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    Epicutaneous immunotherapy may transform allergy treatment

    Evolving EPIT procedures may help treatment options within optometry

    As an allergy sufferer myself, I tend to pore over the journals and literature to learn what new exciting technologies may be on the horizon. My understanding and grasp of content can have limitations. Nevertheless, that does not hinder my thirst to take a deep dive into these new technologies. When I came across epicutaneous immunotherapy (EPIT), my mind went in a multitude of different directions about the endless possibilities for both systemic and ocular allergy management.

    Previous treatments

    Before breaking down new technology, it is always a good idea to take a step back and look at the previous methodology.

    Previously from Dr. Cooper: How to combat vernal keratoconjunctivitis

    Prior to EPIT, allergen-specific immunotherapy (SIT), subcutaneous immunotherapy (SCIT), and sublingual immunotherapy (SLIT) responses are mediated by a level of immune deviation of Th2 to Th1 by increasing the number of regulatory T cells.1–3 With less immune reactivity and tolerance to an allergen, the literature suggests this translates to less IgE and IgG4 concentration.3–6

    These delivery systems can be effective, but they do have drawbacks. SCIT or “allergy shots,” developed over a century ago by Leonard Moon, features two disadvantages: it is time consuming with a need for 30 to 70 medical visits, and it causes localized and systemic side effects due to exposure to the bloodstream.7–10

    Related: How to improve diagnosis and treatment of allergy

    Sublingual therapy has ameliorated some of these concerns through targeted allergen therapy into the dendritic cells of the nasal mucosa by a multi-layered epithelium.11,12 Normally, allowing an allergen to diffuse in the deeper layers including the mast cells would stimulate local oral side effects; however, by avoiding direct penetration into the blood vasculature by injection these effects can be diminished or eliminated.11,12

    Michael S. Cooper, OD
    Michael S. Cooper, OD, is in private practice in Willimantic, CT. He is a consultant to Allergan, BioTissue, Johnson & Johnson Vision ...

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