title: Basic science for the clinician: Mechanisms of sublingual and subcutaneous immunotherapy.
abstract: To discuss the general immunologic changes that occur during immunotherapy, focusing on the differences between subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT).
  
  
  
  PubMed literature review.
  
  
  
  Articles pertaining to SCIT and SLIT, with specific emphasis on those that included immune mechanistic studies.
  
  
  
  Both SCIT and SLIT are characterized by the induction of regulatory B and T cells, decreased allergen-specific T-cell proliferation, a shift from a TH2 to TH1 cytokine milieu and from an IgE to an IgG4/IgA antibody response. These changes are accompanied by clinical improvement in symptoms.
  
  
  
  Immunotherapy using allergen extracts administered via both subcutaneous and sublingual approaches have demonstrated efficacy in the treatment of allergic rhinoconjunctivitis and other allergic conditions. There are subtle differences between the approaches, and understanding these differences may help clinicians select a preferred route of therapy for particular patients or allergens, depending on the immune response that is being targeted.
authors: Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia; Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
authors: Monica G
authors: MG
authors: Lawrence
authors: Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia; Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Carter Immunology Center, University of Virginia Health System, Charlottesville, Virginia.
authors: John W
authors: JW
authors: Steinke
authors: Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia; Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Carter Immunology Center, University of Virginia Health System, Charlottesville, Virginia; Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia. Electronic address: lb4m@virginia.edu.
authors: Larry
authors: L
authors: Borish
mesh_terms: D000485:Allergens / Q000008:administration & dosage / Q000276:immunology; D017951:Antigen Presentation / Q000276:immunology; D016175:B-Lymphocyte Subsets / Q000276:immunology / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism; D003713:Dendritic Cells / Q000276:immunology / Q000378:metabolism; D003888:Desensitization, Immunologic / Q000379:methods*; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology* / Q000628:therapy*; D056747:Immunomodulation; D007279:Injections, Subcutaneous; D008213:Lymphocyte Activation / Q000276:immunology; D063729:Sublingual Immunotherapy / Q000379:methods; D037182:T-Cell Antigen Receptor Specificity; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000378:metabolism; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology / Q000378:metabolism
chemical_list: D000485:Allergens; D016207:Cytokines