Asit therapy contraindications. Possible side effects from treating allergies with allergens. Selection of allergen for specific immunotherapy

Specific immunotherapy aims to reduce the patient’s sensitivity to a causally significant allergen and prevent the formation of complexes between IgE antibodies fixed on the target cell and the allergen.

For more than 80 years (L. Noon, 1911), the principle of repeated administration of subclinical doses of specific allergens to patients in order to reduce hyperreactivity has been used, but the mechanisms specific immunotherapy have not been fully studied.

Nevertheless, the original principle: the introduction of small doses of the allergen in order to reduce the risk of provoking an anaphylactic reaction and increasing antiallergic protection remains unshakable.

A number of position papers on SIT indicate the high effectiveness of this type of therapy.

The World Health Organization, together with leading associations of allergists, recommends that instead of the terms: specific hyposensitization, specific immunotherapy, allergen-specific immunotherapy, the following designations be used to name the method of immunotherapy for allergic diseases: allergen immunotherapy, specific allergy vaccination, specific allergen vaccination, allergen vaccine, therapeutic vaccines for allergic diseases ( January 1997 - WHO Position paper In Allergen Immunotherapy: Therapeutic vaccines for allergic diseases.

History of SIT

The rationale for specific therapy in these cases is the identification of a specific IgE response to these allergens in patients as a leading indicator for prescribing SIT. Another condition for prescribing SIT for atropic diseases is the impossibility of eliminating a causally significant allergen from the patient or preventing the patient’s contact with etiological factor diseases.

It is quite clear that in this case, preparations of pollen and dust allergens justifiably occupy a leading place among therapeutic agents with SIT. In recent years, mold fungi have been classified as “non-eliminable”; allergies to which are detected in the majority of patients with bronchial asthma living in rooms with high humidity.

In the formation of infectious-allergic asthma, an important role is played by allergens of those microbes that live in the lower respiratory tract patients with infectious-allergic (infection-dependent) bronchial asthma.

J. Bousquet and F. Michel, considering the past, present and future of the method of specific immunotherapy, indicate that in recent years there has been significant progress in the quality of SIT performed by patients: therapeutic forms of allergens have been improved, optimal schemes administration of drugs, ways to monitor the effectiveness of SIT, the possibilities of assessing “in vitro” indicators of positive changes in the immune system during allergen-specific therapy have been expanded. As a result of all the above changes, SIT is becoming a reliable, controlled method for the treatment of allergic diseases.

The main events that contributed to the improvement, recognition of mechanisms, and development of the SIT control system can be divided into seven stages in historical terms.

The first stage was led by the work of L. Noon and G. Freeman (1911) - the first work on immunotherapy. This stage can, apparently, be conditionally called empirical, because during these years (before 1920) positive experience was accumulated in the clinical use of SIT.

The second important event, the beginning of the next extremely significant stage of research, summarizing the attempts of various authors to understand the mechanisms of SIT, was the work of R. A. Cooke (1920 - 1930) on identifying “blocking” antibodies in patients treated with SIT and studying the role of these antibodies in antiallergic immunity.

In 1931, G. Freeman proposed a shortened version of the SIT course, trying to reduce the intervals between allergen injections and change the doses of therapeutic allergens. These works served Starting point for subsequent manipulations associated with changing the classical SIT scheme, which involved a gradual increase in the dose of the administered allergen at strictly designated time intervals. Despite the risk of inducing anaphylactic-type reactions with a short course of SIT, in a number of cases it was possible to obtain a good therapeutic effect as a result of specific treatment.

A new milestone on the path to improving the quality of SIT was the work of N. Bruun (1960), who first introduced the principle of the double-blind method in SIT. The principle of the double-blind method made it possible to obtain objective data on the effectiveness of the therapy and to compare the results of observations on SIT obtained in different clinics by different specialists.

However, the decisive event in understanding the mechanisms of SIT was the work of K. Ishizaka, S. G. Johansson (1968) on IgE antibodies and a more in-depth analysis of the mechanisms allergic reactions immediate type and allergen-specific antiallergic therapy.

Sixth period from 1970 to 1990 was characterized by an abundance of work on improving medicinal allergens. Modification of VSE was carried out using glutaraldehyde, formalin and other chemical modifiers. A series of allergoid forms of pollen, mite and other allergens were tested, which showed their higher therapeutic qualities in comparison with VSE. During this period, the question of standardization of drugs administered to patients arises, which develops into the problem of studying the structure of the most relevant allergens and the relationship between the composition and properties of allergens.

The problems of epitope mapping of allergens and the creation of their recombinant analogues arise. These problems were posed and partially solved in last decade. The seventh stage is 1990 - 2000. The structure of more than 80 atopic allergens has been deciphered, new therapeutic drugs have been obtained based on chemical modification of the main pollen allergens, and a direction for creating allergen vaccines of the future is being developed. At present, some pollen allergy vaccines have already been created (see section “Aeroallergens”).

Thus, a historical analysis of the implementation of SIT in allergology shows that the improvement of the SIT method was carried out in parallel with the emergence of new data on the mechanisms of allergic reactions.
This process continues to this day.

Allergen-specific immunotherapy (SIT):

Indications for the use of SIT are:

• impossibility of eliminating an etiologically significant allergen;
• presence of confirmation of IgE-dependent hypersensitivity of the patient to a specific allergen.

Allergen-specific immunotherapy method

The choice of allergen (allergens) for SIT is carried out on the basis of data from a specific allergological diagnosis previously performed on the patient.

Specific diagnosis of allergic diseases is usually called a set of methods aimed at identifying an allergen or a group of allergens, causing disease at the patient.

Specific allergy diagnostics include:

• identification of allergy history,
• performing skin allergy tests,
• implementation of elimination tests according to indicators (cessation of contact of the patient with the allergen),
• specific laboratory allergy diagnostics (in vitro), which is carried out with the aim of clarifying the etiofactor and characterizing individual links in the pathogenesis of the disease.

In accordance with allergy diagnostic data, 1 - 3 causally significant allergens are identified, with therapeutic forms of which SIT is carried out.

When prescribing SIT, an allergist selects patients with IgE-mediated clinical manifestations of allergy to a specific allergen. The experience of previous researchers on the effectiveness of SIT with these allergens is also taken into account.

The principles of selecting allergens for specific immunotherapy are based on the fact that allergens are used for treatment:

• the elimination of which is impossible from the environment where a patient with hypersensitivity to this allergen lives (pollen from trees, grasses, flowers, mites, fungal spores, insect venom), selection of regional forms is most preferable;
• which undoubtedly provoke allergic symptoms in patients.

You should also carefully evaluate the rationale for prescribing SIT and the patient’s individual ability to carry out such long-term treatment (up to 3 years), because only consistency in this case is the key to a good result.

