Preface
SectionI Basics
Chapter1 Allergen Immunotherapy ina Historical Perspective
Chapter2 Definition of an Allergen(Immunobiology)
Chapter3 Allergen Nomenclature
Chapter4 Immunological Responsesto Subcutaneous Allergen Immunotherapy
Chapter5 Immunologic Responses toSublingual Allergen Immunotherapy
Chapter6 Immunologic Responses toOral Allergen Immunotherapy
Chapter7 In Vivo Testing for Allergic Diseases
Chapter8 Serological (In Vitro) Testing Methods in theDiagnosis of Human Allergic Disease
Section II Allergens:Inhalation, Ingested, and Injected
Chapter9 Tree Pollen Allergens
Chapter10 Grass Pollen Allergens
Chapter11 Weed Pollen Allergens
Chapter12 Fungal Allergens
Chapter13 Mite Allergens
Chapter14 Cockroach and OtherInhalant Insect Allergens
Chapter15 Mammalian Allergens
Chapter16 Food Allergens
Chapter17 Hymenoptera Allergens
Chapter18 Biting Insect and TickAllergens
Chapter19 Occupational Allergens
Section III ImmunotherapyTechniques: Preparation and Administration of Subcutaneous and SublingualAllergen Immunotherapy
Chapter20 Standardized Allergen Vaccines in the United States
Chapter21 Manufacturing and Standardizing Allergen Extracts in Europe
Chapter22 Preparing Subcutaneous Allergen Vaccines
Chapter23 Preparing and Administering Sublingual Allergen Vaccines
Chapter24 Subcutaneous Administration of Allergen Vaccines
Chapter25 Administration of Sublingual Vaccines
Chapter26 Subcutaneous Immunotherapy for Allergic Rhinoconjunctivitis,Allergic Asthma, and Prevention of Allergic Diseases
Chapter27 Sublingual Immunotherapy for Allergic Rhinoconjunctivitis,Allergic Asthma, Food Allergy, and Prevention of Allergic Diseases
Chapter28 Oral Immunotherapy for Food and Latex Allergy
Chapter29 Immunotherapy for Hymenoptera Venom Hypersensitivity
Section IV Other Types ofImmunotherapy
Chapter30 Recombinant and Modified Vaccines and Adjuvants Used forAllergenImmunotherapy
Chapter31 Anti-IgE Therapy
Chapter32 Unproven and Controversial Forms of lmmunotherapy
Section V Prevention andManagement of Adverse Effects
Chapter33 Adverse Effects and Fatalities Associated with Allergen SkinTesting and Subcutaneous Allergen Immunotherapy
Chapter34 Adverse Effects Associated with Sublingual Immunotherapy
Chapter35 Adverse Effects Associated with Oral Allergen Immunotherapy
Chapter36 Recognition, Treatment, and Prevention of Anaphylaxis
Chapter37 Instruction and Consent Forms for Subcutaneous AllergenImmunotherapy
Chapter38 Information and Consent Forms for Sublingual and Oral AllergenImmunotherapy
Preface
Greetings and welcome to this fifth edition of Allergens and Allergen Immunotherapy:Subcutaneous, Sublingual, and Oral. The 5th edition has been particularlyrewarding because of the great progress made since the fourth edition waspublished in 2008. The book has grown from its first edition published in1991 with 13 chapters to the current fifth edition containing 38 chapters.
The authors of the chapters are literally a Who’sWho in the world of allergy and immunology as well as allergens and allergenimmunotherapy. What’s new in the fifth edition? Additional chapters have beenadded on Immunologic Responses to Oral Allergen Immunotherapy, in vitro Testingfor Allergic Diseases, Preparing Sublingual Allergen Vaccines, Recombinant andModified Vaccines, Adjuvants Used for Allergen Immunotherapy, and AdverseEffects Associated with Oral Allergen Immunotherapy. Each of the originalchapters is meticulously updated and referenced.
