Sublingual Immunotherapy for Inhalant Allergens
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Sublingual Immunotherapy
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One of the necessary steps in understanding behavior is to adequately classify the existing patterns associated with that behavior. The literature contains evidence for at least three common subtypes of inhalant users: (a) young inhalant users, (b) adolescent polydrug users who frequently use inhalants and (c) adult users. Several national and regional data sources are examined for the presence of these types and the categorization is generally upheld. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com]
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The only disease-modifying treatment that is available for allergic patients is allergen-specific immunotherapy. Two competing application forms are used: subcutaneous immunotherapy, which has been used for > 90 years, and a relatively new immunotherapy where the allergen is applied sublingually. Numerous studies have shown efficacy for subcutaneous immunotherapy and have identified possible mechanisms that are responsible for the observed reduction in allergic responses. In contrast, the efficacy of sublingual immunotherapy has not been documented to the same degree and the responsible immunological mechanisms have not yet been clearly defined. This review focuses on the published clinical and experimental data on sublingual immunotherapy and points at possible mechanisms of how sublingual immunotherapy may differ from subcutaneous immunotherapy in its mode of action, and also discusses the potential advantages and pit falls of both therapies.
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THE PROVOCATIVE inhalant test is a deliberate intracutaneous injection of a potent inhalant extract of sufficient quantity and strength to provoke a mild systemic reaction, and the immediate injection of weaker (or, occasionally, stronger) dilutions of the identical antigen to relieve the provoked symptoms. Lee's experience with foods led him to believe that provocative testing for inhalants was feasible and would be of distinct value in testing and treatment, especially when the patient failed to show improvement with serial dilution antigen titration technique. Provocative inhalant testing is done for house dust, molds, animal danders, and the pollens of trees, grasses, and weeds. Atmospheric contaminants vary with seasonal changes. In inhalant-sensitive patients, sensitivities will show great variations with seasonal change and pollen toxicity. Foods can be controlled in the diet, but inhalants cannot be controlled by the patient. It is the opinion of the senior author that provocative testing and
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While the rate of inhalant abuse continues to rise in this country, it remains one of the least studied or discussed groups of abused substances. This review focuses on the current knowledge of the epidemiology, pharmacology, and sequela of inhalant abuse. We will discuss three groups of inhalants: volatile solvents, nitrous oxide, and nitrites. We will then conclude by proposing means by which inhalant abuse may be prevented and treated.
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