The effectiveness of SIT is determined by:

• quality of medicinal allergen;
• accuracy of patient selection (depends on the ability to carry out full-fledged specific diagnostics, allowing to identify causally significant allergens);
• confirmation of communication clinical manifestations diseases in patients with a specific IgE response to a given allergen.

Skin tests are performed on the dorsum of the forearm. The day before testing, it is not allowed to administer adrenaline to the patient, since the latter can weaken the skin's response to the allergen.

Contact of the patient's skin with a specific allergen is allowed:

• by scarification: a dilution of the allergen is applied to a slightly scarified, non-bleeding area of ​​the skin;
• by injection (according to Prick): a drop of the allergen is applied to the skin, and then a needle is inserted a millimeter through the drop, after which it is quickly removed;
• by injecting 0.01 ml of this allergen into the skin (it is recommended to carry out an intradermal test after preliminary scarification).

Prick test technique: with sterile prick test needles, separate for each patient and drug, a 1.5 mm deep injection is made into the skin of the patient’s forearm.

Table 15. Evaluation of skin testing results using the Prick method

The initial therapeutic concentration of the drug will be the one that gives a weakly positive (or questionable ±) reaction in the patient when titrating the allergy vaccine.

Returning to the history of the introduction of SIT in Russia, the development of hyposensitization methods is associated with the name of academician A.D. Ado and his school, which began its activities with the organization of a research allergological laboratory 40 years ago (NIAL AMS USSR).

Classic scheme specific hyposensitization at bronchial asthma and hay fever was introduced into allergological practice by employees of the research allergological laboratory of the USSR Academy of Medical Sciences (Yu. A. Poroshina, N. V. Adrianova, S. M. Titova) (Table 16). In this case, the diagnostic allergen in appropriate dilutions was used for SIT.

Table 16. Scheme of specific hyposensitization, which was used in the Scientific Research Institute of the USSR Academy of Medical Sciences (1961 - 1980)

Allergen-specific immunotherapy dates back to 1911, when it was used to treat hay fever (seasonal allergic rhinitis). This method of treatment consists of introducing into the patient’s body increasing doses of a water-salt extract of the allergen to which the patient is hypersensitive and which is responsible for the clinical manifestations of the disease. The goal of treatment is to reduce the patient's sensitivity to natural exposure to a given allergen - specific hyposensitization. It was under this name that this method existed for a long time. With the accumulation of information that the therapeutic effect of this method is based on (mainly) immunological mechanisms, it began to be called specific (allergen-specific) immunotherapy. Since the introduction of an allergen achieves an immunologically (mainly) mediated increase in “resistance” to the action of the antigen (allergen), the similarity of the procedure itself was seen with vaccination, and allergenic extracts with vaccines. Therefore, at present, rather often, instead of the terms “allergenic extracts” or “therapeutic allergens,” the term “allergenic vaccines” (“allergenic vaccines”) has begun to be used. Without going into a discussion of the justification and success of such terminological improvements, this information should be provided only so that the practitioner is aware of the meaning of existing terms.

Since the advent of allergen-specific hyposensitizing therapy (allergen-specific immunotherapy - SIT), vast experience has been accumulated clinical application SIT. It has become one of the most scientifically proven and widely used effective treatments for allergic diseases, primarily those associated with the IgE-mediated mechanism of allergy.

Medicinal allergens

Throughout the history of clinical allergology, preparations obtained by extraction have been predominantly used for allergen-specific diagnosis and treatment. water-salt solution active principles from various raw materials (plant and animal origin), upon contact with which allergic diseases and reactions occur. In addition to allergenic ones, such water-salt extracts contain other components that affect the quality of the drug. Therefore, allergenic drugs are subjected to special purification, the methods of which are constantly being improved. The most important problem of the quality of allergenic drugs, which has not been resolved to date, is their standardization. Different continents and different countries have their own principles and methods for standardizing allergens. It is clear that with this approach it is impossible to compare the allergenic activity of drugs from different manufacturers, and the imperfect identification of the allergenic principles themselves in the drugs makes it difficult to compare the allergenic activity of drugs from different series, even from the same manufacturer. Therefore, a common worldwide strategy for the standardization of allergenic drugs is currently being formed, which provides for the mandatory standardization of allergens according to the following three criteria:

• total allergenic activity;
• biological activity;
• content of the main allergens in the preparation per unit mass.

In European countries, the total allergenic activity of a drug is standardized according to the degree of allergic skin reaction it causes (injection test) in patients sensitive to a given allergen, correlated with skin reaction for histamine. The composition of the allergenic drug is characterized using methods such as isoelectric focusing, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, IgE immunoblotting, and cross-radioimmunoelectrophoresis. The IgE-binding properties of the drug are assessed in the RAST inhibition reaction (radioallergosorbent technique). Currently, it has become fundamentally possible for different manufacturers to determine the content of the main allergens in the drug, mainly responsible for the body’s increased sensitivity to a complex allergen. For this purpose, international reference standards (WHO) containing known quantities of the relevant allergens are made available to different countries.

New technologies for cloning protein molecules have already made it possible to obtain many important allergens (pollen allergens, bed mite, epidermis of some animals, insects, hymenoptera venoms, etc.) in the form of individual recombinant proteins that have comparable allergenic activity with the corresponding natural protein allergens. Such new technology will facilitate the standardization of allergen preparations by allowing the rigorous quantification of major allergens in production batches of dosage forms.

Diagnostic and therapeutic allergens currently produced by domestic manufacturers are standardized according to the content of protein nitrogen units in the preparation, and their allergenic activity is determined based on the results of skin testing on patients sensitive to this allergen, but is not quantitatively assessed either in in vitro tests or on patients. It is clear that the domestic technology for obtaining and standardizing allergens must be brought into line with the modern world level, which requires the provision and implementation of relevant national scientific and technical programs.

SIT mechanism

To imagine the mechanism of action of allergen-specific immunotherapy, we should recall the main pathogenetic links allergic process.

Classic and common manifestations of allergies that are subject to SIT are diseases associated with the formation in the body of allergic antibodies belonging to immunoglobulin E (IgE). In case of admission to internal environment of the allergen body, the latter is fragmented in antigen-presenting cells into simplified peptides, which are then presented by these cells to helper T cells (Th cells), which have a Th2 cell profile. This profile is characterized by the cells producing cytokines such as interleukin (IL)-4, IL-13, and IL-5, but not IL-2 or interferon (IFN)-γ. The Th2 cell profile is related to the humoral immune response and, in particular, to the IgE response. The Th1 cell profile is characterized by the cells producing IFN-γ and IL-2, but not IL-4, IL-13 or IL-5. There is a reciprocal relationship between Th1 and Th2 cells, and IFN-γ (a Th1 cell cytokine) inhibits (restrains) the activity of Th2 cells necessary for the IgE response.

