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Alerjen Spesifik İmmünoterapi

Year 2015, Volume: 13 Issue: 1, 46 - 55, 01.06.2015

Şükrü Çekiç Nihat Sapan

https://doi.org/10.4274/jcp.02419

Abstract

Alerjen spesifik immünoterapi SİT , alerjik hastalıklarda kür sağlayabilen tek tedavi yöntemidir. Duyarlı olunan alerjenin belirli aralıklarla ve giderek artan dozlarda verilmesiyle bu alerjene karşı immüntolerans gelişmesi esasına dayanır. Alerjik hastalıkların tedavisinde, alerjenden korunma ve farmakoterapiden sonra gelir. İmmünoterapide klinik tablodan sorumlu, deri prik testi ya da spesifik immünglobulin E pozitifliği ile duyarlılığın gösterildiği alerjenler kullanılmalı ve tedavi alerji uzmanlarının yönetiminde yapılmalıdır. Çalışmalarda; immünoterapi ile astım bulgularında anlamlı iyileşme sağlandığı, hastalarda ilaç kullanımının azaldığı, rinitli hastalarda astım gelişimin önlendiği ve yeni duyarlanmaları azaltılabildiği gösterilmiştir. Önceki yıllarda sık görülen yan etkiler, standardize alerjen solüsyonlarının kullanıma girmesi ile azalmıştır. Ağır astımda kullanımı kontrendikedir, beta bloker ve anjiotensin konverting enzim AKE inhibitörü kullanımı olanlarda immünoterapiden kaçınılması önerilmekle birlikte mecbur kalınılan durumlarda fayda/zarar oranı dikkate alınarak başlanabileceği bildirilmektedir. En sık kullanılan subkütan ve sublingual yollar yanında, epikütan ve intralenfatik kullanım gibi yeni yöntemler geliştirilmektedir

