title: New routes of allergen immunotherapy.
abstract: OBJECTIVE
  Allergen immunotherapy is the only cure for immunoglobulin E mediated type I respiratory allergies. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are the most common treatments. In this article, we reviewed new routes of allergen immunotherapy.
  
  
  METHODS
  Data on alternative routes to allow intralymphatic immunotherapy (ILIT), epicutaneous immunotherapy (EPIT), local nasal immunotherapy (LNIT), oral immunotherapy (OIT), and oral mucosal immunotherapy (OMIT) were gathered from the literature and were discussed.
  
  
  RESULTS
  ILIT features direct injection of allergens into lymph nodes. ILIT may be clinically effective after only a few injections and induces allergen-specific immunoglobulin G, similarly to SCIT. A limitation of ILIT is that intralymphatic injections are required. EPIT features allergen administration by using patches mounted on the skin. EPIT seeks to target epidermal antigen-presenting Langerhans cells rather than mast cells or the vasculature; this should reduce both local and systemic adverse effects. LNIT involves the spraying of allergen extracts into the nasal cavity. Natural or chemically modified allergens (the latter, termed allergoids, lack immunoglobulin E reactivity) are prepared in a soluble form. OIT involves the regular administration of small amounts of a food allergen by mouth and commences with low oral doses, which are then increased as tolerance develops. OMIT seeks to deliver allergenic proteins to an expanded population of Langerhans cells in the mucosa of the oral cavity.
  
  
  CONCLUSIONS
  ILIT, EPIT, LNIT, OIT, and OMIT are new routes for allergen immunotherapy. They are safe and effective.
authors.affiliation: Meram Medical Faculty, Necmettin Erbakan University, Konya Turkey.
authors.forename: Mitat
authors.initials: M
authors.lastname: Aricigil
authors.forename: Nuray Bayar
authors.initials: NB
authors.lastname: Muluk
authors.forename: Engin Umut
authors.initials: EU
authors.lastname: Sakarya
authors.forename: Emine Güven
authors.initials: EG
authors.lastname: Sakalar
authors.forename: Mehmet
authors.initials: M
authors.lastname: Senturk
authors.forename: William R
authors.initials: WR
authors.lastname: Reisacher
authors.forename: Cemal
authors.initials: C
authors.lastname: Cingi
mesh_terms: D000818:Animals; D017951:Antigen Presentation / Q000187:drug effects*; D003888:Desensitization, Immunologic / Q000379:methods*; D004333:Drug Administration Routes; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000628:therapy*; D018928:Immunity, Mucosal; D007073:Immunoglobulin E / Q000378:metabolism; D007801:Langerhans Cells / Q000276:immunology* / Q000637:transplantation; D042601:Lymphatic Vessels / Q000187:drug effects*
chemical_list: D007073:Immunoglobulin E