The resulting IgE antibodies are fixed on specialized receptors that have a very high affinity for them (high-affinity receptors for the Fc fragment of immunoglobulin E - Fc(RI), located on mast cells of the mucous membranes and connective tissue. Thus, armed with IgE antibodies, mast cells are ready to recognize the allergen if it can re-enter the internal environment of the body. When the allergen is re-entered, it is bound by IgE antibodies, activation of mast cells occurs, as a result of which mediators are secreted from them (histamine, prostaglandin D2, leukotrienes C4, D4, E4), platelet activating factor - FAT (tryptase, etc.), which cause an increase in vascular permeability and tissue swelling, contraction of smooth muscles, hypersecretion of mucous glands, irritation of peripheral nerve endings. These changes form the basis of the rapid (early) phase of the allergic reaction (see figure), which develops during the first minutes after exposure to the allergen. In addition to these actions, the released mediators attract other participating cells to the allergic reaction zone: basophils, eosinophils, monocytes, lymphocytes, neutrophils. Additional cells participating in the allergic reaction that come to this zone are activated, as a result of which they also secrete proallergic (proinflammatory) mediators. The action of these cells and their mediators forms the late (or delayed) phase of the allergic reaction. The late phase determines the maintenance allergic inflammation in the tissue, the chronization of the process, the formation and intensification of allergen-nonspecific tissue hyperreactivity, expressed in increased sensitivity not only to a specific allergen, but also to a variety of nonspecific irritants (smoke, gases, strong odors etc.; see picture).

Allergen-specific treatment has fundamental advantages over all other methods of allergy therapy, since it does not act on the symptoms of the disease, but modifies the nature of the body's response to the allergen, interferes with the pathogenesis of the disease and therefore affects all pathogenetic links of the allergic process.

The clinical effectiveness of SIT is expressed in inhibition external manifestations disease and reducing the need for medications, which is due to the following, at least three features of the action of SIT. Firstly, a decrease in tissue (organ) sensitivity to allergenic exposure is formed, which has been confirmed many times, in addition clinical observations, conducting provocative tests with an allergen. Secondly, there is a decrease in nonspecific tissue hyperreactivity, which, in particular, is established by a decrease in sensitivity to various allergy mediators. Thirdly, clinically effective SIT is accompanied by suppression of signs of allergic inflammation.

The decrease in nonspecific tissue hyperreactivity and anti-inflammatory effect, as well as specific hyposensitization, are maintained over a long (many years) observation period after completion of SIT. It is easy to see that these effects of SIT combine the modes of action of a variety of modern antiallergic drugs. pharmacological drugs, only selectively affecting one or another link of the allergic process.

What are the main points of application of the SIT action?

It is known that in atopic patients during the period of natural allergenic exposure (for example, during the flowering period of plants to the pollen of which there is increased sensitivity), an increase in the level of IgE antibodies in the blood occurs. SIT is accompanied by inhibition of this increase in IgE antibodies, and after repeated courses of SIT, there is also a slight decrease in the level of IgE antibodies compared to the initial level. However, there is still no direct connection between the degree of inhibition of IgE antibody production and the severity of the positive clinical effect.

A point of view has long been formed according to which the main mechanism of SIT consists in restructuring the nature of the immune response to the action of an allergen, consisting in the formation of so-called blocking antibodies belonging to IgG and lacking the ability to sensitize tissues, but having allergen-binding activity, due to which they prevent ( or rather, they reduce) the likelihood of interaction of the allergen with IgE antibodies. And yet, a significant increase in the content of allergen-specific IgG antibodies does not always coincide with a pronounced clinical improvement in the condition of patients. IN Lately Information has emerged that the formation of anti-IgE antibodies may also contribute to the therapeutic effect of SIT.

It is most likely that the formation of IgG antibodies, anti-IgE antibodies and inhibition of the production of IgE antibodies mediate the SIT mechanism only partially and in combination with each other and with other processes. In recent years, information has accumulated indicating that SIT, accompanied by a pronounced clinical improvement in the condition of patients, is characterized by inhibition of the involvement in an artificially provoked or natural allergen exposure allergic reaction of those cellular units that mediate the effector stage of allergy. Thus, in tissues after SIT, the content of mast cells decreases, the accumulation of inflammatory cells (eosinophils, neutrophils) decreases, the release of mediators from allergy target cells (mast cells, basophils) is inhibited when stimulated by a specific allergen or nonspecific activators. The action of SIT also affects lymphoid cells in such a way that their profile shifts from Th2 cells towards Th1 cells. All this may explain the influence of SIT not only on the early, but also on the late phase of the allergic process.

So, SIT has a therapeutic effect that extends to all stages of the allergic process and is absent from known pharmacological drugs, including those with multifunctional activity. The action of SIT covers the immunological phase itself and leads to a switch of the immune response from Th2 type to Th1 type, inhibits both early and late phase An IgE-mediated allergic reaction inhibits the cellular pattern of allergic inflammation and nonspecific tissue hyperreactivity. Once again, it should be emphasized that SIT fundamentally distinguishes from pharmacotherapy a long-lasting therapeutic effect after completion of treatment courses.

Clinical effectiveness of SIT

Over the 90-year period of application of SIT, a huge clinical experience, indicating its high therapeutic effectiveness. According to numerous studies, including those conducted in our country, the positive therapeutic effect of SIT is achieved in 80-90% of cases or more. So high level therapeutic effectiveness can be achieved with following conditions:

• correct selection patients with a clearly established IgE-dependent nature of the disease;
• a limited number of allergens that are important in the clinical symptoms of the disease in a given patient;
• use of commercial standardized medicinal forms of allergens;
• the patient’s propensity to carry out SIT and the disposition to perform repeated courses of treatment.

Data from previous years on the high therapeutic effectiveness of SIT have recently been confirmed in special works carried out on the basis of the principles of evidence-based medicine.

These studies were double-blind, placebo-controlled trials in randomized groups of patients selected on the basis of clear clinical criteria and the results of allergy-specific diagnostics, using standardized purified allergens at an optimal maintenance dose (about 5-20 μg of the main allergen per injection for such patients). allergens, such as pollen of weeds, grasses, cat hair, hymenoptera venoms) and subject to sufficient duration (completion) of treatment courses.

The main conclusions of these studies characterizing the clinical effectiveness of SIT can be summarized as follows.

• Effective SIT leads to a decrease in the patient's sensitivity to a given allergen, detected by allergen-specific provocative tests, to the disappearance of clinical symptoms during the period of natural exposure to the allergen or to a decrease in its severity and a decrease in the need for antiallergic drugs.
• SIT is highly effective for allergic seasonal and year-round rhinitis (rhinoconjunctivitis) and atopic bronchial asthma.
• Unlike all existing methods of treating allergic diseases, the positive effect of SIT lasts for a long period (at least for several years).
• The younger the patient and the earlier the stage of the disease observed during SIT, the higher its therapeutic effect.
• Timely and effective SIT prevents the progression of the disease to more severe forms and the transformation of allergic rhinitis into bronchial asthma.
• Clinically, the therapeutic effect of SIT is achieved upon completion of repeated courses (3-5) of treatment, but may appear after the first course.