Keywords

Alerji immünoterapi astım rinit

References

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  • 2. Noon L. Prophylactic inoculation against hay fever. Lancet 1911;1:1572-3.
  • 3. Freeman J. Further observations on the treatment of hay fever by hypodermic inoculations of pollen vaccine. Lancet 1911;2:814- 7.
  • 4. Pajno GB, Caminiti L, Vita D, Barberio G, Salzano G, Lombardo F, et al. Sublingual immunotherapy in mite-sensitized children with atopic dermatitis: a randomized, double-blind, placebo￾controlled study. J Allergy Clin Immunol 2007;120:164-70.
  • 5. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: A practice parameter third update. J Allergy Clın Immunol 2011;127:1-55.
  • 6. Cantani A, Arcese G, Lucenti P, Gagliesi D, Bartolucci M. A three-year prospective study of specific immunotherapy to inhalant allergens: evidence of safety and efficacy in 300 children with allergic asthma. J Investig Allergol Clin Immunol 1997;7:90-7.
  • 7. Metzger WJ, Turner E, Patterson R. The safety of immunotherapy during pregnancy. J Allergy Clin Immunol 1978;61:268-72.
  • 8. Rueff F, Przybilla B, Bilo MB, Müller U, Scheipl F, Aberer W, et al. Predictors of side effects during the build-up phase of venom immunotherapy for Hymenoptera venom allergy: the importance of baseline serum tryptase. J Allergy Clin Immunol 2010;126:105-11.
  • 9. Haeberli G, Bronnimann M, Hunziker T, Muller U. Elevated basal serum tryptase and hymenoptera venom allergy: relation to severity of sting reactions and to safety and efficacy of venom immunotherapy. Clin Exp Allergy 2003;33:1216-20.
  • 10. Robert E, Lenoir NC. Allergen immunotherapy: What can and cannot be mixed? J Allergy Clin Immunol 2008;122:659-60.
  • 11. Abramson MJ, Puy RM, Weiner JM. Allergen immunotherapy for asthma. Cochrane Database Syst Rev 2003;4:CD001186.
  • 12. Scadding GK, Brostoff J. Low dose sublingual therapy in patients with allergic rhinitis due to dust mite. Clin Allergy 1986;16:483- 91.
  • 13. Enrique E, Malek T, Pineda F, Palacios R, Bartra J, Tella R, et al. Sublingual immunotherapy for hazelnut food allergy: a follow￾up study. Ann Allergy Asthma Immunol 2008;100:283-4.
  • 14. de Boissieu D, Dupont C. Sublingual immunotherapy for cow’s milk protein allergy: a preliminary report. Allergy 2006;61:1238-9.
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  • 18. Mondoulet L, Dioszeghy V, Vanoirbeek JA, Nemery B, Dupont C, Benhamou PH. Epicutaneous immunotherapy using a new epicutaneous delivery system in mice sensitized to peanuts. Int Arch Allergy Immunol 2010;154:299–309.
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  • 21. Senti G, Prinz Vavricka BM, Erdmann I, Diaz MI, Markus R, McCormack SJ, et al. Intralymphatic allergen administration renders specific immunotherapy faster and safer: a randomized controlled trial. Proc Natl Acad Sci U S A 2008;105:17908-12.
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  • 23. Coop CA, Tankersley MS. Patient perceptions regarding local reactions from allergen immunotherapy injections. Ann Allergy Asthma Immunol 2008;101:96-100.
  • 24. Roy SR, Sigmon JR, Olivier J, Moffitt JE, Brown DA, Marshall GD. Increased frequency of large local reactions among systemic reactors during subcutaneous allergen immunotherapy. Ann Allergy Asthma Immunol 2007;99:82-6.
  • 25. Windom H, Lockey R. An update on the safety of specific immunotherapy. Curr Opin Allergy Clin Immunol 2008;8:571-6.
  • 26. Portnoy J, Bagstad K, Kanarek H, Pacheco F, Hall B, Barnes C. Premedication reduces the incidence of systemic reactions during inhalant rush immunotherapy with mixtures of allergenic extracts. Ann Allergy 1994;73:409-18.
  • 27. Stewart GE, Lockey RF. Systemic reactions from allergen immunotherapy. J Allergy Clin Immunol 1992;90:567-78.
  • 28. Amin HS, Liss GM, Bernstein DI. Evaluation of near-fatal reactions to allergen immunotherapy injections. J Allergy Clin Immunol 2006;117:169-75.
  • 29. Reid MJ, Lockey RF, Turkeltaub PC, Platts-Mills TA. Survey of fatalities from skin testing and immunotherapy 1985-1989. J Allergy Clin Immunol 1993;92:6-15.
  • 30. Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987;79:660-77.
  • 31. Bernstein DI, Wanner M, Borish L, Liss GM. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990- 2001. J Allergy Clin Immunol 2004;113:1129-36.
