2. Prof Ariyanto Harsono MD PhD
SpA(K)
2
First developed at St Mary Hospital
London at the end of 19th
century.
Basic Principle: Noon and Freeman
Cornerstone in the management of asthma
and allergic rhinitis
10. Prof Ariyanto Harsono MD PhD
SpA(K)
10
Transepithelial
delivery
Indirect proteolysis
of TJ protein
Direct proteolysis
of TJ protein
Der p1/Der f1 Der p1/Der f1 Der p1/Der f1
22. Prof Ariyanto Harsono MD PhD
SpA(K)
22
Pre Immunotherapy
Post Immunotherapy
J Allergy Clin Immunol 2004 • Volume 113 • Number 6 :1234-1237
23. 23
Other study…
Durham 1998, reported
reduce of IL-4 and IL-5;
increase of IFN-γ and
IL-2 as well as reduce
of IgE and increase IgG
resulted in the diminish
late phase reaction
(JACI 1998;102:157-64)
IL-2
Prof Ariyanto Harsono MD PhD
SpA(K)
29. Prof Ariyanto Harsono MD PhD
SpA(K)
29
•Effective in Seasonal allergic rhinitis
•Less effective in perennial allergic rhinitis
•Mark improvement in tolerance of cat
exposure
30. Prof Ariyanto Harsono MD PhD
SpA(K)
30
•Common indication in North America and
Europe
•Meta analysis 1954-1998: beneficial effect
•DBPC: 60-75% reduce of symptom score in
patients with grass pollen allergy
•Economic analysis: less cost than pharmaco-
therapy
33. Prof Ariyanto Harsono MD PhD
SpA(K)
33
-5
0
5
10
15
Group A Group B Group C
IL_5
IL_2
Reduced of IL-5 correlate with significant increased of IL-2
Analysis of discriminant
34. Prof Ariyanto Harsono MD PhD
SpA(K)
34
The improvement of FEV-1 reversibility is a
cumulative result of 4 factors
• decreased IL-4, enhances inhibition of IgE production.
• decreased IL-5, enhances inhibition of eosinophil
maturation in the stem cell, chemo taxis, and prolonged life
span.
• increased IFN-γ enhances isotype switching of
immunoglobuline production in favor of IgG subclass
instead of IgE.
• increased IL-2 enhances the affinity maturation and
differentiation of B cells giving rise to the generation of B
memory cells and antibody secreting plasma cells
producing IgG.
35. Prof Ariyanto Harsono MD PhD
SpA(K)
35
Conclusion
Immunotherapy in asthmatic children
results in elevation of IFN-γ and IL-2, diminish
IL-4 and IL-5.
Addition of inhaled corticosteroid to
immunotherapy results in marked attenuation
of IL-5 correlates with greater elevation of
IL-2 and play an important role in the
modulation of immune response resulting in
the improvement of FEV-1 reversibility.
36. Prof Ariyanto Harsono MD PhD
SpA(K)
36
•Reduce development of Rhinitis to
asthma
•Reduce developing new sensitization
•Prevent allergic children from going on
to develop asthma
•Rhinitis symptom seem to show more
sustain relief
37. Prof Ariyanto Harsono MD PhD
SpA(K)
37
UK 1957-1986: 26 fatal cases 17 for
asthma
5-35% systemic reactions for asthma
Contra indications:
•Auto-immune disease
•Malignancy
•Cardiac disease
•Patients receiving beta blocker
38. Prof Ariyanto Harsono MD PhD
SpA(K)
38
1. The primary mechanism of action is a
shift in the balance of Th-1 and Th-2
cytokine expression in the allergen-
challenged site.
2. Allergen IT is highly form of treatment
of IgE mediated diseases.
3. Highly effective for allergic rhinitis and
hypersensitivity to wasp and bee
venom.
4. Consideration for primary use in
asthma is still controversial in regards
the potential development of adverse
event.
