過敏疾病的免疫治療

Immunotherapy for Allergic Diseases

免疫疾病可分為自體免疫疾病及過敏疾病，引起自體免疫疾病是因自體抗原不正常的暴露而造成，引起過敏疾病是外來過敏原過量的接觸而造成，只有過敏疾病可以用過敏原來免疫治療。過敏原造成之過敏發炎反應有很多臨床表徵和病理變化，可以依接觸的組織器官而分為鼻子過敏、支氣管過敏性氣喘、過敏性食道胃腸炎及異位性皮膚炎，也可依過敏原種類而分為食物過敏、藥物過敏、花粉過敏、塵蟎過敏等；由於過敏疾病是與過敏原的接觸有關，因此治療時還需要減少環境中之過敏原。通常過敏疾病使用藥物治療僅能緩解症狀，但對於病程改善仍然無法完全，唯有過敏免疫治療（AIT）才能改善對過敏原的耐受性。過敏原免疫治療在臨床上已超過百年，傳統上是以皮下注射為主。治療後可以改變過敏原引起之過敏反應，使病人的血清免疫及細胞免疫反應增強同時增加對過敏原耐受性並減少對新的過敏原過敏，不過過敏原注射會引起過敏反應，所以愈來愈少被使用。近年來免疫治療有許多發展及進步，例如：單株抗體dupilumab（第4介質受體抗體）已被美國FDA通過使用在異位性皮膚炎，抗IgE抗體也被使用在過敏原免疫治療之前期來預防過敏。皮下注射也逐漸被其它舌下、口服及鼻内給予之方式取代。這些新的免疫治療方式必定會成為未來主要的治療方式，但確定療效及濃度還需要再深入研究。由於過敏原可以藉由分子結構的破壞來避免過敏反應，也可以藉由佐劑來修飾增強免疫反應並抑制過敏反應，因此，過敏原的結構改變處理再將疫苗給予方式改為非注射方式，這樣過敏原疫苗的免疫治療將更容易被推廣使用。 Abstract: Immunological diseases can be divided into autoimmune diseases and allergic diseases. Autoimmune diseases are triggered by abnormal autoantigen expression and allergic diseases are triggered by the excessive environmental allergen exposure. Only allergic diseases can be treated by environmental allergen. Allergic disease can be classified by the organ of allergic inflammation after allergen exposure, ie allergic rhinitis, allergic bronchial asthma, allergic esophagitis0gastroenteritis, and atopic dermatitis. The diseases also can be classified by the exposed-allergen such as house dust mite, animal dander, pollen, food and drug allergy. The diagnosis of allergic disease is based on the allergen identification and the treatment is mainly by allergen avoidance. Since the effect of these anti-inflammatory agents can obtain only symptomatic relieve and cannot prevent the disease progression. Allergen-based immunotherapy (AIT) is the only one modality which can induce allergen tolerance and modulate the disease course and prevent disease progression. AIT has been used in practice for more than one century. The conventional AIT is given by subcutaneous injection with allergen. It can modify immediate allergic reaction induce humoral and cellular immunity to tolerate old allergen, and prevent new allergen sensitization. There are many problems of AIT not only because its safety but also its convenience. Currently allergen application has been modified through oral, sublingual, intranasal and epi-cutaneous. The allergen can also be modified by allergoid transformation and denaturation. The biologic agents dupilumab (specific monoclonal antibodies against IL4Rα(interleukin-4 receptor alpha)) had been approved for the treatment of atopic dermatitis. The other biologics, anti-IgE, can also be used to avoid allergen-induced reaction prior to AIT. Through the improvement of allergen application and modification of allergenicity, AIT can become a good alternative modality of allergy treatment in the near future.

Abstract: Immunological diseases can be divided into autoimmune diseases and allergic diseases. Autoimmune diseases are triggered by abnormal autoantigen expression and allergic diseases are triggered by the excessive environmental allergen exposure. Only allergic diseases can be treated by environmental allergen. Allergic disease can be classified by the organ of allergic inflammation after allergen exposure, ie allergic rhinitis, allergic bronchial asthma, allergic esophagitis0gastroenteritis, and atopic dermatitis. The diseases also can be classified by the exposed-allergen such as house dust mite, animal dander, pollen, food and drug allergy. The diagnosis of allergic disease is based on the allergen identification and the treatment is mainly by allergen avoidance. Since the effect of these anti-inflammatory agents can obtain only symptomatic relieve and cannot prevent the disease progression. Allergen-based immunotherapy (AIT) is the only one modality which can induce allergen tolerance and modulate the disease course and prevent disease progression. AIT has been used in practice for more than one century. The conventional AIT is given by subcutaneous injection with allergen. It can modify immediate allergic reaction induce humoral and cellular immunity to tolerate old allergen, and prevent new allergen sensitization. There are many problems of AIT not only because its safety but also its convenience. Currently allergen application has been modified through oral, sublingual, intranasal and epi-cutaneous. The allergen can also be modified by allergoid transformation and denaturation. The biologic agents dupilumab (specific monoclonal antibodies against IL4Rα(interleukin-4 receptor alpha)) had been approved for the treatment of atopic dermatitis. The other biologics, anti-IgE, can also be used to avoid allergen-induced reaction prior to AIT. Through the improvement of allergen application and modification of allergenicity, AIT can become a good alternative modality of allergy treatment in the near future.