23Other study…Durham 1998, reportedreduce of IL-4 and IL-5;increase of IFN-γ andIL-2 as well as reduceof IgE and increase IgGresulted in the diminishlate phase reaction(JACI 1998;102:157-64)IL-2Prof Ariyanto Harsono MD PhDSpA(K)
Prof Ariyanto Harsono MD PhDSpA(K)29•Effective in Seasonal allergic rhinitis•Less effective in perennial allergic rhinitis•Mark improvement in tolerance of catexposure
Prof Ariyanto Harsono MD PhDSpA(K)30•Common indication in North America andEurope•Meta analysis 1954-1998: beneficial effect•DBPC: 60-75% reduce of symptom score inpatients with grass pollen allergy•Economic analysis: less cost than pharmaco-therapy
31GROUPControlSub-cutan ITSub-lingual ITMean181614121086PEFR Variability Pre(%)PEFR Variability Post (%)Study from Surabaya(Harsono. Fol Med Indones 2003;39:223-7)Prof Ariyanto Harsono MD PhDSpA(K)
Prof Ariyanto Harsono MD PhDSpA(K)33-5051015Group A Group B Group CIL_5IL_2Reduced of IL-5 correlate with significant increased of IL-2Analysis of discriminant
Prof Ariyanto Harsono MD PhDSpA(K)34The improvement of FEV-1 reversibility is acumulative result of 4 factors• decreased IL-4, enhances inhibition of IgE production.• decreased IL-5, enhances inhibition of eosinophilmaturation in the stem cell, chemo taxis, and prolonged lifespan.• increased IFN-γ enhances isotype switching ofimmunoglobuline production in favor of IgG subclassinstead of IgE.• increased IL-2 enhances the affinity maturation anddifferentiation of B cells giving rise to the generation of Bmemory cells and antibody secreting plasma cellsproducing IgG.
Prof Ariyanto Harsono MD PhDSpA(K)35Conclusion Immunotherapy in asthmatic childrenresults in elevation of IFN-γ and IL-2, diminishIL-4 and IL-5. Addition of inhaled corticosteroid toimmunotherapy results in marked attenuationof IL-5 correlates with greater elevation ofIL-2 and play an important role in themodulation of immune response resulting inthe improvement of FEV-1 reversibility.
Prof Ariyanto Harsono MD PhDSpA(K)36•Reduce development of Rhinitis toasthma•Reduce developing new sensitization•Prevent allergic children from going onto develop asthma•Rhinitis symptom seem to show moresustain relief
Prof Ariyanto Harsono MD PhDSpA(K)381. The primary mechanism of action is ashift in the balance of Th-1 and Th-2cytokine expression in the allergen-challenged site.2. Allergen IT is highly form of treatmentof IgE mediated diseases.3. Highly effective for allergic rhinitis andhypersensitivity to wasp and beevenom.4. Consideration for primary use inasthma is still controversial in regardsthe potential development of adverseevent.