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Allergic rhinitis is a widespread clinical problem, estimated to affect 20 to 40 percent of the population in the U.S. Inhalant allergens, such as plant pollens, characteristically cause seasonal rhinoconjunctivitis and/or asthma; whereas, cat dander, cockroaches, or dust mite allergens may induce symptoms year-round, and are associated with perennial rhinitis and/or asthma. The prevalence of asthma in the U.S. is approximately 9 percent, and approximately 62 percent of individuals with asthma show evidence of also having atopy (i.e., one or more positive-specific IgE levels). The medical management of patients with allergic rhinitis and asthma includes allergen avoidance, pharmacotherapy, and immunotherapy. Allergen-specific immunotherapy (SIT) is typically recommended for patients whose allergic rhinoconjunctivitis and asthma symptoms cannot be controlled by medication and environmental controls, for patients who cannot tolerate medications, or for patients who do not comply with chronic medication regimens. Currently, two forms of specific immunotherapy are used clinically in the U.S. The U.S. Food and Drug Administration (FDA) has approved the use of allergen extracts for subcutaneous administration (subcutaneous immunotherapy) for the treatment of seasonal and perennial allergic rhinitis and allergic asthma. In the U.S., a patient with allergies receives subcutaneous injections of an allergen-containing extract, comprised of the relevant allergens to which the patient is sensitive, in increasing doses, in an attempt to suppress or eliminate allergic symptomatology. Considerable interest has also evolved in using sublingual immunotherapy as an alternative to subcutaneous injection immunotherapy. Sublingual immunotherapy involves placement of the allergen under the tongue for local absorption to desensitize the allergic individual over a period of months to years and diminish allergic symptoms. In 1996, an Immunotherapy Task Force, assembled by the World Allergy Organization, cited the emerging clinical data on sublingual immunotherapy, recognized its potential as a viable alternative to subcutaneous therapy, and encouraged continued clinical investigation to characterize optimal techniques. Over the past two decades, sublingual forms of immunotherapy have gained favor in Europe; sublingual tablet immunotherapy has been approved by the European regulatory authorities. In the U.S., there are currently no FDA-approved sublingual forms of immunotherapy. In the absence of FDA-approved sublingual forms of immunotherapy, some researchers and physicians in the U.S. are exploring the off-label use of subcutaneous aqueous allergens for sublingual desensitization. An increasing number of U.S. physicians are employing this alternate desensitization approach in the treatment of allergic respiratory conditions based on European and U.S. studies, and on the European Medicines Agency's approval of certain oral products; however, due to differing standardization of potency in Europe and the United States, doses have been hard to translate between countries. The primary objective of this comparative effectiveness review is to evaluate the efficacy, effectiveness, and safety of SIT (including both subcutaneous and sublingual immunotherapy) that are presently available for use by clinicians and patients in the U.S. We addressed the following Key Questions (KQs): KQ1. What is the evidence for the efficacy and effectiveness of SIT in the treatment of allergic rhinoconjunctivitis and/or asthma? KQ2. What is the evidence for safety of SIT in patients with allergic rhinoconjunctivitis and/or asthma? KQ3. Is the safety and effectiveness of SIT different in distinct subpopulations with allergic rhinoconjunctivitis and/or asthma? Specifically: Children, Adults, Elderly, Pregnant women, Minorities, Inner-city and rural residents, Monosensitized individuals, Patients with severe asthma.
Get a quick, expert overview of the use of current and novel immunotherapies for use in the management and treatment of allergic reactions and diseases. This concise resource by Dr. Linda Cox covers the full range of allergic disease, including aeroallergens, asthma, food allergies, atopic dermatitis, and stinging insects. With essential coverage of allergen immunotherapies in addition to key topics on emerging allergen-associated immunomodulators, this succinct, comprehensive reference consolidates today's available information on this timely topic into a single convenient resource. - Discusses timely topics such as food tolerance, allergy, and allergen unresponsiveness; biologics for COPD and pediatric asthma; and adherence and pharmacoeconomics. - Summarizes practical guidelines and recommendations for use of immunotherapies in clinical practice. - Provides insight into the background and history of immunotherapies as a treatment for allergic disease. - Includes developments on the horizon, including alternative immunotherapy routes and modified allergens.
The incidence of allergies is increasing worldwide. Beside the well-established symptomatic treatments and subcutaneous immunotherapies, formerly known as de- or hyposensitization, a new form of treatment, local immunotherapy, has been developed in recent years. Local immunotherapy, though still controversially discussed, promises to be a curative, noninvasive, and easily applicable treatment for allergies. This volume summarizes the most current information on local immunotherapy compiled by internationally renowned specialists. In the methodology section, general aspects of local immunotherapy are presented including its history, allergen resorption and biodistribution, mechanisms of oral tolerance and practical experiences. The second section devoted to efficacy and safety presents findings from international placebo-controlled studies on nasal and sublingual immunotherapies with different allergens and for different allergic conditions including asthma and eczema. Possible side effects are also discussed. The concluding chapter critically evaluates the future prospects of this new method, pointing out still unresolved issues such as the exact immunological mechanisms, its long-term effects, or the standardization of dose and application intervals/duration. This state-of-the-art account will be of particular interest to scientists working in the field of allergy, clinical allergologists, pharmacists, and representatives from the pharmaceutical industry.
