How Immunotherapy is Taming the Cypress Allergy Epidemic
Imagine a tree so symbolic of life and eternity that it's planted in cemeteries worldwide, yet for millions, its pollen brings months of pure misery.
This is the paradox of the cypress tree, and for a growing number of people, it's the hidden cause of their relentless springtime allergies.
For years, the only recourse for sufferers was a constant cycle of antihistamines and nasal sprays. Today, a revolution is underway. Allergen Immunotherapy (AIT) is moving beyond merely masking symptoms to actually reprogram the immune system's faulty response. This article explores the cutting-edge science behind two leading strategies: Sublingual Swallow Therapy (SLIT) and Subcutaneous Immunotherapy (SCIT), and how they are changing the game for cypress allergy patients.
The majestic, dark green Italian cypress (Cupressus sempervirens), also known as the Mediterranean or funeral cypress, is a potent source of seasonal misery 6 . Unlike showy flowering trees, cypresses are wind-pollinated, releasing billions of microscopic pollen grains into the air 1 6 .
In certain Mediterranean areas, cypress pollen allergy accounts for half of all seasonal pollen allergies 1 .
4
Month Pollen Season
32%
Max Sensitization Rate
↑
Impact of Global Warming
50%
Of Seasonal Allergies in Mediterranean
The cypress pollination period is notably long, stretching from January through April, and due to global warming, this season is becoming even longer and more intense 1 .
Once considered mainly a Mediterranean issue, cypress pollen allergy is now a global concern, with sensitization rates ranging from 0.6% to a staggering 32% in some populations 1 6 .
For sensitized individuals, the immune system misidentifies harmless cypress pollen proteins (allergens) like Cup s 1 and Cup s 3 as dangerous threats 6 .
While medications suppress symptoms, AIT addresses the root cause of the allergy. The principle is simple yet powerful: administer controlled, increasing doses of the problematic allergen to induce long-term immune tolerance 7 . The two main delivery methods are SLIT and SCIT.
The following table compares these two frontline approaches.
| Feature | Sublingual Immunotherapy (SLIT) | Subcutaneous Immunotherapy (SCIT) |
|---|---|---|
| Method | Tablet or liquid extract placed under the tongue and then swallowed 2 . | Injections of allergen extract into the fat under the skin 3 7 . |
| Location | Self-administered at home after first dose 7 . | Administered in a clinical setting under medical supervision 7 . |
| Frequency | Typically daily 7 . | Initial build-up phase (often weekly), followed by monthly maintenance injections 3 . |
| Key Advantage | Convenience and safety profile; no need for frequent clinic visits 2 7 . | Longest track record of use; strong evidence of long-lasting effect 7 . |
| Considerations | Requires high daily adherence; can cause mouth itching or stomach upset 2 . | Less convenient due to clinic visits; small risk of systemic reactions, including anaphylaxis 7 . |
Both therapies work through similar biological mechanisms. They shift the immune system away from a pro-allergic state (dominated by Th2 cells and IgE antibodies) towards a tolerant one (promoting T-regulatory cells and "blocking" IgG4 antibodies) 7 . This complex immunological shift results in reduced symptoms and less need for rescue medication over time.
Robust clinical evidence supports the efficacy of both SLIT and SCIT for respiratory allergies. Let's examine the outcomes that matter most to patients.
Clinical studies on AIT use standardized metrics to evaluate effectiveness. The data consistently show significant benefits for patients undergoing treatment.
| Outcome Measure | Findings in Immunotherapy Trials |
|---|---|
| Symptom Score Reduction | Significant decrease in combined rhinitis/rhinoconjunctivitis symptoms (e.g., sneezing, itching, congestion) compared to placebo 7 . |
| Medication Use Reduction | Patients require significantly less rescue medication (e.g., antihistamines, nasal corticosteroids) 3 7 . |
| Quality of Life Improvement | Validated questionnaires (e.g., ESPRINT-15) show marked and sustained improvements in health-related quality of life 3 . |
| Immunological Changes | Increase in allergen-specific, protective IgG4 antibodies; long-term shift in immune cell profiles promoting tolerance 3 7 . |
A 2025 real-world study on SCIT for cat allergy provides a compelling model of how this therapy works in practice. While focused on a different allergen, the study design and outcomes mirror those seen in cypress immunotherapy research. In this study, patients receiving a depigmented, polymerized cat extract showed significant and sustained improvements in all domains of their quality of life from month 6 of treatment onwards 3 . Furthermore, the treatment was shown to be effective with an excellent safety profile, with most adverse reactions being mild and local 3 .
Advancements in our understanding of allergies and their treatment rely on a sophisticated array of laboratory tools.
| Tool or Reagent | Function in Allergy Research |
|---|---|
| Standardized Allergen Extracts | Biologically calibrated extracts used in diagnostics (skin prick tests) and immunotherapy to ensure consistent potency and dose 3 . |
| Component-Resolved Diagnostics (CRD) | Microarray technology that pinpoints a patient's specific IgE reactivity to individual allergen molecules (e.g., Cup s 1), enabling personalized diagnosis and prediction of cross-reactivity . |
| ImmunoCAP | A widely used laboratory system to measure levels of specific IgE and IgG4 antibodies in serum, crucial for diagnosis and monitoring immune response during AIT 3 . |
| Depigmented-Polymerized Extracts ("Allergoids") | Modified allergens where the IgE-binding sites are reduced (lowering allergy risk) while the immune-stimulating properties are maintained, improving the safety profile of SCIT 3 . |
| Basophil Activation Test (BAT) | A functional cellular test that measures the activation of basophils (key immune cells in allergies) in response to an allergen, providing a window into the cellular-level response to therapy 5 . |
Ensure consistent potency and dosing for accurate diagnosis and treatment.
Pinpoint specific allergen molecules for personalized treatment approaches.
Measure immune cell responses to track therapy effectiveness at cellular level.
The future of managing cypress and other allergies is bright, driven by precision medicine. Researchers are actively hunting for biomarkers—measurable indicators like specific antibodies or immune cell counts—that can predict who will respond best to therapy and track progress with greater accuracy 5 . The FDA and other regulatory bodies are actively discussing the requirements for adopting such biomarkers in drug development 5 .
Standardized allergen extracts and symptom-based diagnosis
Component-resolved diagnostics and biomarker identification
Hyper-personalized treatment based on epitope mapping and genetic profiling
Emerging diagnostic techniques, such as the Bead-Based Epitope Assay (BBEA), are pushing the boundaries further by mapping the exact sites (epitopes) on an allergen that a patient's antibodies recognize 5 . This could lead to hyper-personalized treatment strategies.
For the millions navigating the extended and intense cypress pollen season, immunotherapy offers more than just symptom control; it offers the promise of long-term desensitization and a lasting improvement in quality of life. By consulting with an allergist, patients can determine if they are candidates for this disease-modifying treatment and embark on a path toward reclaiming their springs.