New Directions in Immunotherapy

Abstract

Allergen immunotherapy (AIT) is effective in reducing the clinical symptoms associated with allergic rhinitis, asthma and venom-induced anaphylaxis. Subcutaneous (SCIT) and sublingual immunotherapy (SLIT) with unmodified allergen extracts are the most widely prescribed AIT regimens. The efficacy of these 2 routes appears comparable, but the safety profile with SLIT is more favorable allowing for home administration and requiring less patient time. However, both require that the treatment is taken regularly over several years, e.g., monthly in a supervised medical setting with SCIT and daily at home with SLIT. Despite the difference in treatment settings, poor adherence has been reported with both routes. Emerging evidence suggests that AIT may be effective in other allergic conditions such as atopic dermatitis, venom sting-induced large local reactions, and food allergy. Research with oral immunotherapy (OIT) for food allergies suggest that many patients can be desensitized during treatment, but questions remain about whether this can produce long term tolerance. Further studies are needed to identify appropriate patients and treatment regimens with these conditions. Efforts to develop safer and more effective AIT for inhalant allergies have led to investigations with modified allergens and alternate routes. Intralymphatic (ILIT) has been shown to produce long-lasting clinical benefits after three injections comparable to a 3-year course of SCIT. Epicutaneous (EPIT) has demonstrated promising results for food and inhalant allergies. Vaccine modifications, such as T cell epitopes or the use of viral-like particles as an adjuvant, have been shown to provide sustained clinical benefits after a relatively short course of treatment compared to the currently available AIT treatments, SLIT and SCIT. These newer approaches may increase the utilization and adherence to AIT because the multi-year treatment requirement of currently available AIT is a likely deterrent for initiating and adhering to treatment.

Current developments for improving efficacy of allergy vaccines

“…Other forms of immunotherapy are sought for more convenient and safer options to treat the large number of allergic individuals who could benefit greatly from informahealthcare.com 10 AIT. The rationale of reducing the allergenicity of allergen extracts to increase safety while maintaining and improving immunogenicity has led to exploration of different routes for delivery and modification of allergens with promising advances over recent years [19,20]. Additionally, adjuvants, adjunct therapies and allergen-independent forms of 'immunotherapy', such as Toll-like receptor (TLR) agonists as monotherapy have been explored as potential new therapies.…”

Immunotherapy in allergy and cellular tests

“…OIT may offer a promising approach to induce specific oral tolerance to selected food allergens, though yet restricted to a small group of molecules, and can represent a potential strategy for long-term curative treatment of food allergy, 125 though many controversial problems about protocol and allergen dose yet exist, even for other AIT protocols. [143][144][145][146][147][148][149][150] The application of BAT in oral immunotherapy should consider also the role of secretory IgAs and their receptor on granulocytes. [151][152][153] Past reports have shown that secretory IgAs induce degranulation in IL-3 primed basophils.…”

The aryl hydrocarbon receptor and food allergy

“…Subcutanous (SCIT) or sublingual (SLIT) immunotherapy are the most widely accepted routes of immunotherapy administration. The efficacy of oral immunotherapy (OIT) on long-term tolerance is not clear yet (Cox et al 2013).…”