Personalized medicine and allergen immunotherapy: the beginning of a new era?

Abstract

The concept of personalized medicine as a diagnostic and therapeutic approach tailored to the medical needs of each patient is currently revolutionizing all fields of medicine and in particular allergology. Allergen immunotherapy (AIT) meets the three main needs for precision medicine: identification of molecular mechanism of disease, diagnostic tools for the mechanism and treatment blocking the mechanism itself. AIT adapts to the spectrum of specific IgE of each individual subject, changing the course and natural history of the disease, so is a clear model of precision and personalized medicine. This first step before the prescription of AIT is to define the sensitization profile of the patient; after that, the healthcare professional has numerous levers for adapting the treatment to the physio-pathological mechanisms involved. AIT allows to adapt treatments to the profile of the patients, but also to the its preferences, to ensure optimal treatment efficacy, resulting in an agile and personalized approach, with the aim to ensure adherence to the treatment, which is usually quite low. AIT also broadens the field of possibilities for healthcare professionals and patients, by allowing to choose the galenic formulation according to patient preferences and on the basis of their clinical history, adapting the product composition to the patient’s sensitization profiles and the underlying biological mechanisms identified at the diagnostic stage, while guaranteeing quality of the prescribed product as the production of allergens and allergoids is today more regulated than in the past years. In the management of AIT, it is also possible to involve patients in decisions throughout their care pathway thanks to multiple services, offering personalized follow-up and support, to ensure the highest treatment efficacy levels, and recalling medication intake, medical appointments and prescription renewals.

Safety of allergen‐specific immunotherapy in children

“…The concept of personalized medicine as a diagnostic and therapeutic approach is currently revolutionizing allergology. AIT fulfills all aspects of precision medicine: identification of molecular mechanism, diagnostic tools for the mechanism, and treatment blocking the mechanism itself 3 . Thus, Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Initiative for Asthma (GINA) guidelines recommend AIT as an add‐on treatment of moderate‐severe allergic rhinitis (+/‐ conjunctivitis) and moderate, but controlled, asthma 4,5 .…”

Predictive Response to Immunotherapy Score: A Useful Tool for Identifying Eligible Patients for Allergen Immunotherapy

“…This could be one of the reasons for the low patient compliance with AIT reported in many clinical studies [41][42][43]. The introduction of personalized medicine, envisioned as a patient-tailored diagnostic and therapeutic approach, is currently influencing all fields of medicine; therefore, dedicated tools for identifying patients eligible for AIT are strongly needed [13].…”

“…To approach the heterogeneity of allergic patients, we developed a multi-parameter score, namely PRIS, potentially able to predict AIT effectiveness and identify eligible patients. PRIS includes clinical and laboratory parameters (Table 2) chosen based on clinical practice, literature review, and previous work evaluating AIT responsiveness and possible predictive factors [1, [10][11][12][13]44,46,48,49,[51][52][53]. We rated each PRIS parameter to reach a maximum of 100 points to mimic the odds of achieving a clinical improvement, thereby making it easy to be used by clinicians and intelligible by the patients.…”

“…For instance, the assessment of serum-specific IgE [10] and the specific and total IgE ratio has been proposed as a biomarker of AIT efficacy [11]. Other studies suggested a possible correlation between some subtypes of IgG (IgG1, sIgG4) and clinical outcomes [12,13]. Finally, changes in cytokine pattern (e.g., IL-4, IL-13, IL-10) have been associated with AIT response [9,14,15].…”

APAAACI 2021 International Conference: a new era of allergy and clinical immunology in digital

“…This was extensively covered in the plenary and symposia on biologics in allergic disease, asthma, rhinitis, and atopic dermatitis. Even AIT [ 9 ] used in airway allergy and food allergy (oral immunotherapy) is also a form of evidence-based precision medicine, potentially guided by artificial intelligence [ 10 ].…”