Sustained improvement of psoriatic lesions in the course of sublingual immunotherapy for airborne allergens: clinical evidence of cross-tolerance

D.S. Theodoropoulos, M.S. Morris, D.L. Morris

Allergy Associates of La Crosse, La Crosse, Wisconsin, USA. dtheodoropoulos@allergy-solutions.com

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• Dermatology

BACKGROUND: A patient with psoriasis is presented who was treated with sublingual immunotherapy for airborne allergens for allergic rhinitis. Allergic rhinitis and psoriasis have entirely different cytokine profiles and result from different aberrations of the immune response. Furthermore, T-cell activation in the two diseases uses different presentation systems, psoriasis being a CD8 cytotoxic cell response requiring presentation through the Major Histocompatibility Complex I, while allergic rhinitis and its treatment with sublingual immunotherapy depend on CD4 T-helper cells and presentation by the Major Histocompatibility Complex II. The rapid and impressive improvement of the psoriatic lesions in the presented patient may, along with evidence of subsiding Th1 activity, give rise to the hypothesis that tolerogenic-to-allergen changes induced by sublingual immunotherapy may induce cross-tolerance and the selective emergence of cytotoxic T cell clones with lessened psoriasis-producing activity.

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