  • 32. Rank MA, Oslie CL, Krogman JL, Park MA, Li JT. Allergen immunotherapy safety: characterizing systemic reactions and identifying risk factors. Allergy Asthma Proc 2008;29:400-5.
  • 33. Ohashi Y, Nakai Y, Murata K. Effect of pretreatment with fexofenadine on the safety of immunotherapy in patients with allergic rhinitis. Ann Allergy Asthma Immunol 2006;96:600-5.
  • 34. Wang YH, Angkasekwinai P, Lu N, Voo KS, Arima K, Hanabuchi S, et al. IL-25 augments type 2 immune responses by enhancing the expansion and functions of TSLP-DC-activated Th2 memory cells. J Exp Med 2007;204:1837-47.
  • 35. Bilsborough J, Leung DY, Maurer M, Howell M, Boguniewicz M, Yao L, et al. IL-31 is associated with cutaneous lymphocyte antigen-positive skin homing T cells in patients with atopic dermatitis. J Allergy Clin Immunol 2006;117:418-25.
  • 36. Liew FY, Pitman NI, McInnes IB. Disease-associated functions of IL-33: the new kid in the IL-1 family. Nat Rev Immunol 2010;10:103-10.
  • 37. Akkoc T, de Koning PJ, Rückert B, Barlan I, Akdis M, Akdis CA. Increased activation-induced cell death of high IFNgamma- producing T(H)1 cells as a mechanism of T(H)2 predominance in atopic diseases. J Allergy Clin Immunol 2008;121:652-8.
  • 38. Meyer N, Zimmermann M, Bürgler S, Bassin C, Woehrl S, Moritz K, et al. IL-32 is expressed by human primary keratinocytes and modulates keratinocyte apoptosis in atopic dermatitis. J Allergy Clin Immunol 2010;125:858-65.
  • 39. Solarewicz-Madejek K, Basinski TM, Crameri R, Akdis M, Akkaya A, Blaser K, et al. T cells and eosinophils in bronchial smooth muscle cell death in asthma. Clin Exp Allergy 2009;39:845-55.
  • 40. Zimmermann M, Koreck A, Meyer N, Basinski T, Meiler F, Simone B, et al. TNF-like weak inducer of apoptosis (TWEAK) and TNF-alpha cooperate in the induction of keratinocyte apoptosis. J Allergy Clin Immunol 2011;127:200-7.
  • 41. Akdis C, Akdis M. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol 2011;127:18-27.
  • 42. Akdis M, Blaser K, Akdis CA. T regulatory cells in allergy: novel concepts in the pathogenesis, prevention, and treatment of allergic diseases. J Allergy Clin Immunol 2005;116:961- 9.
  • 43. Chatila TA, Blaeser F, Ho N, Lederman HM, Voulgaropoulos C, Helms C, et al. JM2, encoding a fork head-related protein, is mutated in X-linked autoimmunity-allergic disregulation syndrome. J Clin Invest 2000;106:75-81.
  • 44. Bennett CL, Christie J, Ramsdell F, Brunkow ME, Ferguson PJ, Whitesell L, et al. The immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX) is caused by mutations of FOXP3. Nat Genet. 2001;27:20-1.
  • 45. Akdis M, Verhagen J, Taylor A, Karamloo F, Karagiannidis C, Crameri R, et al. Immune responses in healthy and allergic individuals are characterized by a fine balance between allergen-specific T regulatory 1 and T helper 2 cells. J Exp Med 2004;199:1567-75.
  • 46. Meiler F, Zumkehr J, Klunker S, Rückert B, Akdis CA, Akdis M. In vivo switch to IL-10-secreting T regulatory cells in high dose allergen exposure. J Exp Med 2008;205:2887-98.
  • 47. Anderson AE, Mackerness KJ, Aizen M, Carr VA, Nguyen D, Du Pre F, et al. Seasonal changes in suppressive capacity of CD4+ CD25+ T cells from patients with hayfever are allergen-specific and may result in part from expansion of effector T cells among the CD25+ population. Clin Exp Allergy 2009;39:1693-9.
  • 48. Han D, Wang C, Lou W, Gu Y, Wang Y, Zhang L. Allergen￾specific IL-10-secreting type I T regulatory cells, but not CD4(+)CD25(+)Foxp3(+) T cells, are decreased in peripheral blood of patients with persistent allergic rhinitis. Clin Immunol 2010;136:292-301.
  • 49. Schandene L, Alonso-Vega C, Willems F, Gérard C, Delvaux A, Velu T, et al. B7/CD28-dependent IL-5 production by human resting T cells is inhibited by IL-10. J Immunol 1994;152:4368-74.
  • 50. Rak S, Hakanson L, Venge P. Immunotherapy abrogates the generation of eosinophil and neutrophil chemotactic activity during pollen season. J Allergy Clin Immunol 1990;86:706-13.
  • 51. Mauri C, Gray D, Mushtaq N, Londei M. Prevention of arthritis by interleukin 10- producing B cells. J Exp Med 2003;197:489-501.
  • 52. Ito S, Ansari P, Sakatsume M, Dickensheets H, Vazquez N, Donnelly RP, et al. Interleukin-10 inhibits expression of both interferon alpha- and interferon gamma- induced genes by suppressing tyrosine phosphorylation of STAT1. Blood 1999;93:1456-63.
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Allergen Specific Immunotherapy

