title: Grass pollen immunotherapy: where are we now.
abstract: During allergen immunotherapy (AIT), the allergic patient is exposed to the disease-inducing antigens (allergens) in order to induce clinical and immunological tolerance and obtain disease modification. Large trials of grass AIT with highly standardized subcutaneous and sublingual tablet vaccines have been conducted to document the clinical effect. Induction of blocking antibodies as well as changes in the balance between T-cell phenotypes, including induction of regulatory T-cell subtypes, have been demonstrated for both treatment types. These observations increase the understanding of the immunological mechanism behind the clinical effect and may make it possible to use the immunological changes as biomarkers of clinical effect. The current review describes the recent mechanistic findings for subcutaneous immunotherapy and sublingual immunotherapy/tablet treatment and discusses how the observed immunological changes translate into a scientific foundation for the observed clinical effects of grass pollen immunotherapy and lead to new treatment strategies for grass AIT.
authors.affiliation: Department of Immunology, Global Research, ALK, Hørsholm, Denmark.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Würtzen
authors.affiliation: Department of Immunology, Global Research, ALK, Hørsholm, Denmark.
authors.forename: Shashank
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Immunology, Global Research, ALK, Hørsholm, Denmark.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brand
authors.affiliation: Department of Immunology, Global Research, ALK, Hørsholm, Denmark.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Andersen
mesh_terms: D000485:Allergens / Q000276:immunology*; D000818:Animals; D003233:Conjunctivitis, Allergic / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D006109:Poaceae / Q000276:immunology; D011058:Pollen / Q000276:immunology*; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: B-cell epitopes; T-cell epitopes; biomarkers; grass allergy; immunotherapy; mechanism of action; recombinant allergens