ALLERGY

DESENSITIZATION
Wisnu Barlianto
Division of Allergy-Immunology
Department of Pediatric
Faculty of Medicine University of Brawijaya
Saiful Anwar Hospital Malang
 Definition
•  Allergen: An antigen that induces an
allergic or hypersensitivity response in
contrast to a classic immune response
produced by the recipient host in
response to most immunogens
•  Desensitization: A method of treatment
used by allergists to diminish the
effects of immunoglobulin E (IgE)-
mediated type I hypersensitivity.
Cruse JM, Lewis RE. Illustrated dictionary of immunology 2nd ed. 2003
•  Allergen immunotherapy is defined as
the repeated administration of specific
allergens to patients with IgE mediated
conditions for the purpose of providing
protection against the allergic
symptoms and inflammatory reactions
associated with natural exposure to
these allergens.
Scurlock AM. Mucosal Immunology 2010;3:345-54
 Mechanism
•  Immune deviation towards Treg-cell response
•  Treg cells suppress proliferation, tissue
infiltration, pro-inflammatory cytokine
production and injury/apoptosis of epithelial
cells by both Th1 and Th2 cells
•  IL-10 and TGF-b induce IgG4 and IgA
respectively from B cells as noninflammatory
immunoglobulin (Ig) isotypes and suppress IgE
production

Jutel M et al., Allergy 2006: 61: 796-807

Immunologic changes during the course of allergen SIT
Akdis CA. J Allergy Clin Immunol 2011;127:18-27
 EFFICACY OF IMMUNOTHERAPY

•  Immunotherapy is effective for the

treatment of allergic rhinitis, allergic
conjunctivitis, allergic asthma, and
stinging insect hypersensitivity.
Therefore immunotherapy merits
consideration in patients with these
disorders as a possible treatment
option. (A)
Allergen immunotherapy: A practice parameter third update. J Allergy Clin Immunol, 2010
•  Immunotherapy for children is effective
and often well tolerated. Therefore
immunotherapy should be considered
(along with pharmacotherapy and
allergen avoidance) in the management
of children with allergic rhinitis, allergic
asthma, and stinging insect
hypersensitivity. It might prevent the
new onset of allergen sensitivities or
progression to asthma. (A)
Allergen immunotherapy: A practice parameter third update. J Allergy Clin Immunol, 2010
Currently indicated Allergic rhinitis
Allergic asthma
Venom allergy
Not indicated Atopic dermatitis
Food allergy
Chronic urticaria/
angioedema
Relative Unstable asthma
contraindications Concurrent use of β-
blockers or ACE inhibitors
Severe coronary artery
disease
malignancy
Mahmoudi M. Allergy and Asthma. 2008
 Summary of controlled trial of immunotherapy

Danders

Grass Weed Tree Molds Mites Cat Dogs

Allergic
++ ++ ++ + ++ ++ +
rhinitis

Asthma + ++ + +/- + ++ +

Lieberman P, Anderson JA. Allergic Disease. 2007

Scurlock AM. Mucosal Immunology 2010;3:345-54
Immunotherapy schedule
Dosis intensif ke Allergen HD Dosis Rute
1 Seri I 0,10 cc subkutan
2 Seri I 0,15 cc subkutan
3 Seri I 0,22 cc subkutan
4 Seri I 0,32 cc subkutan
5 Seri I 0,48 cc subkutan
6 Seri I 0,72 cc subkutan
7 Seri I 1,00 cc subkutan
8 Seri II 0,10 cc subkutan
9 Seri II 0,15 cc subkutan
10 Seri II 0,22 cc subkutan
11 Seri II 0,32 cc subkutan
12 Seri II 0,48 cc subkutan
13 Seri II 0,72 cc subkutan
14 Seri II 1,00 cc subkutan
Immunotherapy schedule
Dosis rumatan ke Allergen HD Dosis Rute
1 Seri III 0,10 cc subkutan
2 Seri III 0,10 cc subkutan
3 Seri III 0,10 cc subkutan
4 Seri III 0,10 cc subkutan
5 Seri III 0,10 cc subkutan
6 Seri III 0,10 cc subkutan
7 Seri III 0,10 cc subkutan
8 Seri III 0,10 cc subkutan
9 Seri III 0,10 cc subkutan
10 Seri III 0,10 cc subkutan
11 Seri III 0,10 cc subkutan
12 Seri III 0,10 cc subkutan
13 Seri III 0,10 cc subkutan
14 Seri III 0,10 cc subkutan
Reaction to Immunotherapy

Urtikaria

Systemic Respiratory
reactions reactions
(3%-7%) (40%-73%)

Hypotension
(10%)

Pediatric Allergy: Principles and Practice, 2nd edition, 2010

 Systemic reactions

•  Although there is a low risk of severe

systemic reactions with appropriately
administered allergen immunotherapy,
life-threatening and fatal reactions do
occur. (A)

Allergen immunotherapy: A practice parameter third update. J Allergy Clin Immunol, 2010
 Future allergen specific
immunotherapy
•  Reconstitution of an extract by five
recombinant allergens
•  Hybrid and chimeric reconstitutions of
several major allergens in one protein as
a T cell directed vaccine, which bypasses
IgE-mediated effects
•  Trimer and fragments of one major
allergen
•  Peptide immunotherapy
Burks AW. J Allergy Clin Immunol 2013;131:1288-96