Year 2015, Volume: 13 Issue: 1, 46 - 55, 01.06.2015

Şükrü Çekiç Nihat Sapan

https://doi.org/10.4274/jcp.02419

Abstract

Allergen specific immunotherapy SIT is the only treatment that can provide a cure for allergic disorders. This treatment is based on development of immune tolerance by exposure to allergen in repetitive and increasing doses. It is tertiary to avoidance of allergen and pharmacotherapy. Allergens used for immunotherapy, must be confirmed by skin prick test or specific IgE and must be applied in supervision of allergy specialists. Studies show that immunotherapy, improve asthma symptoms, decreases drug consumption, prevent development of asthma in rhinitis patients and reduce new sensitizations. Common side effects diminished with the usage of standardized allergen solutions. It is contraindicated in severe asthma. Though it is recommended to avoid immunotherapy in patients using beta blockers and ACE inhibitors, immunotherapy can be considered in mandatory situations regarding possible benefits and harms. Most common ways of administration are subcutaneous and sublingual; new methods such as epicutaneous and intralymphatic injections are currently being studied

Keywords

Allergy immunotherapy asthma rhinitis

References

  • 1. Kılıçturgay K. İmmünolojinin gelişimi. In; İmmünoloji. K Kılıçturgay (ed). Güneş ve Nobel Tıp Kitabevleri, Bursa, pp2, 1997.
  • 2. Noon L. Prophylactic inoculation against hay fever. Lancet 1911;1:1572-3.
  • 3. Freeman J. Further observations on the treatment of hay fever by hypodermic inoculations of pollen vaccine. Lancet 1911;2:814- 7.
  • 4. Pajno GB, Caminiti L, Vita D, Barberio G, Salzano G, Lombardo F, et al. Sublingual immunotherapy in mite-sensitized children with atopic dermatitis: a randomized, double-blind, placebo￾controlled study. J Allergy Clin Immunol 2007;120:164-70.
  • 5. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: A practice parameter third update. J Allergy Clın Immunol 2011;127:1-55.
  • 6. Cantani A, Arcese G, Lucenti P, Gagliesi D, Bartolucci M. A three-year prospective study of specific immunotherapy to inhalant allergens: evidence of safety and efficacy in 300 children with allergic asthma. J Investig Allergol Clin Immunol 1997;7:90-7.
  • 7. Metzger WJ, Turner E, Patterson R. The safety of immunotherapy during pregnancy. J Allergy Clin Immunol 1978;61:268-72.
  • 8. Rueff F, Przybilla B, Bilo MB, Müller U, Scheipl F, Aberer W, et al. Predictors of side effects during the build-up phase of venom immunotherapy for Hymenoptera venom allergy: the importance of baseline serum tryptase. J Allergy Clin Immunol 2010;126:105-11.
  • 9. Haeberli G, Bronnimann M, Hunziker T, Muller U. Elevated basal serum tryptase and hymenoptera venom allergy: relation to severity of sting reactions and to safety and efficacy of venom immunotherapy. Clin Exp Allergy 2003;33:1216-20.
  • 10. Robert E, Lenoir NC. Allergen immunotherapy: What can and cannot be mixed? J Allergy Clin Immunol 2008;122:659-60.
  • 11. Abramson MJ, Puy RM, Weiner JM. Allergen immunotherapy for asthma. Cochrane Database Syst Rev 2003;4:CD001186.
  • 12. Scadding GK, Brostoff J. Low dose sublingual therapy in patients with allergic rhinitis due to dust mite. Clin Allergy 1986;16:483- 91.
  • 13. Enrique E, Malek T, Pineda F, Palacios R, Bartra J, Tella R, et al. Sublingual immunotherapy for hazelnut food allergy: a follow￾up study. Ann Allergy Asthma Immunol 2008;100:283-4.
  • 14. de Boissieu D, Dupont C. Sublingual immunotherapy for cow’s milk protein allergy: a preliminary report. Allergy 2006;61:1238-9.
