Advances in upper airway diseases and allergen immunotherapy in 2007

The purpose of this review is to highlight important articles on upper airway diseases and immunotherapy that appeared in 2007. Advances in rhinitis include the realization that allergic rhinitis might be caused by local nasal IgE sensitization to aeroallergens in the absence of systemic evidence of IgE sensitization. After inhalation, allergens might reach systemic circulation. Epidemiologic studies continue to show that allergic rhinitis impairs school performance and is a risk factor for future asthma. New pathways are being identified in chronic sinusitis, as well as in different types of allergic ocular diseases. New treatments for patients with allergic rhinitis include use of beta-1,3-glucan, a mushroom product that can reduce allergic symptoms by inducing T(H)1 response, and olopatadine nasal spray. Studies on immunotherapy in 2007 suggest that sublingual immunotherapy induces similar immunologic alterations as those induced by subcutaneous immunotherapy, although to a lesser degree. Among allergists in the United States, there is a sizable variation in clinical practice, particularly related to concomitant administration of immunotherapy and beta-blockers, to administration of angiotensin-converting enzyme inhibitors, and to patients with HIV or autoimmune diseases. The combination of omalizumab with allergen subcutaneous immunotherapy can enhance clinical efficacy. Recombinant technology can modify allergen structure to prevent binding to IgE (allergenicity) while enhancing immunogenicity (stimulation of T cells), which might improve the safety and efficacy of immunotherapy.