OTHER NAMES

• Immunotherapy,
• hyposensitization.

DEFINITION

The immunotherapy with allergens in the allergic illnesses consists of administering gradually increasing quantities of an extract alergénico to a patient to improve the symptomatology caused by the exhibition later to the causative allergen.

JUSTIFICATION

In the last years, diverse organizations and international scientific societies as for example the group of work in immunotherapy of Immunotherapy of the EAACI (Europaean Academy of Allergology and Clinical Immunology) and the committee of Immunotherapy of the ESPACI (Europaean Society of Pediatric Allergology and Clinical Immunology) have done formless different publics on immunotherapy. Recently the WHO has published a regulation on immunotherapy fruit of the meeting experts' in immunotherapy celebrated in Geneva in 1997.

These recommendations have been necessary since as it was possible to have demonstrated in several countries and specifically in Spain, the use or rather the desuetude of the immunotherapy has determined between other things a major cost of the treatment of the asthma.

On the other hand the scientific source is with the presence of numerous scientific works on the beneficial effect of the subcutaneous immunotherapy with specific allergens in the treatment of those of the respiratory allergic illnesses produced for aeroalergenos and come up by IgE. The problem of the Immunotherapy has been a motive of controversy and discussion since it begun being used by Noon and Friedman in 1911. His results have not been accepted easily since the methodology and the evaluation of the studies have been very heterogeneous.

The document on Immunotherapy, recently published by the WHO he emphasizes that the controlled studies have confirmed the efficacy of the Immunotherapy in the allergic rinitis and conjunctivitis induced by pollen and in general it is effective when there are valued the bronchial symptoms and the need for the medication. The immunotherapy with mites reduces the symptoms and/or the need for medication especially in children, although in any studies the results are not so conclusive, but that in the patients monosensitized to Dermatophagoides pteronyssinus the children present an improvement significantly major than the adults.

The importance of this international regulation takes root in that it is endorsed by the world Organization of the Health WHO and by important organizations and international scientific Societies related to the respiratory allergic illnesses which members use the immunotherapy as vaccines alergénicas.

FORMS OF ADMINISTRATION

Along with the traditional form of subcutaneous Immunotherapy, there are developing other routes of application of extracts for the treatment of the allergic illnesses: The nasal, bronchial, oral immunotherapy and sublingual have been carefully be evaluated by them by the group of work in "local immunotherapy" concluding that the bronchial and oral Immunotherapy, they are not recommended for the clinical practice, except like part of controlled studies and as for the nasal Immunotherapy and sublingual it seems that more studies are precise to be recommended of general form in children like alternative to the subcutaneous Immunotherapy. This topic has been treated previously.

In the consensus of experts endorsed by the WHO the vaccines are considered to be useful alergénicas in pathologies related to mechanisms dependent IgE, for it it is necessary to demonstrate the existence of the illness, his cause by means of cutaneous tests or measurement of specific IgE, and the relation between both processes illness - allergy.

The target that chases with the immunotherapy debit of being a double:

• Global. The immunotherapy is part of the treatment of the allergy as factor etiológico, but it is necessary to complement with a suitable environmental control and with the suitable preventive and symptomatic treatment.
• Dynamic. All the measurements of environmental control and of preventive and symptomatic treatments must be exact to the need in every moment of the process, and in many cases they can be suspended.

Another topic that is tackled in this regulation is the existence of the allergy like systemic illness, that is to say that it affects to other organs simultaneously and in the same patient there will coexist the conjunctivitis, the rinitis and the asthma in major or minor measurement, for it the vision of the asthma as an aspect of a systemic illness will help to understand better the indications of the Immunotherapy.

TO SEE ALSO

• Side effects of the vaccine of the allergy
• Efficacy of the vaccine of the allergy
• Indications of the vaccine of the allergy
• Consult the Specialist

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Source: WHO Position Paper. Allergen immunotherapy: therapeutic vaccines for allergic diseases. J Busquet, R Lockey, H J Malling. Allergy 1998; 53: 1-43