  • 15. Kerzl R, Simonowa A, Ring J, Ollert M, Mempel M. Life￾threatening anaphylaxis to kiwi fruit: protective sublingual allergen immunotherapy effect persists even after discontinuation. J Allergy Clin Immunol 2007;119:507-8.
  • 16. Bahçeciler NN, Özdemir C, Barlan I. Sublingual İmmünoterapi. Turkiye Klinikleri J Int Med Sci 2007;3:30-5.
  • 17. Werfel T. Epicutaneous allergen administration: a novel approach for allergen-specific immunotherapy? J Allergy Clin Immunol 2009;124:1003-4.
  • 18. Mondoulet L, Dioszeghy V, Vanoirbeek JA, Nemery B, Dupont C, Benhamou PH. Epicutaneous immunotherapy using a new epicutaneous delivery system in mice sensitized to peanuts. Int Arch Allergy Immunol 2010;154:299–309.
  • 19. Senti G, Graf N, Haug S, Rüedi N, von Moos S, Sonderegger T, et al. Epicutaneous allergen administration as a novelmethod of allergen-specific immunotherapy. J Allergy Clin Immunol 2009;124:997-1002.
  • 20. Mondoulet L, Dioszeghy V, Vanoirbeek JA, Nemery B, Dupont C, Benhamou PH. Epicutaneous Immunotherapy Using a New Epicutaneous Delivery System in Mice Sensitized to Peanuts. Int Arch Allergy Immunol 2011;154:299–309.
  • 21. Senti G, Prinz Vavricka BM, Erdmann I, Diaz MI, Markus R, McCormack SJ, et al. Intralymphatic allergen administration renders specific immunotherapy faster and safer: a randomized controlled trial. Proc Natl Acad Sci U S A 2008;105:17908-12.
  • 22. Martínez-Gómez JM, Johansen P, Erdmann I, Senti G, Crameri R, Kündig TM. Intralymphatic injections as a new administration route for allergen-specific immunotherapy. Int Arch Allergy Immunol 2009;150:59-65.
  • 23. Coop CA, Tankersley MS. Patient perceptions regarding local reactions from allergen immunotherapy injections. Ann Allergy Asthma Immunol 2008;101:96-100.
  • 24. Roy SR, Sigmon JR, Olivier J, Moffitt JE, Brown DA, Marshall GD. Increased frequency of large local reactions among systemic reactors during subcutaneous allergen immunotherapy. Ann Allergy Asthma Immunol 2007;99:82-6.
  • 25. Windom H, Lockey R. An update on the safety of specific immunotherapy. Curr Opin Allergy Clin Immunol 2008;8:571-6.
  • 26. Portnoy J, Bagstad K, Kanarek H, Pacheco F, Hall B, Barnes C. Premedication reduces the incidence of systemic reactions during inhalant rush immunotherapy with mixtures of allergenic extracts. Ann Allergy 1994;73:409-18.
  • 27. Stewart GE, Lockey RF. Systemic reactions from allergen immunotherapy. J Allergy Clin Immunol 1992;90:567-78.
  • 28. Amin HS, Liss GM, Bernstein DI. Evaluation of near-fatal reactions to allergen immunotherapy injections. J Allergy Clin Immunol 2006;117:169-75.
  • 29. Reid MJ, Lockey RF, Turkeltaub PC, Platts-Mills TA. Survey of fatalities from skin testing and immunotherapy 1985-1989. J Allergy Clin Immunol 1993;92:6-15.
  • 30. Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987;79:660-77.
  • 31. Bernstein DI, Wanner M, Borish L, Liss GM. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990- 2001. J Allergy Clin Immunol 2004;113:1129-36.
  • 32. Rank MA, Oslie CL, Krogman JL, Park MA, Li JT. Allergen immunotherapy safety: characterizing systemic reactions and identifying risk factors. Allergy Asthma Proc 2008;29:400-5.
  • 33. Ohashi Y, Nakai Y, Murata K. Effect of pretreatment with fexofenadine on the safety of immunotherapy in patients with allergic rhinitis. Ann Allergy Asthma Immunol 2006;96:600-5.
  • 34. Wang YH, Angkasekwinai P, Lu N, Voo KS, Arima K, Hanabuchi S, et al. IL-25 augments type 2 immune responses by enhancing the expansion and functions of TSLP-DC-activated Th2 memory cells. J Exp Med 2007;204:1837-47.
  • 35. Bilsborough J, Leung DY, Maurer M, Howell M, Boguniewicz M, Yao L, et al. IL-31 is associated with cutaneous lymphocyte antigen-positive skin homing T cells in patients with atopic dermatitis. J Allergy Clin Immunol 2006;117:418-25.