雖然花粉疫苗「注射療法」在20世紀初被引入臨床實踐，但該方法的發展根源於古代免疫功能的起源和演變。在此歷史背景下觀察過敏原免疫療法。在這個歷史背景下,過敏原免疫治療的賞析如下。
免疫作為一種自然發生的現象，早在公元前五世紀就被認識到，觀察到在雅典瘟疫期間從流行病中康復的人並沒有受到同樣第二次傷害。
通過應用自然原理，原型方法引入了由於故意暴露於病原體而導致的誘導免疫現象：（i）通過攝入亞毒性劑量誘導植物毒物的耐受性（密蘇拉德六世，公元前63年）和（ii）通過接觸從疾病病灶中回收的物質來防止天花（人痘接種；十一世紀中國醫治者）。
通過接種（i）輕度疾病的生物學相關病原體（疫苗），（ii）非致病性減毒微生物和（iii）滅活細菌，改良人痘接種誘導免疫，降低風險。儘管接種是一種相對無害的程序，但接種顯示了與免疫同時產生炎症效應的可能性（後來被定義為致敏機制）。
通過接種一系列亞致死劑量毒液來證明動物模型免受致命蛇毒的傷害，為開發抗微生物毒素的免疫方法和鑑定血清中的抗體產物（抗毒素）提供了介紹性途徑。
過敏反應的全身性休克反應，被發現為免疫不良反應，提供用於研究超敏反應是一種異常免疫現象的動物模型;特別相關的是激發致敏豚鼠，其呼吸表現提示人類花粉熱和哮喘的對應表現。由於過敏性抗體的暫時耗盡，在休克恢復後出現難治性狀態，導致通過反覆注射遞增耐受劑量的抗原，發展了「脫敏」方法。
由於錯誤認為季節性花粉熱是由草花粉毒素引起的，因此通過連續注射花粉溶液產生血清抗毒素來誘導免疫，引入了過敏原免疫治療的概念。該方法隨後被定義為逆轉花粉蛋白致敏的方法。並通過使用來自各種空氣傳播的季節性和常年的過敏原疫苗，擴大了範圍。
與超敏反應和脫敏治療相關的血清因子分別被區分為皮膚致敏抗體（ssa）和沉澱抗體（pa）。同時誘發的沉澱抗體的存在及皮膚致敏抗體水平的升高，與天然存在的特應性疾病反應相同，在注射過敏原疫苗之後引起與治療相關的局部和體質性反應。
在過敏原免疫療法中，當脫敏被認為不可獲得如動物過敏模型一樣的效果時，其目的是誘導弱化（低）的致敏。對減敏過敏原注射劑產生的抗體的研究證明了其化學性質及其「阻斷」皮膚致敏（反應）抗體與過敏原的反應，以解釋推測的相關免疫機制。
水包油乳劑中摻入過敏原疫苗的佐劑效應被證明具有作為超免疫功能，誘導漿細胞腫瘤增殖的內在潛力，因此在過敏原免疫治療中是禁忌的。
過敏性藥物反應性（如青黴素和胰島素）的脫敏是通過一種特殊的免疫治療注射的緊急方案完成的，該免疫治療注射旨在影響半抗原抑制的機制。
Chapter1
Allergen Immunotherapy ina Historical Perspective
Although 「injection treatments」 with pollenvaccines were introduced into clinical practice in the early 1900s, developmentof the method is rooted in the genesis and evolution of immune function datingback to antiquity. An appreciation of allergen immunotherapy viewed in thishistorical context follows.
Immunity, as a naturally occurring phenomenon,was recognized as early as the fifth century bc, with the observation thatthose who recovered from epidemic illness during the plague of Athens were notsimilarly stricken a second time .
By applying the principles of nature, prototypemethods introduced the phenomenon of induced immunity as a result of deliberateexposure to causative agents: (i)tolerance to plant poisons by ingestion of subtoxic doses (Mithradates VI, 63bc) and (ii) protection from smallpoxby contact with material recovered from disease lesions (variolation;11th-century Chinese healers).
Modification of variolation introduced methodsfor induc-ing immunity with reduced risk by inoculations of (i) biologically related agent of milddisease (vaccination ), (ii)nonpathogenic attenuated microorganisms, and (iii) killed bacteria . In spite of being a relatively harmlessprocedure, inoculation demonstrated a potential for producing inflammatoryeffects concurrent with immunity (later defined as sensitization mechanisms).
Demonstration of protection of an animal modelfrom lethal snake venom by inoculation series of sublethal doses provided theintroductory approach to the development of methods for immunization againstmicrobial toxins and identification of the antibody product, antitoxin, inblood serum .
Systemic shock reaction of anaphylaxis—discoveredas an adverse effect of immunization —provided animal models for the study ofhypersensitivity as an aberrant immune phenomenon ; particularly relevant wasthe challenged-sensitized guinea pig whose respiratory manifestations suggesteda counterpart expression of human hay fever and asthma. Discovery of refractorystate following recovery from shock—attributed to temporary depletion ofanaphylactic antibody —led to the development of the method of 「desensitization」by repeated injections of incremental tolerated doses of antigens.
In the erroneous belief that seasonal hay feverwas caused by grass pollen toxin, serial injections of pollen solutions—designedto induce immunity by production of serum anti-toxin—introduced the concept ofallergen immunotherapy. This method was subsequently defined as an approach toreverse sensitization to pollen proteins and expanded in scope by employingvaccines derived from a variety of air-borne seasonal and perennial allergens .
Serum factors associated with hypersensitivityand desensitization treatments were differentiated as skin-sensitizing antibody(ssa) and precipitating antibody (pa), respectively. Detection of concurrent inductionof pa and increase in levels of ssa—identical with naturally occurring atopicdisease reagins—following injections of allergen vaccines accounted for localand constitutional reactions associated with therapy.
Desensitization, as effected in animalanaphylactic models, when recognized as not attainable in allergenimmunotherapy, aimed at the objective of inducing diminished (hypo)sensitization. Studies of antibody raised by allergen-hyposensitizinginjections demonstrated its chemical properties and its 「blocking」 of reactionsof skin-sensitizing (reaginic) antibodies with allergens to explain putativeresponsible immune mechanisms.
Demonstrated adjuvant effect of allergen vaccineincorporated in oil-in-water emulsion had the inherent potential for inducingplasma cell neoplastic proliferation as a function of hyperimmunization, andwas thus contraindicated in allergen immunotherapy.
Desensitization of anaphylactic drug reactivity(e.g., penicillin and insulin) was accomplished by a special rush protocol ofimmunotherapeutic injections designed to affect the mechanism of hapteninhibition.
以上內容來自博卡生物副總經理黃志堅對《過敏原和過敏原免疫治療（第5版）》第一章內容的要點翻譯，後續將連載更多章節的譯文，敬請關注！