Oral presentations Satellite Symposium ALLERGOLOGY CURRENT POSSIBILITIES IN THERAPY OF ALLERGIC DISEASES – FROM GENE TO CLINICAL EFFICIENCY Shifting the balance between anti-inflammatory pharmacotherapy with glucocorticoids and specific immunotherapy in asthma and allergic rhinitis

Asthma and allergic rhinitis are Ig-E mediated diseases characterized by chronic airway inflammation. The key role in IgE-dependent allergic rhinitis and asthma management is played by methods inhibiting allergic inflammation: either in a nonspecific way as glucocorticoids (GCs) or in a specific way as specific immunotherapy (SIT). So far clinical practice has given priority to pharmacological methods with GCs, especially inhaled GCs (GCs-IH), because they powerfully suppress the early and late airway inflammatory response, improve the pulmonary function, reduce airway hyperreactivity and successfully control these disease reducing their morbidity and mortality. In the widely accepted pharmacology-oriented therapeutic paradigm, SIT has been viewed as a second or third-line treatment. The so far minor importance of SIT in asthma and rhinitis treatment has been due to relatively insufficient knowledge of SIT’s mechanisms, and its remote and poorly documented therapeutic effects. Recent years have brought, however, new data about the mechanisms by means of which SIT evokes immunity to allergens. Numerous studies have confirmed the method’s high efficacy, additionally stressing its long-lasting effects persisting after cessation of the treatment and pointing out its preventive properties like: lesser occurrence of asthma in rhinitis patients who were administered SIT, and reduction in the occurrence of new allergisations. The fact that among the available method SIT is the only allergen-specific one, that is causal and specifically targeted at IgE-dependent diseases, makes us perceive SIT in asthma and rhinitis management not as a furtherline but a complementary treatment. The growing importance of SIT also results from the recognized limitations of inhaled GCs’ therapy: the impossibility of the therapy’s permanent curative effect, adverse effects of GCs’ higher doses, unavailability of new drugs characterized by a potent local anti-inflammatory action, and limited perspectives of the method’s further dynamic development. Contrary to GCs pharmacotherapy, SIT is making a rapid progress, which is promising with regard to the prospects of its growing efficacy and safety; among SIT’s latest advanced strategies are: adjuvants such as monophoshoryl lipid A or nucleotide immunostimulatory sequences derived from bacteria that potentiate “antiallergic” Th1 responses, genetically modified non-IgE binding recombinant allergens, and allergen derived peptides. In view of the recent dynamic developments of SIT we can predict a continuation of the shit of balance from GCs therapy towards SIT.