Consensus Guidelines on Practical Issues of Immunotherapy–Canadian Society of Allergy and Clinical Immunology (CSACI)

Looking ahead at the potential benefits of biotechnology-derived allergen therapeutics

“…Endogenous protease activity is problematic because it can degrade active ingredients in the therapeutic, resulting in reduced product stability and shelf-life [21]. Stability can be ameliorated by formulating the extract in glycerol [22], but these products are not favoured since glycerol produces pain at the injection site [5]. Moreover, since many patients undergoing SIT are allergic to more than one allergen, the mixing of allergenic extracts is often required to include all of the relevant allergens [5].…”

“…Stability can be ameliorated by formulating the extract in glycerol [22], but these products are not favoured since glycerol produces pain at the injection site [5]. Moreover, since many patients undergoing SIT are allergic to more than one allergen, the mixing of allergenic extracts is often required to include all of the relevant allergens [5]. The mixing of proteolytic extracts with others must be avoided – usually by isolating specific extracts in distinct vials – but the therapeutic regime will require additional injections for the distinct extracts, which can make the therapy less pleasant for the patient.…”

“…The most common method of SIT employs the subcutaneous injection of extracts of biological material that contains the allergen. Gradual, increasing doses of the administered allergenic extract serves to physiologically moderate the immune system so that it is less primed for a hyperimmune response upon subsequent exposure to the allergen (for a concise review, see: [5], p. 49–51). An inherent problem with SIT is that it carries a low but significant risk of inducing severe and sometimes fatal systemic reactions such as anaphylaxis [6].…”

“…An inherent problem with SIT is that it carries a low but significant risk of inducing severe and sometimes fatal systemic reactions such as anaphylaxis [6]. It is therefore advised that SIT be performed by trained allergists in facilities that are equipped to treat anaphylactic reactions, and that patients be monitored for 30 minutes after the treatment [5]. …”

Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma: an umbrella review

“…The most recent Canadian guidelines recommend allergen immunotherapy for the treatment of allergic rhinitis or asthma caused by allergens for which clinical efficacy and safety have been shown. 36 Recent German guidelines caution that, despite the welldocumented efficacy of allergen immunotherapy, high heterogeneity between trials renders generic recommendations difficult. 37 Indeed, we found moderate to high heterogeneity for most outcomes, likely because of differences in included populations, allergens, and formulations of SCIT or SLIT.…”