On the issue of clinical effectiveness There are different points of view regarding SIT performed by bacterial allergens, but, according to a number of researchers, even in this case a pronounced positive clinical effect can be obtained.

Place of SIT in the system of antiallergic treatment

A long-recognized and substantiated position in allergology is that the first mandatory stage of antiallergic treatment should be a set of measures aimed at eliminating or limiting allergenic effects on the patient. If elimination measures are insufficient, then carrying out SIT becomes necessary, of course, subject to the conditions mentioned above.

Pharmacotherapy of allergic diseases is currently carried out by several groups of antiallergic drugs that can effectively control the symptoms of the disease (H1-antihistamines, antileukotriene drugs, stabilizers of allergy target cells - cromoglycic acid and nedocromil sodium preparations, xanthine derivatives, β2-agonists, topical and systemic corticosteroid drugs). However, on the one hand, the use of pharmacological drugs should not replace SIT, and on the other hand, SIT provides for the additional use and pharmacological agents, if the need arises. Contained in a number of international and national recommendations The proposal to start SIT only in cases where pharmacotherapy is ineffective cannot be accepted. This is explained by the fact that SIT is more effective the earlier it begins.

In addition, as indicated above, timely SIT allows, firstly, to prevent the progression of the disease to more severe forms, and secondly, it reduces (or even completely eliminates) the need for medications. Finally, after completing SIT, it is possible to achieve long-term remission, which cannot be achieved with drugs.

To what has been said, one more argument should be added, which is justified by the mechanism of action of SIT. Let us recall that SIT extends its effect to all links of the allergic process: to the immunological link itself, to effector cells (mast cells) of the early phase, to cells participating in the late phase of the allergic response, it reduces not only allergen-specific tissue sensitivity, but also non-specific tissue hyperreactivity, prevents the expansion of the range of allergens to which hypersensitivity develops. No other pharmacological drug has such a multifunctional effect. It is precisely because of these important circumstances that in domestic allergology there has long been an opinion about the need for as much early start carrying out allergen-specific treatment to prevent exacerbations of the disease.

SIT safety

During SIT, undesirable reactions may occur in response to the introduction of an allergen. side effects in the form of local or systemic reactions.

Local reactions include those that occur at the site of allergen injection and are characterized by local hyperemia, sometimes a feeling of itching in the injection area, and signs of tissue swelling. These reactions usually occur within the first 30 minutes, although it should be borne in mind that they may occur later. The occurrence of local reactions is a reason for adjusting the dose of the allergen (reducing it) during subsequent administration.

Systemic reactions are reactions that occur outside the area of ​​allergen administration. They usually appear within a few minutes after the allergen injection and in rare cases - after 30 minutes. It is justified to divide systemic reactions into those that do not threaten the patient’s life and those that threaten (anaphylactic shock, vital edema). important organs- swelling of the larynx). Systemic reactions may include headaches, joint pain, and discomfort. TO moderate symptoms systemic reactions include mild manifestations of rhinitis or bronchial asthma (peak expiratory flow not lower than 60% of the expected value or the patient’s value during a period of stable remission), well controlled by appropriate medications (H1-antagonists or inhaled β2-agonists). A more pronounced degree of reaction corresponds to signs of urticaria, Quincke's edema, impaired bronchial obstruction (peak expiratory flow rates below 60% of the proper value or the patient's value during a period of stable remission), controlled by appropriate treatment. Life-threatening reactions require intensive care. If systemic reactions occur, it is imperative to review the SIT program for the patient.

Although there are indications that the timing of systemic reactions correlates with their severity, it should be kept in mind that these reactions can occur 30-60 minutes after allergen injection. The intensity of the local reaction is not a reliable indicator of the manifestation of a systemic reaction. A number of studies summarizing a large number of observations have shown that, as a rule, systemic reactions occurred in the absence of a previous strong local reaction.

Analysis of systemic reactions shows that in most cases they arose as a result of deviations from the accepted rules for conducting SIT. In particular, the following factors were identified:

• error in the dose of allergen used;
• use of an allergen during SIT from a new bottle (switching to another series, with a different allergenic activity);
• extremely high degree hypersensitivity patient (and, accordingly, insufficiently adjusted dosage regimen);
• administration of an allergen to patients with bronchial asthma during the period of clinical manifestations of the disease;
• administration of the next therapeutic dose of the allergen against the background of exacerbation of the disease;
• simultaneous useβ-blocker patients.

Researchers studying the clinical effectiveness and safety of SIT have repeatedly raised the question of the possibility of reducing the risk of systemic reactions by prior use of antiallergic pharmacological agents. As an option, it was proposed to carry out premedication with a combination of methylprednisolone and ketotifen, and theophylline preparations long acting. Such proposals are not perfect, since theophylline may have undesirable effects on the cardiovascular system, and ketotifen may have a sedative effect. Concerning steroid drugs, then their use in this case cannot be justified, since it is impossible to exclude an inhibitory effect on the Th1 type of immune response, with which the therapeutic effect of SIT is associated.

There is special data, including double-blind, placebo-controlled studies, indicating that antihistamines (H1 antagonists) reduce the incidence of systemic and especially local reactions during SIT. Previously, during the use of first-generation H1 antagonists, their use for these purposes was considered unjustified. Such restrictions were associated with concerns that the use of these drugs, without preventing the systemic reaction itself, may obscure its clinical precursors, resulting in the initial signs of a systemic reaction being missed. These concerns are well founded, since the first generation H1 antagonists, on the one hand, have a relatively weak affinity for histamine H1 receptors, and on the other hand, have sedative effect, as a result of which the patient loses an adequate assessment of his condition. In addition, other side effects of first-generation antihistamines (primarily the effect on the cardiovascular system) may increase the manifestations of systemic reactions.

The situation has changed significantly with the advent of H1-antagonists of the second and third generations, which have a high affinity for H1 receptors (i.e., very high selective antihistamine activity) and do not have a sedative effect (or have a weakly expressed sedative effect) and unwanted side effects inherent in their predecessors. These drugs effectively prevent the occurrence of local reactions during SIT and reduce the incidence of systemic reactions. It is clear that preference in this case should be given to drugs that have the best safety profile, high antihistamine activity and do not have a sedative effect. Such a drug, as is known, is the third generation H1 antagonist - fexofenadine (Telfast), which is a pharmacologically active metabolite of the second generation drug (terfenadine). It has an impeccable safety profile, has no cardiotropic (cardiotoxic) properties and has absolutely no sedative effect.

