The efficacy of allergen immunotherapy for the treatment of allergic rhinoconjunctivitis with or without seasonal bronchial asthma and anaphylaxis caused by the sting of the hymenoptera class of insects has been clearly demonstrated in numerous well-designed, placebo-controlled trials. Immunotherapy whether by subcutaneous injection of allergen extract or by oral/sublingual routes modifies peripheral and mucosal TH2 responses in favour of TH1 responses and augments IL-10 synthesis by TRegs both locally and by peripheral T cells. Recent researches into the cellular and molecular basis of allergic reactions have advanced our understanding of the mechanisms involved in allergic diseases. They have also helped the development of innovative approaches that are likely to further improve the control of allergic responses in the future. Novel approaches to immunotherapy that are currently being explored include the use of peptide-based allergen preparations, which do not bind IgE and therefore do not activate mast cells, but reduce both TH1 and TH2-cytokine synthesis, while increasing levels of IL-10. Alternative strategies include the use of adjuvants, such as nucleotide immunostimulatory sequences derived from bacteria CpG or monophosphoryl lipid A that potentiate TH1 responses. Blocking the effects of IgE using anti-IgE such as omalizumab, a recombinant humanized monoclonal antibody that selectively binds to IgE, has been shown to be a useful strategy in the treatment of allergic asthma and rhinitis. The combination of anti-IgE-monoclonal antibody omalizumab with allergen immunotherapy has proved beneficial for the treatment of allergic diseases, offering improved efficacy, limited adverse effects, and potential immune-modifying effects. This combination may also accelerate the rapidity by which immunotherapy induces TReg cells. If allergic diseases are due to a lack of allergen-specific TReg cells, then effective therapies should target the induction and the development of TReg cells producing cytokines such as IL-10.

Food allergy is responsible for most frequent allergic reactions in children under one year of age. Diagnostic tests such as skin test or specific IgE assay commonly need highly purified preparations of allergenic proteins. The aim of the present work was to purify three main proteins; casein, alpha-lactalbumin and beta-lactoglobulin allergenic extracts. First, casein was isolated by isoelectric precipitation of skimmed fresh milk serum or whey. Purification of alpha-lactalbumin was based on fractionittion of whey proteins by ammonium sulphate and gel filtration on a Sephadex G-50 column. Beta-lactoglobulin was purified by polyethylene glycol fractionation of whey proteins and ion exchange chromatography on a DEAE-Sepharose column. The isolated proteins were analyzed by polyacrylamide gel from fresh skimmed milk by hydrochloric acid were more soluble in weak alkaline water and purer than the other preparations. Purity of extracts in SDS-PAGE was estimated 95 percent. SDS-PAGE result of isolated alpha-lactalbumin and beta-lactoglobulin and reaction of these products with specific antibodies produced in immunized rabbits showed that they are highly pure. Electrophoretic pattern of purified alpha-lactalbumin or beta-lactoglobulin were composed of a -Singleband, in 14 or 18 KD respectively. In the present investigation three major milk proteins were highly purified. These products can be used in specific tests, i.e. skin test or ELISA.

Allergen-specific immunotherapy (AIT) involves administering allergen extracts. It is used to desensitize allergic patients. Herbal allergen extracts that are optimum in efficacy and fewest in side effects are still challenging to produce. To overcome these limitations, oral immunotherapy, epicutaneous immunotherapy, intralymphatic immunotherapy, and artificial recombinant allergen preparations have been evaluated. Recombinant allergens have become more popular with the development of molecular diagnostics and therapeutics. Besides food and drug allergens, pollen, fungal spores, and other allergens have been studied. Based on related clinical studies, this comprehensive overview will present the latest perspectives on AIT methods and available allergenic products, as well as discuss the challenges and opportunities for treating allergic disorders.

Since 20th century, when allergy was defined, an ongoing attempt for discovering the mechanisms underlying it and its treatment began. Defining allergens as well as cells such as regulatory T-cells and characterizing the antibodies involved in the pathogenesis (including blocking antibodies) have helped very much towards a better understanding of the immunologic process.However, Allergen specific immunotherapy (SIT), as a specific curative treatment for allergy also dates back to the beginning of the previous century and has progressed considerably during these years. SIT similar to natural immunomodulation, directs the immune response towards tolerance.New strategies in this field, such as using recombinant allergens, T- and B-cell-epitope-containing peptides, and DNA vaccination have shown promising results. Sublingual immunotherapy, although not yet FDA-approved, as an alternative strategy in SIT has demonstrated efficacy as well as safety.Furthermore, allergen extracts, their standardization and their modification have also been the focus of much research. Undoubtedly, specific immunotherapy is proven to be an efficacious method to treat allergy, so its cost-effectiveness should be estimated in developing countries in order to include it in the country's health priorities. Informing physicians about the new anti-vaccination movement is also crucial.

Background: Skin test using a pure and sterile extract proper allergen substances is one of the most sensitive and important procedures for the diagnosis of environmental allergic agents. However, these extracts are expensive and always are not available. This study was conducted to compare the Iranian and French (Standard) extracts of chenopodium album by Prick skin test in Tehran Children Medical Center in 2002. Materials and Methods: This analytical double blind study was conducted on 100 volunteers (aged 20-58: 54 males , 46 females). Patients who had a severe disease, atopy or taking antihistamins or anticonvulsants were excluded from the study. All the patients, had positive histamine tests. Patients who showed an skin inflation more than 4 mm in diameter considered as positive control and patients who showed no reaction were considered as negative control. Three different dilutions of both extracts were tested in Prick procedure on ulnar area of both arms by a physician. Kind of reaction such as inflation and redness was observed and noted after 20 minutes. Inflation more than 3mm associated with redness around it was considered as a positive reaction. Results: In the study none of the subjects had positive reaction in 100-fold dilution of extracts. In 10-fold dilutions 4 positive reactions (diameter 3-6 mm), and 6 positive reactions (diameter 3-5 mm) with the standard and Iranian extracts were observed respectively. On the other hand, 17 positive reactions (3-10 mm) and 22 positive reactions (3-10 mm) with the Standard and Iranian undiluted extracts were observed respectively. The specificity and sensitivity of the Iranian undiluted extract was 92.7% and 94% respectively and the correlation coefficient between the two extracts was 0.78. Conclusion: Due to the high The sensitivity and specificity of the Iranian extract and the degree of concordance between these two it can be suggested that the Iranian extract can be substituted for the standard extract. The use of undiluted Iranian extract is recommended.

EDITOR: We read with great interest the article of Yadzir et al. 1 We would like to underline some adjunctive topics in favor of serum allergen-specific IgE (sIgE) assessment in AR patients management. Component resolved diagnostics (CRD) is particularly useful in AR management to correctly define real allergy, so to prescribe the causal allergen for AIT. We would like to remark another important consideration: polysensitization should not be an obstacle for AIT prescription. There is a belief that AIT is contraindicated in polysensitized patients, but a series of studies evidenced that AIT (with 1-2 allergen extracts) may be effective in polysensitized patients. 2 The reason is that thorough allergy work-up, including sIgE assay, usually allows the causal allergen(s) to be defined....