  • 36. Liew FY, Pitman NI, McInnes IB. Disease-associated functions of IL-33: the new kid in the IL-1 family. Nat Rev Immunol 2010;10:103-10.
  • 37. Akkoc T, de Koning PJ, Rückert B, Barlan I, Akdis M, Akdis CA. Increased activation-induced cell death of high IFNgamma- producing T(H)1 cells as a mechanism of T(H)2 predominance in atopic diseases. J Allergy Clin Immunol 2008;121:652-8.
  • 38. Meyer N, Zimmermann M, Bürgler S, Bassin C, Woehrl S, Moritz K, et al. IL-32 is expressed by human primary keratinocytes and modulates keratinocyte apoptosis in atopic dermatitis. J Allergy Clin Immunol 2010;125:858-65.
  • 39. Solarewicz-Madejek K, Basinski TM, Crameri R, Akdis M, Akkaya A, Blaser K, et al. T cells and eosinophils in bronchial smooth muscle cell death in asthma. Clin Exp Allergy 2009;39:845-55.
  • 40. Zimmermann M, Koreck A, Meyer N, Basinski T, Meiler F, Simone B, et al. TNF-like weak inducer of apoptosis (TWEAK) and TNF-alpha cooperate in the induction of keratinocyte apoptosis. J Allergy Clin Immunol 2011;127:200-7.
  • 41. Akdis C, Akdis M. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol 2011;127:18-27.
  • 42. Akdis M, Blaser K, Akdis CA. T regulatory cells in allergy: novel concepts in the pathogenesis, prevention, and treatment of allergic diseases. J Allergy Clin Immunol 2005;116:961- 9.
  • 43. Chatila TA, Blaeser F, Ho N, Lederman HM, Voulgaropoulos C, Helms C, et al. JM2, encoding a fork head-related protein, is mutated in X-linked autoimmunity-allergic disregulation syndrome. J Clin Invest 2000;106:75-81.
  • 44. Bennett CL, Christie J, Ramsdell F, Brunkow ME, Ferguson PJ, Whitesell L, et al. The immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX) is caused by mutations of FOXP3. Nat Genet. 2001;27:20-1.
  • 45. Akdis M, Verhagen J, Taylor A, Karamloo F, Karagiannidis C, Crameri R, et al. Immune responses in healthy and allergic individuals are characterized by a fine balance between allergen-specific T regulatory 1 and T helper 2 cells. J Exp Med 2004;199:1567-75.
  • 46. Meiler F, Zumkehr J, Klunker S, Rückert B, Akdis CA, Akdis M. In vivo switch to IL-10-secreting T regulatory cells in high dose allergen exposure. J Exp Med 2008;205:2887-98.
  • 47. Anderson AE, Mackerness KJ, Aizen M, Carr VA, Nguyen D, Du Pre F, et al. Seasonal changes in suppressive capacity of CD4+ CD25+ T cells from patients with hayfever are allergen-specific and may result in part from expansion of effector T cells among the CD25+ population. Clin Exp Allergy 2009;39:1693-9.
  • 48. Han D, Wang C, Lou W, Gu Y, Wang Y, Zhang L. Allergen￾specific IL-10-secreting type I T regulatory cells, but not CD4(+)CD25(+)Foxp3(+) T cells, are decreased in peripheral blood of patients with persistent allergic rhinitis. Clin Immunol 2010;136:292-301.
  • 49. Schandene L, Alonso-Vega C, Willems F, Gérard C, Delvaux A, Velu T, et al. B7/CD28-dependent IL-5 production by human resting T cells is inhibited by IL-10. J Immunol 1994;152:4368-74.
  • 50. Rak S, Hakanson L, Venge P. Immunotherapy abrogates the generation of eosinophil and neutrophil chemotactic activity during pollen season. J Allergy Clin Immunol 1990;86:706-13.
  • 51. Mauri C, Gray D, Mushtaq N, Londei M. Prevention of arthritis by interleukin 10- producing B cells. J Exp Med 2003;197:489-501.
  • 52. Ito S, Ansari P, Sakatsume M, Dickensheets H, Vazquez N, Donnelly RP, et al. Interleukin-10 inhibits expression of both interferon alpha- and interferon gamma- induced genes by suppressing tyrosine phosphorylation of STAT1. Blood 1999;93:1456-63.
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There are 67 citations in total.

