Chemical immunology and allergy最新文献

Specific immunotherapy was introduced for the treatment of grass pollen-induced hay fever in 1911. The treatment was soon extended to other pollens as well as perennial allergens, and to the treatment of bronchial asthma. Definitive studies of its efficacy for both rhinitis and asthma came only many decades later. Understanding gradually emerged of the underlying immunologic mechanisms that include the generation of regulatory T lymphocytes, immune deviation from allergen-specific Th2 to Th1 responses, and a shift in allergen-specific antibody production from immunoglobulin (Ig) E to IgG4. Along with understanding of the immune basis came an appreciation that immunotherapy modifies allergic disease expression, producing protection against disease progression and symptomatic improvement that persists for years after the treatment is discontinued. Recent new directions for immunotherapy include sublingual administration of inhalant allergens and use of the oral route to treat food allergy.

This review of the major milestones in the history of ocular allergy and immunology shows how significantly this subdiscipline has contributed to the tremendous progress in the understanding of mechanisms of allergic and immunologic diseases, as well as in their better management. It also indicates unmet needs and priority areas for future research.

Over the last 2,000 years a variety of terms have been used for the description of phenomena possibly related to allergy. Many have been forgotten, while some of them have remained. In Greco-Roman literature the term 'idiosyncrasy' was used to describe an individual characterization of a health condition, possibly comparable to 'constitution'. The same term was also used to describe individual reaction patterns, and the term 'antipathy' was used in a similar sense. 'Hypersensitivity' originated from the German word 'Überempfindlichkeit' and was first used in a medical sense by Emil von Behring when he described untoward reactions to his antitoxin containing serum therapy. 'Anaphylaxis' was coined by Richet and Portier to describe the new phenomenon of a life-threatening general pathogenic reaction after repeated injection of antigen. In 1906, Clemens von Pirquet introduced the term 'allergy' in order to bring more clarity to the confusing debate regarding protective and harmful immunity. In order to characterize the familial occurrence of hypersensitivity reactions such as asthma, hay fever and others, the American allergists A.F. Coca and R.A. Cooke introduced the term 'atopy'. Contrary to anaphylaxis, which was experimentally induced, this type of 'hypersensitiveness' occurred spontaneously. The nature of the pathogenic factor was called the 'atopic reagin' and was found to be transferable with serum by Prausnitz and Küstner. After the detection of immunoglobulin (Ig) E as the carrier of this type of hypersensitivity, the term 'atopy' gained a new sense, since IgE is a characteristic - yet not exclusive - parameter of the so-called atopic diseases. Clinically similar diseases such as asthma, rhinoconjunctivitis or eczema can be found in the absence of IgE, and are then called 'intrinsic' variants of the same disease.

In chronic inflammatory airway diseases such as asthma and chronic obstructive pulmonary disease (COPD), changes in bronchial microvasculature are present and contribute to airway wall remodeling. Angiogenesis and vascular leak seem to be prevalent in asthma, while vasodilatation and vascular leak seem to be prevalent in COPD. The functional meaning of bronchial vascular remodeling is not completely known. The increase in vessel number and size as well as the vascular leakage may concur to the thickening of the airway wall and to the narrowing of the bronchial lumen. Accordingly, pharmacological control of bronchial vascular remodeling may be crucial for symptom control in asthma and COPD. In asthmatic airways, steroids can downregulate vascular remodeling by acting on proangiogenic factors, whereas long-acting β2-agonists seem to be mostly effective in decreasing vascular permeability. In COPD, there is less available experimental evidence on the effect of the currently used drugs on airway microvascularity changes. Importantly, vascular endothelial growth factor, the most specific grow factor for vascular endothelium, is crucially involved in the pathophysiology of the airway vascular remodeling, both in asthma and COPD. The inhibition of vascular endothelial growth factor and its receptors has the potential for the treatment of the vascular changes in the airway wall.