This fifth edition of the bestselling Allergens and Allergen Immunotherapy is now completely updated and revised to include subcutaneous, sublingual, and oral immunomodulator treatments of allergic disease.The redesigned book continues to provide comprehensive coverage of all types of allergens and allergen vaccines, giving clinicians the essential
This issue of Immunology and Allergy Clinics, guest edited by Drs. Linda S. Cox and Anna Nowak-Wegrzyn, is devoted to Immunotherapy for Aeroallergens, Foods, and Venoms. Articles in this issue include: Mechanism of Immunotherapy: Focus SCIT and SLIT; Subcutaneous Immunotherapy Safety: Incidence per surveys and risk factors; Sublingual Immunotherapy for Other Indications: Venom large local, latex, atopic dermatitis and food; Questions and Controversies regarding venom immunotherapy; Socioeconomics or Comparative Effectiveness of Immunotherapy; Risk Reduction in Peanut Immunotherapy; Food OIT with Adjuvants; Peanut OIT: State of the art; Evolution of Immune Responses in Food Immunotherapy; Safety of Food Oral Immunotherapy: What we know and what we need to learn; Novel Vaccines for Food Allergy; IgG and IgE in Food Allergy - What's the connection?; and Sublingual and Patch Immunotherapy for Food Allergy.
Enlarged to describe more than a decade of advances in the immunotherapy of allergic diseases and asthma, this Third Edition contains the most recent studies on the mechanisms, manufacture, and standardization of various allergen groups and their utilization in the treatment of allergic diseases-containing 8 new chapters detailing various pharmacoe
Seasonal allergic rhinitis (SAR), also known as hay fever, is an allergic reaction in the upper airways that occurs when sensitized individuals encounter airborne allergens (typically tree, grass, and weed pollens and some molds). Although pollen seasons vary across the United States, generally, tree pollens emerge in the spring, grass pollens in the summer, and weed pollens in the fall. Outdoor molds generally are prevalent in the summer and fall. SAR is distinguished from perennial allergic rhinitis (PAR), which is triggered by continuous exposure to house dust mites, animal dander, and other allergens generally found in an individual's indoor environment. Patients may have either SAR or PAR or both (i.e., PAR with seasonal exacerbations). The four defining symptoms of allergic rhinitis are nasal congestion, nasal discharge (rhinorrhea), sneezing, and/or nasal itch. Many patients also experience eye symptoms, such as itching, tearing, and redness. Additional signs of rhinitis include the “allergic salute” (rubbing the hand against the nose in response to itching and rhinorrhea), “allergic shiner” (bruised appearance of the skin under one or both eyes), and “allergic crease” (a wrinkle across the bridge of the nose caused by repeated allergic salute). SAR can adversely affect quality of life, sleep, cognition, emotional life, and work or school performance. Treatment improves symptoms and quality of life. Treatments for SAR include allergen avoidance, pharmacotherapy, and immunotherapy. Although allergen avoidance may be the preferred treatment, for SAR, total allergen avoidance may be an unrealistic approach, as it may require limiting time spent outdoors. Thus, pharmacotherapy is preferable to allergen avoidance for SAR symptom relief. Although there are multiple guidelines for the treatment of allergic rhinitis, the guidelines are not consistently based on systematic reviews of the literature and often do not address the treatment of SAR in children and pregnant women. Guidelines generally support the use of intranasal corticosteroids as first-line treatment of moderate/severe SAR. However, agreement is lacking about four other issues of importance to patients and clinicians: First-line treatment for mild SAR The comparative effectiveness and safety of SAR treatments used in combination with each other for both mild and moderate/severe SAR The comparative effectiveness of as-needed use compared with daily dosing The comparative effectiveness and harms of SAR treatments for eye symptoms and asthma symptoms that often co-occur with SAR This review addresses the four issues above. The scope of this review is comparisons across pharmacologic classes. Key Questions addressed include: KQ1. What is the comparative effectiveness of pharmacologic treatments, alone or in combination with each other, for adults and adolescents (12 years of age or older) with mild or with moderate/severe SAR? KQ2. What are the comparative adverse effects of pharmacologic treatments for SAR for adults and adolescents (12 years of age or older)? KQ3. For the subpopulation of pregnant women, what are the comparative effectiveness and comparative adverse effects of pharmacologic treatments, alone or in combination with each other, for mild and for moderate/severe SAR? KQ4. For the subpopulation of children (less than 12 years of age), what are the comparative effectiveness and comparative adverse effects of pharmacologic treatments, alone or in combination with each other, for mild and for moderate/severe SAR?
Allergy and Allergen Immunotherapy: New Mechanisms and Strategies is a valuable and comprehensive book that covers allergy and causative allergens and provides diagnostic and therapeutic aspects as well. With chapters from internationally recognized experts in the field, the book provides a balanced approach to enumerating pollen allergens as well as allergy diagnosis and therapeutic management and safety assessment of genetically engineered food allergens. The book features a special section on allergic diseases and allergens from tropical countries, including such countries such as India, Sri Lanka, Iran, and South Korea, giving the book a global appeal. The book is broken in the following sections: Epidemiology, Pathophysiology, and Diagnosis of Allergy Aerobiology and Allergic Diseases Pollen Allergy in the Tropics and Temperate Regions Allergy in Children Food Allergy Evaluation Allergen Immunotherapy and Anti IgE The book deals not only on basics of allergy and allergen immunotherapy but also discusses indoor environments and safety considerations of genetically modified food allergens. The first of its kind volume from the Indian subcontinent that caters to the needs of clinicians, aerobiologists, environmentalists, and regulatory agencies as well, the volume will be of immense interest for clinicians and patients of allergy as well as diagnostic and therapeutic management of allergy in tropics.
The sixth edition of Lockey and Ledford's Allergens and Allergen Immunotherapy continues to provide comprehensive coverage of all types of allergens and allergen vaccines, providing clinicians the essential information they need to accurately diagnose and manage all allergic conditions. With new and updated chapters, the sixth edition is the most up-to-date, single resource on allergy and immunotherapy. Key Features Completely revised and updated Detailed single source reference on allergy and immunotherapy Reorganized to provide clinicians with essential information to make diagnoses and offer the best treatments