TOXICITY OF PENICILLIN.
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Hyposensitization was introduced in 1911 and after nearly 70 years of this kind of immunotherapy the mechanisms involved are still obscure. Although some results may be conflicting, there is much evidence from many placebo-controlled studies that hyposensitization has a beneficial effect in patients with allergic diseases. A critical view of the immunological effects shows that increased local and systemic tolerance to the injected allergens seems to be caused by many mechanisms. The injection treatment apparently triggers the synthesis of so-called blocking antibodies, reduces IgE production and may influence the mode of macrophage presentation of allergenic determinants to the immunocompetent lymphocyte and/or the stimulation of T suppressor cells. Considering these assumptions, the understanding and probably the future of hyposensitization depends on the production of better characterized allergen extracts and on the development of simple methods for the monitoring of immunologic effects during therapy.
Ants, bees, and other stinging hymenoptera can induce serious anaphylactic reactions in susceptible individuals. Certainly, hymenoptera venom contains potent antigens that have been useful in testing and treating hymenoptera-sensitive patients who fail to acquire protection from whole body extract therapy. However, before whole body extracts are forever abandoned, their antigen content and stability should be re-examined by means of modern immunologic methods.
Control of seasonal symptoms by means of a preventive and easy to use (only one intradermal injection eight weeks before the pollen peak) immunotherapy, is recommended nowadays. We verified the clinical efficacy of E.P.D. (Enzyme Potentiated Desensibilization) in a double-blind, placebo-controlled study. This particular immunotherapy consists of an intradermal injection mix, made up of allergenic extracts at extremely low doses and an enzyme called beta-glucuronidase. The vaccine is administered once a year, eight weeks before pollen peaks. We studied a group of 40 patients allergic to grass pollen. The results, analysed statistically on the basis of a symptoms score, showed good clinical efficacy and a significant reduction of drug consumption during the high pollen period. Due to the clinical effectiveness, easy administration (only on injection) and excellent tolerance of the immunotherapy, E.P.D. is particularly suited for the prevention of seasonal symptoms in patients allergic to grass pollen.
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Immunotherapy in allergic rhinitis should be initiated only when other efforts at elimination and treatment of symptoms prove ineffective. The indications become more convincing if symptoms of bronchial hyperreactivity and asthma are also present. General preconditions which must be fulfilled prior to treatment are the establishing of a precise diagnosis, and that the allergen planned for treatment must play a decisive part in the disease. The main contra-indications are other, concurrent immunological diseases, and pregnancy.
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