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    Immunotherapy: Does it play a role in ocular allergy?

    Numerous clinical trials are under way that may help to define the role of immunotherapy in ocular allergy.


    By Paul Gomes

    Therapeutic approaches to ocular allergic disease are at a crossroad. Topical and systemic antihistamines have evolved to once-daily treatments that provide effective symptomatic relief to a large segment of the population, but for another group—perhaps as many as one-third of the 40 million people in the United States with seasonal or perennial allergy—none of the current treatments provide consistent relief.

    One therapeutic strategy common outside the United States is immunotherapy, a technique of re-training or desensitizing the immune system so that responses to common allergens such as pollen, animal dander, or dust mites are attenuated. Multiple immunotherapy trials are under way or recently completed in the United States, so it is a good time to consider this new technique and how it might impact therapy of allergic conjunctivitis.

    Diseases such as atopic dermatitis, rhinitis, and AC are a related group of disorders that—together with asthma—comprise what has been referred to as the atopic march. All of these conditions involve development of a type-2 regulatory T-cell response to common environmental allergens, leading to an inappropriate IgE production and immunological sensitization.

    When subsequently exposed to the allergenic culprit, these antibodies can initiate mast cell degranulation and the entire sequela of an allergic response. If the same antigen is exposed to dendritic cells or other antigen-presenting cells at low concentrations, it is possible to initiate a shift in the regulatory balance between the type-2 T-regs and the non-allergenic type-1 T-cells.

    Although this desensitization process is not completely understood, suppression of allergen-specific IgE production is also thought to be important in immunotherapy.1


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