee venom.

4. Consideration for primary use in asthma is still controversial in regards the potential development of adverse event.

Allergen immunotherapy for allergic diseases

Education

EAACI Guideline on Allergen immunotherapy: Prevention … · 1 EAACI Guideline on Allergen immunotherapy: Prevention of allergy ... 7 use of AIT for prevention of allergic sensitization,

Allergen Immunotherapy Extract Preparation...Allergen immunotherapy is usually well tolerated; however, adverse reactions do occur, ranging in severity from mild to severe. Allergen

Allergen Immunotherapy Guidelines - EAACI.org · Allergen Immunotherapy Guidelines Part 1: Systematic reviews Editors Antonella Muraro Graham Roberts Editorial Board Ioana Agache

ALLERGIC RHINITIS: ALLERGEN-SPECIFIC IMMUNOTHERAPY – OPPORTUNITY ANALYSIS … · reference code gdhc023poa | publication date september 2014 allergic rhinitis: allergen-specific

Allergen Immunotherapy and · PDF fileAllergen Immunotherapy and Asthma Overview: burden/prevalence of asthma and allergic disease Allergen immunotherapy and asthma: is it effective?

Clinical process for properly prescribe allergen immunotherapy

EAACI Guideline on Allergen Immunotherapy - allergic asthma · EAACI Guideline on Allergen Immunotherapy - allergic asthma ... control, asthma exacerbations ... inconvenience and

University of Groningen Allergen immunotherapy for allergic ... · Eﬃcacy of sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: a systematic review and

DR Gill allergen immunotherapy apr 2nd, 2014

Allergen Immunotherapy Guidelines - Centrora Security · 2017-10-11 · Allergen Immunotherapy Guidelines Part 2: Recommendations Editors Antonella Muraro Graham Roberts Editorial

Allergen immunotherapy: a practice parameter · the development of practice guidelines for allergen immuno-therapy. The document “Allergen immunotherapy: a practice parameter”

Original Article Efficacy of Allergen Immunotherapy for ... · Allergen immunotherapy (AIT) is the only treatment modality that can change the natural course of allergic disease.7,10

Quality of Allergen Products for Specific Immunotherapy

CBER/FDA update: allergen immunotherapy...immunotherapy for the treatment of grass pollen-induced allergic rhinitis with or without conjunctivitis confirmed by positive skin test or

Allergen immunotherapy: A practice parameter third - TAAIS

Clinical Developments in Allergen Immunotherapy

ACAAI’s Allergen Immunotherapy - College Learning ... · ACAAI Allergenic Extract Preparation - Physician Instruction Guide Revised: January 2017 . 1 . ACAAI’s Allergen Immunotherapy

Guidelines for practice of Allergen Immunotherapy in Indiancraai.org/immunotherapy-guidelines-for-india.pdf · 2013-04-23 · Guidelines for practice of Allergen Immunotherapy in

LDA Low Dose Allergen Immunotherapy - Dr. Shrader · LDA Low Dose Allergen Immunotherapy Patient Instruction Booklet How to regain your health through optimal immunotherapy For patients

Immunotherapy and allergic rhinitis