Details

Primary Language Turkish
Journal Section Collection
Authors

Şükrü Çekiç

Nihat Sapan This is me

Publication Date June 1, 2015
Published in Issue Year 2015 Volume: 13 Issue: 1

Cite

APA Çekiç, Ş., & Sapan, N. (2015). Alerjen Spesifik İmmünoterapi. Güncel Pediatri, 13(1), 46-55. https://doi.org/10.4274/jcp.02419
AMA Çekiç Ş, Sapan N. Alerjen Spesifik İmmünoterapi. Güncel Pediatri. June 2015;13(1):46-55. doi:10.4274/jcp.02419
Chicago Çekiç, Şükrü, and Nihat Sapan. “Alerjen Spesifik İmmünoterapi”. Güncel Pediatri 13, no. 1 (June 2015): 46-55. https://doi.org/10.4274/jcp.02419.
EndNote Çekiç Ş, Sapan N (June 1, 2015) Alerjen Spesifik İmmünoterapi. Güncel Pediatri 13 1 46–55.
IEEE Ş. Çekiç and N. Sapan, “Alerjen Spesifik İmmünoterapi”, Güncel Pediatri, vol. 13, no. 1, pp. 46–55, 2015, doi: 10.4274/jcp.02419.
ISNAD Çekiç, Şükrü - Sapan, Nihat. “Alerjen Spesifik İmmünoterapi”. Güncel Pediatri 13/1 (June 2015), 46-55. https://doi.org/10.4274/jcp.02419.
JAMA Çekiç Ş, Sapan N. Alerjen Spesifik İmmünoterapi. Güncel Pediatri. 2015;13:46–55.
MLA Çekiç, Şükrü and Nihat Sapan. “Alerjen Spesifik İmmünoterapi”. Güncel Pediatri, vol. 13, no. 1, 2015, pp. 46-55, doi:10.4274/jcp.02419.
Vancouver Çekiç Ş, Sapan N. Alerjen Spesifik İmmünoterapi. Güncel Pediatri. 2015;13(1):46-55.