Compared to the millions of allergen injections administered annually worldwide, the incidence of adverse systemic reactions is low. Problems associated with the occurrence of complications of SIT in the form of severe systemic reactions appear in those countries in which not allergists, but doctors of other specialties and doctors are allowed to perform SIT. general practice. This was the case, for example, in Great Britain, where from 1957 to 1986 26 deaths, which could be associated with SIT. When analyzing these cases, it turned out that they were caused by unprofessional performance of SIT. On the contrary, in countries where SIT is performed only by specialists with experience and legal authority to carry out such treatment, and the treatment itself is carried out in specialized medical institutions that have the necessary means to treat possible side effects, systemic reactions, if they occurred, did not lead to serious consequences. Thus, in Denmark, when analyzing 10 thousand therapeutic injections performed in the allergy department of the National University in Copenhagen, not a single case of systemic anaphylactic reactions was found. Similar data were obtained in allergological offices in Moscow, which now have 40 years of experience in the use of SIT. Therefore, it is mandatory to comply with the following rule: allergen-specific immunotherapy (allergen-specific hyposensitization) should be performed only by trained specialists (allergists) with experience in conducting this treatment, in an allergy office or hospital.

It is in the specialized allergological department that the availability of necessary funds not only for carrying out SIT, but also for stopping adverse reactions if they occur. Such rules have been observed in our country since the creation of the allergy service in the early 60s, thanks to which domestic allergology was able to avoid the sad experience of countries in which other specialists, in particular doctors, were allowed to carry out SIT generalist. The general practitioner's responsibility is to refer the patient with established diagnosis allergic disease or with suspicion of such a diagnosis, contact an allergist to decide, in particular, the issue of performing SIT.

Improving SIT

Improvement of SIT and medicinal forms of allergens is aimed, on the one hand, at reducing the ability of medicinal drugs to cause allergic reactions, and on the other, at maintaining or enhancing their immunogenic properties. This is necessary to increase the therapeutic effectiveness of SIT and improve the safety profile of medicinal forms of allergens.

To achieve this goal, both changing the methods of administration and delivery of therapeutic allergens, and various methods of modifying the allergenic principles themselves are used.

In addition to injecting allergens, they are testing different variants local (topical) SIT in the form of oral administration of allergens, intranasal, inhalation administration, administration of allergens as part of liposomes. So far, definitive evidence of the sufficient effectiveness of such techniques has not been obtained.

Allergen modification is achieved different ways: polymerization of allergens (formaldehyde, glutaraldehyde, etc.), obtaining sorbed forms (on L-tyrosine, on aluminum hydroxide), using a variety of natural and synthetic carriers, allergen-IgG-containing complexes, using plasmid DNA encoding them instead of the allergens themselves, IgE-binding allergenic haptens (unable to activate allergy target cells, but binding to IgE and thereby preventing the subsequent connection of the antibody with the allergen), obtained by biotechnological methods of individual allergen molecules and their fragments. The following list scientific directions, currently being developed, indicates the great interest that researchers around the world are showing in the problem of allergen-specific treatment of allergic diseases.

True, most of these developments are still at the stage experimental research, but some have already been introduced into widespread medical practice, including in our country. Thus, commercial polymerized allergens (allergoids) are produced, which have reduced allergenic activity, but preserved immunogenic activity. Thanks to this, allergoids can be used in higher maintenance doses, but with less frequent administration therapeutic doses than water-salt extracts. This provides greater therapeutic efficacy, a better safety profile and greater convenience of SIT.

For a number of years, at the Institute of Immunology of the Ministry of Health of the Russian Federation, work has been carried out on the targeted modification of the immunogenic and allergenic properties of common allergens by obtaining complex compounds of allergen molecules and immunostimulants. The result of these works was the creation of medicinal preparations based on allergoids of pollen allergens and the immunostimulant polyoxidonium. These drugs are currently prepared for clinical trials.

The development of these new and highly relevant scientific directions will ensure an increase in the effectiveness of allergen-specific therapy and will further expand its use in the complex of antiallergic therapeutic and preventive measures.

Literature:

People's is growing every year. The reason for this is - genetic inheritance, environmental pollution, consumption of unnatural products, use of chemical products in everyday life and much more.
Doctors fight for the health of patients, resorting to 3 types of solutions to the problem:

ASIT therapy. What it is?

Allergy is a word familiar to many. The reason is the individual characteristics of our immune reactions. Thanks to the protection of the immune system, the body is able to fight viruses and bacteria on its own, but with allergies, even seemingly ordinary things can become enemies to health: dust, wool, food products. Histamine, which is produced during allergies, causes swelling and spasms.

Many have heard about this method of treatment as ASIT therapy. What it is?

The method has been used in medicine for more than 100 years. During this time, the positive results obtained firmly established this technique. ASIT works to treat allergies, to identify the cause, and not just the consequences. With this therapy, allergens are introduced to a person, gradually increasing the dose. The body gradually produces antibodies to substances that previously provoked an allergic reaction. Real and complete resolution of allergies is what ASIT therapy is aimed at. The scheme of the method is quite simple.

Methodology

The system includes 2 systematic stages.

Allergen introduction stage. The initiating phase includes taking doses, the concentration of which gradually increases to the limit.

The second phase lasts a long time. Over the course of several years, the patient systematically receives maximum dose allergen, but with long breaks. Typically the treatment period is 3-5 years.

Therapy is divided into 3 types

Year-round. This scheme is used when chronic manifestations, for example, if you are allergic to wool or dust.

Pre-season. Characterized by seasonal allergic reactions, for example, to the flowering of certain plants.

Pre-season.

The allergist-immunologist selects the correct choice of treatment regimen.

Allergy symptoms

• Sneezing.
• Cough.
• Watery eyes.
• Skin manifestations.

Consequences

• Sleep disturbance.
• Chronic fatigue.
• Low performance.
• Various health problems.

What and how is it used?

Preparations for ASIT therapy are based on water-salt extracts, as well as various forms medicinal allergens. In Russia, standardization occurs based on the number of units of protein nitrogen in the preparation.

Reception methods

The vaccine can be administered in several ways.

Intradermal administration (injections).

Drops under the tongue or sublingual method.

Dissolving tablets.

Allergists and immunologists are inclined to believe that the most effective methods are injections and drops under the tongue.

Sublingual method It is considered the most convenient for everyone and has many advantages compared to injections.

• Injections must be carried out in a specially equipped sterilized room, under the supervision of a doctor. Not everyone has time to constantly visit the hospital. Drops under the tongue are a very convenient way to treat at home.
• The sublingual method has a minimum of possible side effects compared to others.
• A great way for children who are afraid of injections.

