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December 10, 1997, Vol 278, No. 22 >
ARTICLE | December 10, 1997

Immunotherapy With Allergens FREE

Richard W. Weber, MD
JAMA. 1997;278(22):1881-1887. doi:10.1001/jama.1997.03550220087012
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Article
References

Allergen immunotherapy has been shown to be efficacious in numerous studies for the clinical indications of allergic asthma and rhinitis, as well as hymenoptera venom hypersensitivity. How allergen immunotherapy improves clinical symptoms is still not entirely clear. Decreases in specific IgE follow a complex cascade of effects: a shifting of the cytokine milieu from TH2 to TH1 predominance, with resultant decrease in interleukin 4, decreased recruitment and activation of eosinophils, and decreased proliferation of mast cells. Allergen exposure has a lessened ability to stimulate an inflammatory cell response, with decreased target organ hyperreactivity. Since allergen immunotherapy is not without risk, the decision needs to be made whether injection therapy is safe and provides benefit not achievable by medical management. The continued clarification of optimal allergen concentrations through careful studies of standardized extracts will allow better control of adverse events by limiting unnecessarily potent mixtures.

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9 +
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10 +
Ohman JL, Findlay SR, Leitermann KM.  Immunotherapy in cat-induced asthma . J Allergy Clin Immunol . 1984;;74:230-239.
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Oppenheimer JJ, Nelson HA, Bock SA, Christensen F, Leung DYM.  Treatment of peanut allergy with rush immunotherapy . J Allergy Clin Immunol . 1992;;90:256-262.
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Loveless MH.  Immunologic studies in pollinosis, IV: the relationship between thermostable antibody in the circulation and clinical immunity . J Immunol . 1943;;47:165-180.
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Zeiss CR, Metzger WJ, Levitz D.  Quantitative relationships between IgE antibody and blocking antibodies specific for antigen E in patients given immunotherapy with ragweed antigen E . Clin Exp Immunol . 1977;;28:250-255.
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Gleich GJ, Zimmerman EM, Henderson LL, Yunginger JW.  Effect of immunotherapy on immunoglobulin E and immunoglobulin G antibodies to ragweed antigens: a six-year prospective study . J Allergy Clin Immunol . 1982;;70:261-271.
35 +
Creticos PS, Van Metre TE, Mardiney MR, Rosenberg GL, Norman PS, Adkinson NF Jr.  Dose response of IgE and IgG antibodies during ragweed immunotherapy . J Allergy Clin Immunol . 1984;;73:94-104.
36 +
Djurup R, Osterballe O.  IgG subclass antibody response in grass pollen-allergic patients undergoing specific immunotherapy . Allergy . 1984;;39:433-441.
37 +
Rocklin RE, Sheffer AL, Greineder DK, Melmon KL.  Generation of antigen-specific suppressor cells during allergy desensitization . N Engl J Med . 1980;;302:1213-1219.
38 +
Tamir R, Castracane JM, Rocklin RE.  Generation of suppressor cells in atopic patients during immunotherapy that modulate IgE synthesis . J Allergy Clin Immunol . 1987;;79:591-598.
39 +
Hsieh K-H.  Altered interleukin-2 (IL-2) production and responsiveness after hyposensitization to house dust . J Allergy Clin Immunol . 1985;;76:188-194.
40 +
Hsieh K-H.  Decreased production of interleukin-2 receptors after immunotherapy to house dust . J Clin Immunol . 1988;;8:171-177.
41 +
Bonno M, Fujisawa T, Iguchi K, et al.  Mite-specific induction of interleukin-2 receptor on T lymphocytes from children with mite-sensitive asthma: modified immune response with immunotherapy . J Allergy Clin Immunol . 1996;;97:680-688.
42 +
Hsieh K-H, Ng C-K.  Increased plasma plateletactivating factor in children with acute asthmatic attacks and decreased in vivo and in vitro production of platelet-activating factor after immunotherapy . J Allergy Clin Immunol . 1993;;91:650-657.
43 +
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84 +
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86 +
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87 +
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88 +
Trede NS, Urbanek R.  Combination of parenteral and oral immunotherapy in grass pollen-allergic children . Allergy . 1989;;44:272-280.
89 +
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90 +
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91 +
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Noon. L.  Prophylactic inoculation against hayfever . Lancet . 1911;;1:1572-1573.
2 +
Freeman J.  Further observations on the treatment of hay fever by hypodermic inoculations of pollen vaccine . Lancet . 1911;;2:814-817.
3 +
Lowell FC, Franklin W.  A double-blind study of the effectiveness and specificity of injection therapy in ragweed hay fever . N Engl J Med . 1965;;273:675-679.
