title: T-cell biology in immunotherapy.
abstract: OBJECTIVE
  This review discusses the current state of immunotherapy and how the CD4 T-cell response is pivotal in altering the allergic response.
  
  
  METHODS
  PubMed literature review.
  
  
  METHODS
  Articles pertaining to subcutaneous, sublingual, and oral immunotherapies, with specific emphasis on those describing the T-cell response.
  
  
  RESULTS
  Although many drugs are available that help ameliorate allergic symptoms, the only intervention that has proved to provide long-term benefit and modulation of disease is immunotherapy. Many routes of immunotherapy are being pursued, including subcutaneous, sublingual, and oral immunotherapies; however, subcutaneous immunotherapy has the historical record of leading to immune changes that alter the immune response at subsequent allergen exposure. These changes are mediated by the induction of peripherally derived T-regulatory cells and appear to occur only after high-dose therapy for 3 to 5 years. Newer methods of sublingual and oral immunotherapies are currently being investigated, but their efficacy is not yet on par with subcutaneous immunotherapy.
  
  
  CONCLUSIONS
  The primary cells ultimately responsible for successful immunomodulation are CD4 T cells, specifically peripherally derived T-regulatory cells.
authors.affiliation: Asthma and Allergic Disease Center, Carter Immunology Center, University of Virginia Health Systems, Charlottesville, Virginia. Electronic address: js3ch@virginia.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Steinke
authors.affiliation: Asthma and Allergic Disease Center, Carter Immunology Center, University of Virginia Health Systems, Charlottesville, Virginia.
authors.forename: Monica G
authors.initials: MG
authors.lastname: Lawrence
mesh_terms: D015704:CD4 Antigens / Q000378:metabolism; D003888:Desensitization, Immunologic / Q000379:methods; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000628:therapy*; D007167:Immunotherapy / Q000379:methods*; D007279:Injections, Subcutaneous; D016753:Interleukin-10 / Q000276:immunology; D053645:Interleukin-2 Receptor alpha Subunit / Q000378:metabolism; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*; D016212:Transforming Growth Factor beta / Q000276:immunology
chemical_list: D015704:CD4 Antigens; D053645:Interleukin-2 Receptor alpha Subunit; D016212:Transforming Growth Factor beta; D016753:Interleukin-10