Relationship between ASIT and other branches of medicine

If we analyze the methodology, it becomes clear that it is partially borrowed from homeopathy and vaccination. Homeopathy offers to treat, as they say, wedge with wedge, allergies - with their own allergens. Small doses of allergens that cause allergies in larger doses can improve immunity and create antibodies. From vaccination ASIT acquired proper preparation to the introduction of foreign organisms, as well as the correct concentration.

Advantages

The technique has enough advantages.

Reduction and disappearance of symptoms of the disease.

Protects the patient from complications and the transition of allergies to a more severe level.

Prevention.

Reduces the need to use other antiallergic medications that reduce symptoms.

Long-term remission, which often turns into lifelong.

A person’s quality of life improves due to the complete disappearance of symptoms.

Not all methods are ideal, including ASIT therapy. Side effects include possible itching and redness at the injection site. This goes away on its own or with the help of ice. Sometimes an allergic reaction to the composition of the administered drug occurs: runny nose, redness of the mucous membranes, hives or swelling. To avoid this, you need to carefully select your doctor. An allergist-immunologist monitors the effects of the vaccine for 30 minutes to prevent possible negative consequences.

Indications

Bronchial asthma.

Hay fever.

Allergies to dust, insect bites, flowering plants, etc.

Contraindications

Presence of cancer.

Mental disorders.

Pregnancy at any stage.

Diseases of internal organs.

Children under 5 years old.

Immunodeficiency.

Chronic diseases in the acute stage.

Infectious diseases.

Blood diseases.

ASIT can be combined with pharmacological therapy during acute form allergies, when symptoms are most pronounced.

Entrust all injection procedures to professionals in medical institutions and remain there for some time after the procedures for examination.

Talk to your allergist about all your body's reactions.

For sublingual and other methods that do not require physician manipulation, follow the instructions and recommendations exactly.

Efficiency

Improvements appear after several months of treatment. Often therapy is prescribed in a series of repeated courses to consolidate the result. The consequences of ASIT therapy will be:

ASIT therapy. Reviews from doctors and patients

Based on patient reviews, you can evaluate all the advantages of this method of treating allergies, such as ASIT therapy. Not all people who want to get rid of allergies know what it is and the consequences of the modern method. Patients are advised by qualified people who work in hospitals every day and bring relief to people with such an unpleasant and uncomfortable disease. Some time after the start of therapy, patients already feel the first positive changes in their health, relief allergic symptoms or leave for good. From the experience of people who have undergone treatment, it becomes clear that one should not rush in such a matter as ASIT therapy. What does it mean? Complete completion of treatment is required, which may take considerable time. You should be patient and follow all the doctor’s recommendations.

Patients are especially pleased with the opportunity to choose the use of medications. If earlier therapy was carried out only with the help of injections, now there are other, convenient and painless methods, for example, drops.

Doctors urge their patients not to be afraid of treatment and to go through all stages of ASIT therapy. According to doctors, this is an effective assistant in the fight against allergies, not only its symptoms, but also the cause itself. They won't have that effect. regular medications, which, in fact, only weaken the manifestations of the disease.

Previously, no one could imagine that such a method of treating allergies as ASIT therapy would ever appear. They found out what it was in 1911. Since then, ASIT has been successfully used in medicine. Centuries-old practice has proven the high effectiveness of this method. Therapy helps not only to remove severe symptoms, but also to achieve complete remission. Doctors should study in detail the causes of allergies and prescribe appropriate doses, which will be systematically increased during the first phase of treatment. The main thing is to systematically follow the rules and doses of the drug prescribed by the attending physician. An allergist-immunologist must have an appropriate higher education degree. medical education and experience in this treatment. Patients who follow the above instructions are satisfied with the result and forget about the problem.

A breakdown in the immune response and the complex structure of the immune system explain why this moment there is not one one hundred percent way allergy treatment. How to eliminate the existing defect? Scientists and doctors have been looking for an answer to this question since the role of the body’s altered immune response in the development of allergies was established.

The prerogative of allergists is a method of treating allergies, which is called specific immunotherapy (SIT, allergy vaccination). Using this method, they try to influence the disturbed (altered) immune response.

Currently, there are many terms denoting this treatment method - specific immunotherapy (SIT), allergen-specific immunotherapy (ASIT), specific desensitization, specific hyposensitization, allergen immunotherapy, allergen vaccine therapy, allergy vaccination. Patients often refer to SIT as “allergy shots” or “allergen treatment.” Based on modern immunological
ideas about the mechanisms of “allergen treatment” - it is more correct to call this method allergy vaccination or allergy vaccination therapy.

The main drawback of any drug treatment for allergies and asthma: using symptomatic medications such as antihistamines or steroid hormones may reduce allergy symptoms, but these drugs do nothing to completely relieve you of the disease.

Drug treatment for allergies and asthma involves continuous use of medications. Being experienced in this issue, in this you can see what is called consumption propaganda... Inhaled hormones(becotide, flixotide, budesonide), cromones (intal, tyled) - undoubtedly effective drugs, but they "work" as long as you keep using them. Therefore, these drugs should be taken for a long time, sometimes constantly. Symptomatic medications - bronchodilators (salbutamol, Berotec) - can temporarily eliminate difficulty breathing; antihistamines - eliminate conjunctival and nasal manifestations of allergies, but the disease will remain, and as soon as you stop treatment, it may appear again...

However, the correct selection of drug treatment, taking into account individual characteristics, is necessary. It makes it possible to control your condition and prevent exacerbations.

Specific immunotherapy has a number of advantages over drug treatment:

1. Specific immunotherapy is the traditional and only method of treating allergies and bronchial asthma, which affects the immunological nature of allergic inflammation. That is, it eliminates, rather than suppresses, the underlying cause of allergy and asthma symptoms.
2. After SIT (especially several courses in a row), long-term remission of the allergic disease is observed.
3. This immunotherapy prevents the expansion of the range of allergens to which hypersensitivity develops.
4. Prevents the worsening of the disease and the transition of milder clinical manifestations, for example, rhinitis, to more severe ones - bronchial asthma.
5. After a course of therapy, the need for antiallergic drugs decreases.
6. This therapy is performed in patients aged 5 to 50 years, if the role of IgE-mediated allergy in the course of the disease has been proven. This is primarily a respiratory allergy - for example, hay fever (pollen allergy), allergy to molds, mites house dust and other household allergens.
7. It is very effective in preventing serious allergic reactions to wasp and bee stings (insect allergies).
8. SIT is effective for hormone-dependent bronchial asthma. The possibility of reducing the doses of corticosteroid hormones used and even their complete abolition after this treatment method has been proven. A special type of specific immunotherapy is vaccine therapy with bacterial allergens for infectious-allergic bronchial asthma.
9. SIT turns out to be effective and significantly facilitates the course of both the main and concomitant diseases in patients with a combination of asthma with diseases of the ENT organs, endocrine, cardiovascular, gastroenterological diseases and neuroses.