4 +
Frankland AW, Augustin R.  Prophylaxis of summer hay-fever and asthma . Lancet . 1954;;1:1055-1057.
5 +
Franklin W, Lowell FC.  Comparison of two dosages of ragweed extract in the treatment of pollinosis . JAMA . 1967;;201:915-917.
6 +
Pence HL, Mitchell DQ, Greely RL, Udegraff BR, Selfridge HA.  Immunotherapy for mountain cedar pollinosis: a double-blind controlled study . J Allergy Clin Immunol . 1976;;58:39-50.
7 +
Aas K.  Hyposensitization in house dust allergy asthma: a double-blind controlled study with evaluation of the effect on bronchial sensitivity to house dust . Acta Paediatr Scand . 1971;;60:264-268.
8 +
Warner JO, Price JF, Soothill JF, Hey EN.  Controlled trial of hyposensitization to Dermatophagoides pteronyssinus in children with asthma . Lancet . 1978;;2:912-915.
9 +
Bousquet J, Calvayrac P, Guérin B, et al.  Immunotherapy with a standardized Dermatophagoides pteronyssinus extract, I: in vivo and in vitro parameters after a short course of treatment . J Allergy Clin Immunol . 1985;;76:734-744.
10 +
Ohman JL, Findlay SR, Leitermann KM.  Immunotherapy in cat-induced asthma . J Allergy Clin Immunol . 1984;;74:230-239.
11 +
Van Metre TE Jr, Marsh DG, Adkinson NF Jr, et al.  Immunotherapy for cat asthma . J Allergy Clin Immunol . 1988;;82:1055-1068.
12 +
Hedlin G, Graff-Lonnevig V, Heilborn H, et al.  Immunotherapy with cat- and dog-dander extracts, V: effects of 3 years of treatment . J Allergy Clin Immunol . 1991;;87:955-964.
13 +
Østerballe O.  Immunotherapy with grass pollen major allergens . Allergy . 1982;;37:379-388.
14 +
Frostad AB, Grimmer Ø, Sandvik L, Moxnes A, Aas K.  Clinical effects of hyposensitization using a purified allergen preparation from timothy pollen as compared to crude aqueous extracts from timothy pollen and a four-grass mixture respectively . Clin Allergy . 1983;;13:337-357.
15 +
Creticos PS, Marsh DG, Proud D, et al.  Responses to ragweed-pollen nasal challenge before and after immunotherapy . J Allergy Clin Immunol . 1989;;84:197-205.
16 +
Passalacqua G, Albano M, Ruffoni S, et al.  Nasal immunotherapy to Parietaria . Am JRespir Crit Care Med . 1995;;152:461-466.
17 +
Malling H-J, Dreborg S, Weeke B.  Diagnosis and immunotherapy of mould allergy, V: clinical efficacy and side effects of immunotherapy with Cladosporium herbarum . Allergy . 1986;;41:507-519.
18 +
Horst M, Hejjaoui A, Horst V, Michel F-B, Bousquet J.  Double-blind, placebo-controlled rush immunotherapy with a standardized Alternaria extract . J Allergy Clin Immunol . 1990;;85:460-472.
19 +
Van Bever HP, Stevens WJ.  Suppression of the late asthmatic reaction by hyposensitization in asthmatic children allergic to house dust mite (Dermatophagoides pteronyssinus) . Clin Exp Allergy . 1989;;19:399-404.
20 +
Crimi E, Voltolini S, Troise C, et al.  Local immunotherapy with Dermatophagoides extract in asthma . J Allergy Clin Immunol . 1991;;87:721-728.
21 +
Rogers BL, Bond JF, Craig SJ, et al.  Potential therapeutic recombinant proteins comprised of peptides containing recombined T cell epitopes . Mol Immunol . 1994;;31:955-966.
22 +
Hunt KJ, Valentine MD, Sobotka AK, et al.  A controlled trial of immunotherapy in insect hypersensitivity . N Engl J Med . 1978;;299:157-161.
23 +
Strom GB, Boswell RN, Jacobs RL.  In vivo and in vitro comparison of fire ant venom and fire ant whole body extract . J Allergy Clin Immunol . 1983;;72:46-53.
24 +
Abramson MJ, Puy RM, Weiner JM.  Is allergen immunotherapy effective in asthma? Am J Respir Crit Care Med . 1995;;151:969-974.
25 +
Creticos PS, Reed CE, Norman PS, et al.  Ragweed immunotherapy in adult asthma . N Engl J Med . 1996;;334:501-506.
26 +
Barnes PJ.  Is immunotherapy for asthma worth-while? N Engl J Med . 1996;;334:531-532.
27 +
Adkinson NF Jr, Eggleston PA, Eney D, et al.  A controlled trial of immunotherapy for asthma in allergic children . N Engl J Med . 1997;;336:324-331.
