Does allergen immunotherapy alter the natural course of allergic disorders?

Allergy in patients with atopy is caused by clinical adverse reactions to environmental antigen, which is often associated with allergen-specific immunoglobulin (Ig)E production. Since allergy reflects an inappropriate immunological reaction, a therapeutic approach related to immunology is likely to actively alter the natural course of allergic disorders. Allergen immunotherapy, known at various times as desensitisation or hyposensitisation, is very recently defined by the World Health Organization as therapeutic vaccines for allergic diseases. At present, it has become a common clinical practice in selected patients for the treatment and prevention of the recurrence of allergic disorders caused by insect venoms and has proven to be effective in changing the course of allergic responses induced by grass and tree pollen, animal hair and dander, house dust mite and mold, as demonstrated by improvement in clinical symptoms, skin prick test and medication scores. Reported effects of allergen immunotherapy on the natural course of allergic disorders include (i) prevention of reaction following re-sting in insect venom allergy; (ii) prevention or decrease the rate of the natural progress of allergic rhinitis to asthma; and (iii) inhibition of new sensitisation in monosensitised children. Many aspects of the immune responses associated with allergic disorders, including antibody production, cytokine secretion, T cell activation and local inflammatory reactions, are found to be significantly altered during and/or after immunotherapy. Specifically, the ratio of allergen-specific IgG4 to IgG1 correlates well with positive clinical outcome caused by allergen immunotherapy in patients with pollen-allergy. Allergen immunotherapy affects the cytokine profile of allergen-specific T cells and switches T(H)2 type immune responses in patients with atopy towards T(H)0 or T(H)1 type responses. Although the changes in the absolute value of T(H)1 or T(H)2 cytokines appear quite variable, the increase in the ratio of T(H)1/T(H)2 cytokines is very consistent among published reports, especially in the late stage of treatment. Accumulating evidence indicates that appropriate immunotherapy prevents the onset of new sensitisation and prevents the progress of allergic rhinitis to asthma. Although the changes in B cell and T cell responses, especially IgG antibodies and T(H)1/T(H)2 cytokine production, may be the major mechanism underlying the clinical efficacy of allergen immunotherapy and the prevention of the development of allergic phenotypic changes, multiple mechanisms may be involved in the outcome of alteration of the natural course of allergic disorders.

Normal human immunoglobulin G4 is bispecific: it has two different antigen-combining sites

Unlike other immunoglobulin G (IgG) subclasses, IgG4 antibodies in plasma have been reported to be functionally monovalent. In this paper we show that the apparent monovalency of circulating IgG4 is caused by asymmetry of plasma IgG4. A large fraction of plasma IgG4 molecules have two different antigen-binding sites, resulting in bispecificity. Sera from patients with IgG4 antibodies to both house dust mite and grass pollen induced cross-linking of Sepharose-bound grass pollen antigen to radiolabelled house dust mite allergen Der p I. This bispecific binding activity was not observed in sera with IgG4 antibodies to either grass pollen or house dust mite exclusively. Depletion of IgG4 antibodies resulted in disappearance of the bispecific activity. By size exclusion chromatography we excluded the possibility that bispecific activity was caused by aggregation of IgG4 antibodies. These results indicate that circulating (polyclonal) IgG4 antibodies have two different antigen-binding sites and therefore are functionally monovalent antibodies.

In vitro production of IgG4 by peripheral blood mononuclear cells (PBMC): the contribution of committed B cells

IgG4 and IgE isotypes contribute marginally to the pool of circulating antibodies in healthy individuals, but are elevated during atopic diseases and particularly upon helminth infections. To examine whether the high levels of these isotypes in circulation are reflected in a higher capacity of PBMC to produce IgG4 and IgE, we examined cells from patients infected with filarial nematodes that exhibit high levels of IgG4 and IgE. Indeed, IgG4 production by PBMC correlated strongly with plasma levels of IgG4 (r=0.534, P=0.002), but such correlation was not found for IgE. The replacement of CD19+ cells from PBMC by IgD+ cells abrogated the high capacity of PBMC to make IgG4. This indicates that an altered B cell compartment accounts for the high IgG4-producing capacity of the PBMC. The high production of IgG4 in vitro was not dependent on IL-4 and IL-13, as neutralizing antibodies to these cytokines did not inhibit IgG4. However, IgE release by PBMC was dependent on IL-4 and IL-13. Antifilarial IgG4 was detected in culture supernatants from filarial patients and its production was independent of IL-4 and IL-13. These results demonstrate that in individuals with elevated IgG4. the B cell compartment in PBMC carries cells that are already committed to IgG4 production and are independent of IL-4 and IL-13.

Mouse/human chimeric IgG1 and IgG4 antibodies directed to the house dust mite allergen Der p 2: use in quantification of allergen specific IgG

BACKGROUND AND OBJECTIVE

Chimeric mouse/human monoclonal IgG1 and IgG4 antibodies were developed against the house dust mite allergen Der p 2. These chimeric IgG antibodies, hIgG1-Dp2 A and hIgG4-Dp2 A, have the same binding characteristics as the previously reported chimeric hIgE-Dp2 A and are composed of the heavy chain variable domains and light chains of the original murine monoclonal antibody 2B12, whereas the heavy chain constant domains have been replaced by the human IgG1 or IgG4 heavy chain. The expression level of hIgG1-Dp2 A and hIgG4-Dp2 A was 1 and 3.5 microg/mL, respectively.

METHODS AND RESULTS

Since all IgG in these culture supernatants is allergen-specific, they are useful reference reagents and enable the calculation of the amount of allergen specific IgG1 and IgG4 antibodies in absolute IgG amounts. The results obtained with two panels of sera from patients in immunotherapeutic treatment were evaluated and compared in Der p 2 IgE, IgG1 and IgG4 RAST and with reversed IgG4 RAST using labelled purified Der p 2. Close agreement between the results for the two IgG4 assays was found.

CONCLUSION

With these chimeric reference reagents the quantities of isotype specific antiallergen antibodies can be calculated and compared.