IMMUNOLOGY TEXTBOOK - Mercury Podillia 2013

BASIC PRINCIPLES OF IMMUNODEFICIENCY TREATMENT

Diseases and Complications Caused by Immunotherapy and Immunoprophylaxis

Immunotherapy (IT) and immunoprophylaxis (IP) can sometimes induce specific diseases. These are typically caused by increased body reactivity leading to allergic and pseudo-allergic reactions, decreased reactivity resulting in immunodeficiencies, Metabolic Disorders, and enzyme deficiencies. Depending on the type of IT, the following conditions are distinguished:

- diseases caused by active immunotherapy and IP (post-vaccination complications, see below);

- diseases resulting from passive IT (anaphylactic Shock, serum sickness);

- immunomodulation pathology: a) immunosuppressive syndrome, b) immunostimulation syndromes (allergic, autoimmune, and lymphoproliferative disorders), c) unpredictable pathological immunomodulations (due to impaired receptor expression or secretion of immunotropic factors);

- other non-specific complications (metabolic, toxic, etc.).

Pathology of immunomodulation, which encompasses immunosuppression and immunostimulation syndromes, occurs quite frequently in cases of inappropriate or incorrect use of immunotherapeutic agents. The Use of immunomodulators always implies the suppression of certain branches of The Immune System while stimulating others. To prevent complications, It is important to monitor both suppressive and stimulatory effects to ensure they do not become pathological.

Immunosuppression carries the risk of complications such as bacterial, fungal, and viral infections. Furthermore, the stronger the immune suppression, the higher the probability of their occurrence. When immunosuppressants are applied topically, complications primarily appear at the site of administration due to the suppression of local defense reactions and altered tissue METABOLISM. For example, The Use of corticosteroid aerosols induces mucosal candidiasis of the respiratory tract.

Immunostimulation syndrome clinically manifests as allergic and autoimmune diseases. Specific manifestations include various Clinical forms of drug allergy (anaphylactic shock, urticaria, angioedema, toxicoderma, visceral lesions). These reactions can follow an immediate or delayed type and may be either genuinely allergic or pseudo-allergic. Adverse drug reactions frequently induce autoimmune diseases as well (systemic lupus erythematosus, autoimmune hemolytic anemias, leukopenias, etc.). Immunostimulation can also trigger lymphoproliferative syndromes (lymphomas, lymphocytic leukemias, etc.).

The use of immunotherapeutic drugs may lead to complications such as the hyperstimulation of a specific link in the immune system, or conversely, the inhibition of the synthesis of certain immune factors, as well as allergic reactions to impurities resulting from insufficient drug purification. These effects manifest as various disorders—metabolic, toxic, and allergic—caused by changes not only in immune system Functions but also in the nervous and endocrine systems.

Toxic and metabolic complications are very often caused by the direct action of the immunotherapeutic agent on the target tissue. Most drugs cause complications characteristic of their specific profile.

Cytostatics inhibit Cell proliferation and hematopoiesis; glucocorticosteroids alter all Types of Metabolism, leading to a range of complications; the immunomodulator levamisole (decaris) inhibits leukopoiesis, causing agranulocytosis and Skin rashes, among other effects. Many Adverse effects of immunomodulators are related to their insufficiently selective tropism for the immune system and their unintended impact on other Organs and systems. Recombinant, genetically engineered drugs—such as interferons and interleukins—typically cause fever, malaise, leukopenia or leukocytosis, and other adverse effects.

To prevent complications of immunotherapy and immunoprophylaxis, scientifically sound rationale, clear indications, and a thorough evaluation of potential contraindications are essential. This applies to both prophylactic anti-infective immunization and anti-relapse immunoprophylaxis in allergies, immunomodulation, and immunosuppressive therapy. Active immunotherapy is generally contraindicated in most acute, severe diseases.

A novel approach to obtaining heterologous Antibodies involves Monoclonal Antibodies derived from murine hybrids.