Mechanisms of specific immunotherapy

Since allergies are an immunological disease, by changing the reactivity of the immune system, the disease can be eliminated. This method reduces or completely eliminates allergy symptoms by correcting abnormalities in the immune system.

Hyposensitization- This is a decrease in the body's sensitivity to the allergen. This is precisely the purpose of the SIT. Sensitivity to allergens decreases - allergy symptoms decrease or stop.

The mechanisms of SIT are diverse - it is a restructuring of the nature of the immune and cytokine response, the production of “blocking” antibodies, a decrease in the production of IgE, and an inhibitory effect on the mediator component of allergic inflammation. SIT inhibits both the early and late phases of the immediate allergic reaction, inhibits the cellular pattern of allergic inflammation, nonspecific and specific bronchial hyperreactivity in bronchial asthma. Due to the complexity of the mechanisms of the immune response, it is impossible to explain the mechanisms of SIT clearly.

How specific immunotherapy is carried out. Regular administration of a small amount of therapeutic allergen with gradual increase dose stimulates your immune system. Over time, resistance to the allergen develops. Purified allergens, allergoids or other modified allergens are used as therapeutic drugs.

Treatment lasts at least six months (unlike ineffective regimens used in general clinical practice). The total dose of therapeutic allergen you receive is at least 10,000 PNU (PNU - protein nitrogen unit). The frequency of injections is 1 time every 7-10 days. Allergen injections are carried out with the thinnest needles, subcutaneously, which eliminates pain.

SIT is a fairly lengthy treatment method, but its successful implementation can result in a significant reduction in the need for medicines and, possibly, a complete cessation of allergy symptoms or asthma attacks for many years! Until your immune system responds to the introduction of allergens, you may still need the medications you are already using. After two to three months of treatment, your need for medication will decrease and your symptoms will become less severe.

Specific immunotherapy for bronchial asthma. SIT is still considered the mainstay treatment for asthma, affecting immunological cause allergic inflammation in the bronchi and is, perhaps, the only method of therapy that provides long-term remission of asthma. The probability of remission of the disease within 20 years after completing a 3-year course of treatment is estimated by some scientists at 70%.

Effects of specific immunotherapy

• The frequency of use of symptomatic drugs and medications is reduced emergency care, in case of respiratory allergies (antihistamines, bronchodilators, etc.).
• Reduced need for drugs basic therapy(including hormonal drugs) for bronchial asthma and allergic rhinitis.
• There is a high chance that you will not experience any problems in work, leisure and sports during the pollen allergy season.
• The natural development of an allergic disease is stopped, for example, the transition from hay fever to asthma, and/or the development of a new allergy (to other allergens) is prevented.

If you feel that allergy symptoms are not sufficiently suppressed by the administration of various medications and your need for antiallergic medications is significant, you should consult with a specialist allergist about the possibility of specific immunotherapy (allergy vaccination).

Be healthy!

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Most qualified allergists say that it is impossible to completely overcome allergies. Moreover, mild allergic reactions can develop into more severe pathologies.

When using this method of treatment, complex reactions occur in the immune system, which ultimately leads to the fact that the immune system stops responding to allergens as foreign proteins.

ASIT therapy is often referred to in medicine by other terms - the most famous of them are:

• allergen immunotherapy;
• specific hyposensitization;
• allergy vaccination;
• specific immunotherapy.

The duration of ASIT therapy is calculated at least two years; at the end of the course of treatment, a long-term remission occurs or allergy symptoms decrease so much that the sick person no longer needs to take it.

When was the ASIT method first used?

The first mention of specific immunotherapy is found in medical literature dating back to the beginning of the 20th century.

At this time, allergen immunotherapy began to be actively used to eliminate allergies that arise after contact with mite and dust irritants.

ASIT therapy has been successfully used a hundred years ago to treat patients with asthma, year-round rhinitis, etc.

The first therapeutic allergens were water-salt extracts of the identified allergen.

Today, when carrying out specific hyposensitization, more advanced drugs with a prolonged mechanism of action are used.

Compared to previously used water-salt extracts, modern therapeutic allergens have many advantages:

• They are virtually free of side effects;
• They have an enhanced therapeutic effect on the body;
• They have a minimal degree of allergenicity.

An example can be given.

Drugs for ASIT therapy are selected individually for each patient with allergies.

They can be:

• injection;
• in the form of drops or tablets;
• for sublingual administration.

ASIT principle

When conducting ASIT therapy, a microscopic dose of an allergen extract, that is, a substance to which the body is hypersensitive, is introduced into the human body in different ways.

The dose of the allergen is increased gradually and this helps reduce hypersensitivity.

It has been established that an allergic reaction occurs as a consequence of certain changes in the human immune system. At the same time it comes out into the blood a large number of immunoglobulins IgE and antibodies from class E, which are specific for each specific allergen.

The contact of immunoglobulins and antibodies with the allergen causes the development of all allergy symptoms.

Allergen immunotherapy causes several changes in the body. This treatment method causes the activation of lymphocytes responsible for the production of positive immunoglobulins IgE, and at the same time reduces the production of those lymphocytes that form antibodies.

As a result, the connection between the allergen and immunoglobulin is blocked, and conditions that contribute to the triggering of a hypersensitivity reaction are eliminated.

ASIT therapy:

1. Eliminates allergy symptoms;
2. Improves quality of life;
3. Provides long-term remission;
4. Prevents the transition of mild forms of allergic reactions to more severe ones - anaphylactic shock, Quincke's edema, asthma;
5. It prevents the occurrence of hypersensitivity to other types of allergens;
6. Leads to a dose reduction and, in mild cases, allows one to completely abandon antiallergic treatment.

The effect of specific hyposensitization is determined by a dozen factors, including the individual reaction of each person.

In some patients, a noticeable improvement in general well-being appears after completing the first course of ASIT therapy.

For others only after a few years course treatment stable remission occurs.

But repeated courses of treatment with therapeutic allergens are always necessary; their duration and frequency are determined by an allergist.

Specific immunotherapy is carried out in two stages:

• The first stage is the initiating phase. The main task at this stage is to achieve the maximum tolerated dose of the therapeutic allergen. The patient is gradually injected with increasing concentrations of the allergen drug at short intervals.
• The second phase, supporting. The goal is to achieve stable remission. At this stage, the time intervals between which the maximum, always stable, dose of the allergen is introduced are expanded.

Indications for Asit therapy

The effectiveness of allergen immunotherapy has been proven in the treatment of patients with:

• Seasonal allergies and hay fever;
• Year-round rhinitis allergic origin;
• An allergic reaction to the poison secreted by Hymenoptera;
• Bronchial asthma.

