Immunotherapy

The present article summarizes the 2008-2009 literature on allergen standardization and immunotherapy for inhalant and food sensitivities, with emphasis on delineation of the underlying immunologic changes and on evidence-based conclusions from such and clinical data.

The efficacy of subcutaneous immunotherapy for inhalant allergies has been established but that for sublingual therapy only in the mono-sensitized with pollen or house dust mite sensitivities. Immunotherapy for food sensitivities is promising but adverse reactions and a dearth of robust trials with control groups preclude routine use in clinical practice. Lack of standardization of many allergens used in immunotherapy for inhalants, and all for food sensitivities, remains a major impediment to comparing data among studies, but progress is being made toward construction of the major allergens of common inhalant agents via recombinant techniques.

Immunotherapy for inhalant sensitivities by the subcutaneous route is clinically effective, albeit with the need for standardization of many common antigens and further elucidation of the basic immunologic changes involved. Further investigation of many aspects of sublingual immunotherapy seems warranted before such therapy can be regarded as equivalent to the subcutaneous route. Oral (subcutaneous or ingestion) desensitization for food allergy is currently best confined to carefully controlled trials.