1. Epicutaneous immunotherapy Boonthorn 4 december 2009

4. Specific immunotherapy: current meta-analysis (Sc IT) Enrico C. et al., Ann Allergy Asthma Immunol. 2009;102:22–28 Source Patients Characteristics Outcomes Abramson et al 2003 1,064 adults and children Meta-analysis of RCT of asthma Double-blind, single-blind, and open studies 75 studies for outcomes (36 with HDM , 20 pollen, 10 animal dander, 2 Cladosporium mould allergy, 1 latex, and 6 multiple allergens) significant improvements in asthma symptom scores Calderon et al, 2007 1,063 adults Meta-analysis of randomized DBPC studies of rhinitis 15 studies for outcomes (a variety of allergens were administered: ragweed, mixed grass, timothy, Parietaria , birch, orchard, cedar, Bermuda grass, Juniperus ashei , and Cocos Symptom scores , Medication scores were reduced in the immunotherapy

5. Meta-analysis ( SL IT ) Enrico C. et al., Ann Allergy Asthma Immunol. 2009;102:22–28 Source Patients Characteristics Outcomes Calamita et al 2006 303 adults and children Meta-analysis of randomized placebo-controlled,open and blinded studies of asthma 9 studies (5 with pollen and 4 with mites) no significant reduction in asthma symptoms Penagos et al 2008 441 children Meta-analysis of randomized DBPC studies of asthma 9 studies for the outcomes (6 with mites and 3 with pollens) Overall, there was a significant reduction in symptoms Olaguibel et al 2005 256 children Meta-analysis of randomized DBPC clinical trials of respiratory asthma or allergic rhinitis 7 studies for the outcomes Decreased symptom and m edication scor e Penagos et al 2006 484 children Meta-analysis of randomized DBPC studies of AR 10 studies for the outcomes (6 with pollens and 4 with HDM ) There were significant reductions in symptom scores Wilson et al 2005 959 adults and children Meta-analysis of randomized DBPC studies of AR 22 studies for the outcomes (6 with HDM , 5 grass pollen, 5 Parietaria , 2 olive, and 1 ambrosia, cat, and cupressaceous Overall there were significant reductions in symptoms

6. Efficacy of specific immunotherapy (SIT). Summary of meta-analysis results expressed as effect size on symptoms. ( SMD, standardized mean difference ) Enrico C. et al., Ann Allergy Asthma Immunol. 2009;102:22–28

7. Immunological mechanism Nat Rev Immunol 2006;6:761-71

8. Mechanisms of allergic reactions Nat Rev Immunol 2006;6:761-71

9. Effects of allergen-specific immunotherapy on clinical and experimental i mmune parameters Nat Rev Immunol 2006;6:761-71

10. Proposed role of regulatory T cells and cytokines in allergen-specific immunotherapy Nat Rev Immunol 2006;6:761-71

35. Results J Allergy Clin Immunol 2009;124:997-1002

36. Safety and tolerability 10 pts . used topical corticosteroids for total duration of 13 +/- 20 days J Allergy Clin Immunol 2009;124:997-1002

38. Subjective symptom scores J Allergy Clin Immunol 2009;124:997-1002