ASIT therapy is prescribed under the following conditions:

• If complete cessation of contact with the allergen is impossible. This applies to cases of allergies to pollen, reactions to.
• The allergen has been accurately identified;
• Allergies develop when the body is exposed to no more than three allergens.

Contraindications

Specific hyposensitization, like any other treatment method, has its contraindications.

Absolute contraindications to ASIT therapy include:

• Active malignant process in organism;
• Severe pathologies of the immune and cardiovascular systems;
• Mental illness;
• Somatic diseases in the stage of decompensation;
• Pregnancy. However, if immunotherapy for allergies was started before pregnancy, it is not recommended to interrupt its course;
• The patient's age is up to 5 years.

ASI therapy is not prescribed to patients if they have:

• , that is, allergies develop from exposure to more than three types of irritants;
• Urticaria and Quincke's edema;
• Allergy to fungal spores, mold, ;
• Allergic reaction to non-pathogenic microflora.

With the pathologies and diseases listed above, the load on the immune system is increased several times, and additional stimulation of the immune system can lead to undesirable consequences.

By whom and where is ASIT therapy performed?

ASIT therapy should be carried out in medical institution. The injections are administered by a nurse with the appropriate certificate. An allergist should monitor the patient’s condition.

Order of conduct

The effectiveness of hyposensitization of the body and the absence of side effects from treatment depends on how correctly all stages of allergen immunotherapy are followed.

The doctor must tell the patient how to prepare the body, during what period the medications can be used, and what needs to be done after their administration.

Patient preparation.

The timing of ASIT therapy is planned in advance. The start of drug administration should occur during the period of remission of the disease.

When it comes to seasonal allergies, allergen immunotherapy is usually prescribed for the autumn-winter months.

For year-round reactions to allergens, treatment is carried out against the background of a basic course of therapy, but remission of the disease must be achieved.

Patient preparation includes:

1. Conducting to identify a specific allergen;
2. Avoiding contact (or reducing it to the bare minimum) with the identified allergen;
3. Stop taking antihistamines. For mild forms of allergies, it is recommended to stop taking medications 7 days before ASIT therapy; for severe forms, 3 days before.

During the period of administration of therapeutic allergens, a person must be absolutely healthy.

Rules that must be followed.

To minimize possible negative reactions for therapeutic allergens must be observed following rules:

• Carry out the procedure strictly in medical office where everything is medications to provide emergency assistance. This point is especially mandatory when carrying out the first manipulations.
• Stay in a medical facility under the supervision of a nurse or doctor for at least an hour after the drug is administered.
• Inform medical staff about any, even minor, changes in your health.
• When using allergen extracts on your own, strictly follow all the recommendations of your doctor.

Schemes for ASIT therapy.

Allergen immunotherapy regimens are selected individually, but any of them is divided into simulating and maintenance phases.

Hyposensitization courses are repeated several times. Usually three or four courses are carried out.

Forms of treatment with ASIT therapy.

Therapeutic allergens are currently administered in two ways: subcutaneous injection and sublingual.

With the subcutaneous method of ASIT therapy, allergens are administered once every 2-6 weeks.

The sublingual method involves the use of solutions or sublingual tablets.

Today, sublingual ASIT therapy is considered the most effective and safe.

Tablets and solutions are more easily tolerated by small children, and the therapeutic allergen is quickly absorbed by the mucous membrane and immediately activates the immune system.

But for the sublingual method, in addition to the main ones listed, there are a number of contraindications, these are:

• Ulcerative lesions and erosion of the oral cavity;
• Periodontal diseases;
• Rehabilitation period after surgical interventions in the oral cavity;
• Inflammatory diseases organs of the oral cavity;
• Gingivitis with bleeding gums.

To enhance ASIT therapy, in some cases immunomodulatory drugs are prescribed.

What are special prolonged allergens?

Long-acting allergens are those drugs whose effect lasts for a long time.

That is, they will affect the human immune system for a sufficiently long period of time, which allows the specific immune response to foreign proteins to change to normal.

The introduction of prolonged allergens is different least amount adverse reactions. Therefore, these drugs are suitable for prescribing ASIT therapy even to overly sensitive patients.

When to expect the effect of the procedure.

Carrying out immunotherapy with allergens in most patients improves their overall well-being after completion initial course, that is, in a few months.

A series of courses of ASIT therapy over several years sometimes leads to the complete elimination of allergic reactions.

In allergology, a number of indicators are used, the assessment of which will help determine the effectiveness of allergen-specific immunotherapy. This is primarily a decrease in IgE compared to tests performed before the start of therapy.

The use of ASIT therapy allows you to achieve:

• Relieving symptoms of allergic reactions. The severity of the disease decreases with each course, and the reaction to the allergen may completely disappear after several years of treatment;
• Reducing the frequency of use of antiallergic drugs;
• Transition of severe forms of allergies to milder ones;
• Significant improvement vitality and well-being.

Age restrictions.

ASIT therapy is not given to children under 5 years of age. There is no upper age limit, but it is still better to carry out this treatment for people no older than 60 years.

Possible adverse reactions

Therapeutic allergens undergo controlled studies and are released into production only with a small percentage of identified side effects.

But this does not guarantee that an individual intolerance reaction will not occur; it can be local and systemic.

TO local manifestations side effects of ASIT therapy include the appearance of changes at the injection site, these are:

• Swelling;
• Hyperemia;

The systemic reaction manifests itself:

• Quincke's edema;
• Anaphylactic shock;
• An attack of bronchial asthma.

In addition, it is often observed general deterioration well-being, expressed by headache, aches in muscles and joints, discomfort throughout the body.

A systemic reaction is considered dangerous to the body, which is why it is so important to be under medical supervision for the first 60 minutes after administration of the drug.

If a healthcare professional detects signs indicating hypersensitivity to therapeutic allergens, he will quickly provide the necessary medication assistance, it is:

• In applying a tourniquet above the injection site;
• By applying adrenaline directly to the area of ​​the previous injection;
• When administering aminophylline into a vein for bronchospasm;
• In the intravenous administration of antishock and antihistamine drugs.

If symptoms of systemic intolerance develop outside the walls of a medical facility, then it is imperative to call an ambulance.

Measures to reduce adverse reactions

In order to reduce the likelihood of side effects, it is necessary to comply with all conditions for ASIT therapy.

First of all, it is necessary to establish the absence of all contraindications to treatment; it is imperative to find out the causative allergen.

During the period of immunotherapy with allergens, the patient must be completely healthy.

Allergists advise starting to follow hypoallergenic therapy a few days before ASIT therapy. It is advisable to adhere to it throughout the course of treatment.

Symptomatic drugs prescribed in addition

During specific hyposensitization, the allergist must monitor the patient and evaluate any changes in well-being.

If necessary, the doctor prescribes additional medications, these may be:

In addition to these medications, the allergist may prescribe other medications to help cope with negative side reactions.