Is The Allergen Really Needed in Allergy Immunotherapy?

Abstract

Opinion StatementImmunotherapy for type I allergies is well established and is regarded to be the most efficient treatment option besides allergen avoidance. As of today, different forms of allergen preparations are used in this regard, as well as different routes of application. Virus-like particles (VLPs) represent a potent vaccine platform with proven immunogenicity and clinical efficacy. The addition of toll-like receptor ligands and/or depot-forming adjuvants further enhances activation of innate as well as adaptive immune responses. CpG motifs represent intensively investigated and potent direct stimulators of plasmacytoid dendritic cells and B cells, while T cell responses are enhanced indirectly through increased antigen presentation and cytokine release. This article will focus on the function of VLPs loaded with DNA rich in nonmethylated CG motifs (CpGs) and the clinical experience gained in the treatment of allergic rhinitis, demonstrating clinical efficacy also if administered without allergens. Several published studies have demonstrated a beneficial impact on allergic symptoms by treatment with CpG-loaded VLPs. Subcutaneous injection of VLPs loaded with CpGs was tested with or without the adjuvant alum in the presence or absence of an allergen. The results encourage further investigation of VLPs and CpG motifs in immunotherapy, either as a stand-alone product or as adjuvants for allergen-specific immunotherapy.

Preliminary evaluation of cytosine‐phosphate‐guanine oligodeoxynucleotides bound to gelatine nanoparticles as immunotherapy for canine atopic dermatitis

“…None of the latter ones could be observed in the present study. It is assumed that by omitting the allergens in immunotherapy of AD, the risk of potentially life-threatening anaphylactic reactions can be reduced or even eliminated (Kundig and others 2015). However, it remains to be seen if the adverse effects seen here (exclusive local swellings and gastrointestinal signs) using CpG GNP will be confirmed in larger placebo-controlled studies.…”

CpG oligodeoxynucleotide nanomedicines for the prophylaxis or treatment of cancers, infectious diseases, and allergies

“…97 Furthermore, even when the Qβ-derived nanoparticle complex was administered without the allergen, there was a clear therapeutic effect on patients with house dust allergy. 98 This shows that in the treatment of house dust allergy, it is not necessary to administer the allergen, as the Qβ-derived nanoparticle complex suffices to give a therapeutic effect. The reason that the allergen is not necessary is likely because the house dust mite is present everywhere throughout the seasons, so the allergen is naturally acquired from the environment.…”

All the small things: How virus‐like particles and liposomes modulate allergic immune responses

“…However, the authors pointed out in their study that HDM represent an ubiquitous allergen source and the possibility that the patients were exposed to (minimal) amounts of HDM‐allergen while receiving the vaccine could not be ruled out completely. Thus, an antigen‐dependent component contributing to vaccine efficacy could not be entirely excluded in that study . In a subsequent study, patients suffering from mild‐to‐moderate persistent allergic asthma against one aeroallergen were treated with Qβ‐G10 particles.…”