28 +
Graft DF, Schuberth KC, Kagey-Sobotka A, et al.  A prospective study of the natural history of large local reactions after Hymenoptera stings in children . J Pediatr . 1984;;104:664-668.
29 +
Graft DF.  When to start, when to stop, and what to measure in venom immunotherapy: issues in allergy grand seminar, AAAI annual meeting 1990 . J Allergy Clin Immunol . 1991;;88:409-413.
30 +
Oppenheimer JJ, Nelson HA, Bock SA, Christensen F, Leung DYM.  Treatment of peanut allergy with rush immunotherapy . J Allergy Clin Immunol . 1992;;90:256-262.
31 +
Loveless MH.  Immunologic studies in pollinosis, IV: the relationship between thermostable antibody in the circulation and clinical immunity . J Immunol . 1943;;47:165-180.
32 +
Alexander HL, Johnson MC, Bukantz SC.  Studies on correlation between symptoms of ragweed hay-fever and titer of thermostable antibody . J Allergy . 1948;;19:1-8.
33 +
Zeiss CR, Metzger WJ, Levitz D.  Quantitative relationships between IgE antibody and blocking antibodies specific for antigen E in patients given immunotherapy with ragweed antigen E . Clin Exp Immunol . 1977;;28:250-255.
34 +
Gleich GJ, Zimmerman EM, Henderson LL, Yunginger JW.  Effect of immunotherapy on immunoglobulin E and immunoglobulin G antibodies to ragweed antigens: a six-year prospective study . J Allergy Clin Immunol . 1982;;70:261-271.
35 +
Creticos PS, Van Metre TE, Mardiney MR, Rosenberg GL, Norman PS, Adkinson NF Jr.  Dose response of IgE and IgG antibodies during ragweed immunotherapy . J Allergy Clin Immunol . 1984;;73:94-104.
36 +
Djurup R, Osterballe O.  IgG subclass antibody response in grass pollen-allergic patients undergoing specific immunotherapy . Allergy . 1984;;39:433-441.
37 +
Rocklin RE, Sheffer AL, Greineder DK, Melmon KL.  Generation of antigen-specific suppressor cells during allergy desensitization . N Engl J Med . 1980;;302:1213-1219.
38 +
Tamir R, Castracane JM, Rocklin RE.  Generation of suppressor cells in atopic patients during immunotherapy that modulate IgE synthesis . J Allergy Clin Immunol . 1987;;79:591-598.
39 +
Hsieh K-H.  Altered interleukin-2 (IL-2) production and responsiveness after hyposensitization to house dust . J Allergy Clin Immunol . 1985;;76:188-194.
40 +
Hsieh K-H.  Decreased production of interleukin-2 receptors after immunotherapy to house dust . J Clin Immunol . 1988;;8:171-177.
41 +
Bonno M, Fujisawa T, Iguchi K, et al.  Mite-specific induction of interleukin-2 receptor on T lymphocytes from children with mite-sensitive asthma: modified immune response with immunotherapy . J Allergy Clin Immunol . 1996;;97:680-688.
42 +
Hsieh K-H, Ng C-K.  Increased plasma plateletactivating factor in children with acute asthmatic attacks and decreased in vivo and in vitro production of platelet-activating factor after immunotherapy . J Allergy Clin Immunol . 1993;;91:650-657.
43 +
Kuna P, Alam R, Kuzminska B, Roznieki J.  The effect of preseasonal immunotherapy on the production of histamine-releasing factor (HRF) by mononuclear cells from patients with seasonal asthma . J Allergy Clin Immunol . 1989;;83:816-824.
44 +
Jung CM, Prinz JC, Rieber EP, Ring J.  A reduction in allergen-induced Fc∈R2/CD23 expression on peripheral B cells correlates with successful hyposensitization in grass pollinosis . J Allergy Clin Immunol . 1995;;95:77-87.
45 +
Otsuka H, Mezawa A, Ohnishi M, Okubo K, Seki H, Okuda M.  Changes in nasal metachromatic cells during allergen immunotherapy . Clin Exp Allergy . 1991;;21:115-119.
46 +
Rak S, Björnson A, å L, Sörenson S, Venge V.  The effect of immunotherapy on eosinophil accumulation and production of eosinophil chemotactic activity in the lung of subjects with asthma during natural pollen exposure . J Allergy Clin Immunol . 1991;;88:878-888.
47 +
Iliopoulos O, Proud D, Adkinson NF Jr, et al.  Effects of immunotherapy on the early, late, and rechallenge nasal reaction to provocation with allergen . J Allergy Clin Immunol . 1991;;87:855-866.
48 +
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