New approaches to immunotherapy in house dust mite allergy

Abstract

Allergen immunotherapy (AIT) has developed over the last few decades and has emerged as a promising treatment. House dust mite is a target allergen in AIT, and various modified house dust mite allergens have been improved for their efficacy. Moreover, clinical trials have proved their significantly therapeutic effects in allergy. This article review focuses on house dust mite allergens developed for AIT efficacy, and determines that their action mechanisms are strongly based on immune tolerance.Treatments for house dust mite allergens have been optimized by modification or/and addition of adjuvants, and clinically evaluated by subcutaneous and sublingual administration. Representative allergens used in AIT are chemically modified allergoids and recombinant allergens, including altered epitopes. The effective mechanisms subsequent to AIT include the suppressive actions of interleukin-10 and transforming growth factor-β secreted by regulatory cells, including regulatory T cells and regulatory B cells, and isotype switching from immunoglobulin E to immunoglobulin G4. Further studies of AIT are needed to achieve the milestone in treating allergies.

Trends in food allergen immunotherapy in Korea after changed national regulations

“…In the current issue of Clinical and Experimental Pediatrics , Kim et al [ 10 ] reviewed the practical issues of OIT for egg or milk allergies. This article provides the perfect timing for the transition of OIT using heated milk/egg in real-world practice in Korea.…”

“…The authors have already published conventional OIT studies using egg white powder [ 7 ] and modified OIT studies using boiled eggs [ 6 ]. This article introduces a schematized comparison of the two protocols, especially in the build-up phase [ 10 ]. In previous studies of OIT using heated milk/egg, various foods were used, such as boiled eggs, biscuits, muffins, cookies, donuts, cupcakes, bread, heated milk powder, microwave oven-heated milk, and even standard bakery products for OIT by nonprofit mass manufacturing [ 6 , 8 - 10 ].…”

“…PTAH is available only through the PALFORZIA Risk Evaluation and Mitigation Strategy, a restricted program with serious safety concerns required by the Food and Drug Administration in which prescribers, healthcare settings, pharmacies, and patients should enroll. Even outside research settings, FA-AIT should be administered by specialist physicians with experience administering oral food challenge tests and managing severe allergic reactions [ 4 , 5 , 10 ].…”

“…6) This article introduces a schematized comparison of the two protocols, especially in the build-up phase. 10) In previous studies of OIT using heated milk/egg, various foods were used, such as boiled eggs, biscuits, muffins, cookies, donuts, cupcakes, bread, heated milk powder, microwave oven-heated milk, and even standard bakery products for OIT by nonprofit mass manufacturing. 6,[8][9][10] In Europe, FA-AIT is most commonly performed in tertiary hospitals.…”

“…10) In previous studies of OIT using heated milk/egg, various foods were used, such as boiled eggs, biscuits, muffins, cookies, donuts, cupcakes, bread, heated milk powder, microwave oven-heated milk, and even standard bakery products for OIT by nonprofit mass manufacturing. 6,[8][9][10] In Europe, FA-AIT is most commonly performed in tertiary hospitals. 4) PTAH is available only through the PALFORZIA Risk Evaluation and Mitigation Strategy, a restricted program with serious safety concerns required by the Food and Drug Administration in which prescribers, healthcare settings, pharmacies, and patients should enroll.…”