Personalized medicine for allergy treatment: Allergen immunotherapy still a unique and unmatched model

Abstract

The introduction of personalized medicine (PM) has been a milestone in the history of medical therapy, because it has revolutionized the previous approach of treating the disease with that of treating the patient. It is known today that diseases can occur in different genetic variants, making specific treatments of proven efficacy necessary for a given endotype. Allergic diseases are particularly suitable for PM, because they meet the therapeutic success requirements, including a known molecular mechanism of the disease, a diagnostic tool for such disease, and a treatment blocking the mechanism. The stakes of PM in allergic patients are molecular diagnostics, to detect specific IgE to single‐allergen molecules and to distinguish the causative molecules from those merely cross‐reactive, pursuit of patient's treatable traits addressing genetic, phenotypic, and psychosocial features, and omics, such as proteomics, epi‐genomics, metabolomics, and breathomics, to forecast patient's responsiveness to therapies, to detect biomarker and mediators, and to verify the disease control. This new approach has already improved the precision of allergy diagnosis and is likely to significantly increase, through the higher performance achieved with the personalized treatment, the effectiveness of allergen immunotherapy by enhancing its already known and unique characteristics of treatment that acts on the causes.

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

“…Figure 1 summarizes the tailoring and the field of possibilities of personalizing AIT, which makes it feasible to develop therapeutic objectives and protocols adapted to each allergic patient, increasing treatment efficacy. This tailored approach enhances the expertise and role of the healthcare professional in developing, in collaboration with the patient, a personalized treatment plan [ 10 ].

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Stellungnahme zum Einsatz von topisch-inhalativem Budesonid bei COVID-19-Infektion

“…Die deutschen Gesellschaften AeDA (Ärzteverband Deutscher Allergologen), DGP (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin), DGAKI (Deutsche Gesellschaft für Allergologie und klinische Immunologie), DGHNO-KHC (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie) gemeinsam mit internationalen Organisationen wie ARIA (Allergic Rhinitis and its Impact on Asthma Initiative), EAACI (European Academy of Allergy and Clinical Immunology) und GAL 2 EN (Global Allergy and Asthma European Network) betonten die Notwendigkeit der Fortführung und des konsequenten Einsatzes von ICS bei erkrankten Patienten bereits zu Beginn der Pandemie [ 12 , 13 ]. Ähnliche Empfehlungen wurden auch für weitere allergische Erkrankungen während der Pandemie erstellt [ 18 – 20 ].…”

“…Hierbei wiesen wir auch darauf hin, dass eine gute antientzündliche Kontrolle der oberen und unteren Atemwege durch topische GKS nach aktuellem Stand des medizinischen Wissens ein guter Schutz vor durch Viren ausgelöste Exazerbationen für diese Patienten darstellt [ 1 , 2 ]. Aus heutiger Sicht gibt es genügend Daten, dass Patienten mit chronisch-entzündlichen Atemwegserkrankungen im Rahmen der COVID-19-Pandemie eine leitliniengerechte pharmakologische Behandlung erhalten sollten, die, falls erforderlich, nGKS, ICS und Biologika-Therapien einschließt [ 12 , 13 ]. Zu den o. g. topischen Glukokortikosteroiden gehört auch Budesonid.…”

Precision Medicine in House Dust Mite-Driven Allergic Asthma

“…AIT is the only etiological treatment for airway allergy, able to prevent disease progression (e.g., asthma onset in children with AR) and displaying a sustained beneficial effect after therapy discontinuation [66][67][68] (Table 3). AIT is also an example of precision medicine where patient selection is guided by detailed phenotyping (confirmation of sensitization and its clinical relevance), and the treatment administered selectively targets the altered immune response towards the allergen driving the symptoms [11]. AIT works via the generation of regulatory sT cells, which counterbalance the effect of sTh2 cells and promote the synthesis of sIgG 4 [69,70].…”

“…Identifying allergic triggers of asthma is interesting because AA patients can be treated with allergen immunotherapy (AIT). AIT is an etiologic intervention displaying a sustained clinical benefit after discontinuation and a capacity to prevent disease progression, as long as it is administered for a minimum cycle of three years [11]. In recent years, new HDM immunotherapy modalities registered as pharmaceutical products have been approved for the treatment of HDM-driven AA [12].…”