Immunotherapy of allergy: anergy, deletion, and immune deviation

Decreased allergen-specific T cell proliferation and dysregulated cytokine synthesis accompany allergen immunotherapy, consistent with mechanisms of anergy and immune deviation. Recent studies emphasise the pivotal role of decreased T cell IL-4:IFN-γ ratios. A landmark clinical trial of T cell epitope peptides for venom-immunotherapy shows efficacy and safety; murine models suggest intramolecular epitope-suppression inhibits responses to the whole allergen.