АЛЛЕРГЕН-СПЕЦИФИЧЕСКАЯ ИММУНОТЕРАПИЯ: ТЕРАПЕВТИЧЕСКИЕ ВАКЦИНЫ ДЛЯ АЛЛЕРГИЧЕСКИХ ЗАБОЛЕВАНИЙ

Наиболее эффективным методом лечения аллергии является аллерген-специфическая иммунотерапия (АСИТ), которая заключается в введении малых доз антигена, ответственного за развитие состояния у конкретного пациента. При этом происходит десенсибилизация организма к этому антигену. История применения АСИТ насчитывает более 100 лет, и за это время накоплена огромная доказательная база по использованию метода в клинической практике. Применение АСИТ приводит к уменьшению симптомов и потребности в лечении и, кроме того, имеет потенциал для долгосрочного клинического эффекта, предотвращая развитие аллергии и ее симптомов. Лечение действует на основные иммунологические механизмы, ответственные за развитие клинической симптоматики. АСИТ – противовоспалительное, патогенетическое и профилактическое лечение аллергических заболеваний дыхательных путей. В обзоре проанализированы результаты важнейших клинических исследований применения АСИТ для лечения аллергических заболеваний органов дыхания (аллергический ринит и бронхиальная астма). Рассматриваются различные схемы проведения АСИТ, различные ее варианты (инъекционная и сублингвальная АСИТ), вопросы выбора препарата для АСИТ из имеющихся на сегодняшний день на фармацевтическом рынке, критерии отбора пациентов и вопросы использования современных достижений молекулярной аллергодиагностики (картирования аллергенной сенсибилизации пациента на молекулярном уровне) для их оптимизации. Рассмотрен вопрос об иммунологических механизмах АСИТ, имеющиеся сведения о которых на сегодняшний день достаточно противоречивы. Эффект АСИТ реализуется через следующие основные иммунологические механизмы: подавление увеличения концентрации эозинофилов, уменьшение продолжительности фазы замедленной гиперчувствительности, также с помощью инициации и поддержания перехода от Th2к Th1-подобному иммунологическому ответу. Регуляторные T-клетки играют основную роль в иммунологической реализации механизма АСИТ, они оказывают значительное влияние на подавление Th2-ответа. Одним из механизмов, с помощью которого это происходит, является увеличение производства специфических антител IgG, в первую очередь, подтипа IgG4. Смещение баланса между IgE и IgG4 в сторону продукции IgG4 считается на сегодняшний день принципиально важным условием для успешной АСИТ. Доказано, что аллерген-специфические IgG4 антитела против IgE сохраняются после прекращения лечения и могут обеспечить долгосрочную клиническую толерантность. Рассмотрены перспективы создание новых форм и разновидностей лекарственных препаратов для АСИТ. До клинической практики на настоящий момент дошли две группы препаратов для АСИТ: аллергены и аллергоиды (аллергены, химически модифицированные путем обработки формальдегидом с целью повышения их иммуногенности и снижения частоты побочных аллергических реакций, возникающих при их применении). Отдельно рассматриваются иммунологические механизмы СЛИТ (сублингвальной иммунотерапии). СЛИТ является на сегодняшний день наиболее безопасным и перспективным вариантом АСИТ, ее применение наиболее целесообразно в педиатрической практике.

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