Specific Immunotherapy in Allergic Rhinitis

Abstract

Specific immunotherapy (SIT) was introduced in 1911 for the treatment of pollinosis by Noon and Freeman [1]. Immunotherapy is still controversial since many protocols have been devised empirically, some allergens are still poorly defined, the mechanisms of action are not yet clear, the duration is poorly characterized and the therapeutic index of SIT has been contested for many years. In the 1970s, SIT was found to be ineffective, especially in asthma [2]. In the 1980s, it was found that SIT was effective under optimal conditions including a demonstrated immunoglobulin (Ig)E-mediated disease, a high-quality extract, an optimal allergen dose and a correct indication [3], but its safety was questioned as systemic reactions that may exceptionally become life-threatening were noticed [4–7]. It is possible that the use of potent extracts may have resulted in a greater number of systemic reactions and possibly of deaths, especially in asthmatics. Thus, the value of SIT was again contested and its use threatened with some decline for pneumoallergens. However, SIT is still one of the most common treatments in children and adolescents in many parts of the world. In this current decade, pharmacoeconomic considerations may also cause problems, since the costs for SIT may be greater than that of pharmacotherapy. However, SIT is the only treatment that can affect the natural course of the disease, and it may prevent the onset of asthma.