Perspectives in allergen immunotherapy: 2017 and beyond

Abstract

The Future of the Allergists and Specific Immunotherapy (FASIT) workshop provides a regular platform for global experts from academia, allergy clinics, regulatory authorities and industry to review developments in the field of allergen immunotherapy (AIT). The most recent meeting, held in February 2017, had two main themes: advances in AIT and hot topics in AIT from the regulatory point of view. The first theme covered opportunities for personalized AIT, advances in adjuvants and delivery systems, and the development of new molecules and future vaccines for AIT. Key topics in the second part of the meeting were the effects of the enactment of European Directive 2001/83 on the availability of allergens for therapy and diagnosis across the EU, the challenges of conducting Phase 3 studies in the field, the future role of allergen exposure chambers in AIT studies and specific considerations in performing AIT studies in the paediatric population. Finally, the group highlighted the forthcoming EAACI guidelines and their particular importance for the standardization of practice in the treatment of allergies. This review presents a comprehensive insight into those panel discussions and highlights unmet needs and also possible solutions to them for the future.

Alum impairs tolerogenic properties induced by allergoid‐mannan conjugates inhibiting mTOR and metabolic reprogramming in human DCs

“…9,[12][13][14] Aluminium hydroxide (alum) remains the most widely used adjuvant in AIT. [15][16][17] For long time, the main effects attributed to alum have been related to its depot effect leading to the slow release of the adsorbed allergens. 15,18 Alum also activates innate immune responses in DCs and macrophages.…”

Clinical trials in allergen immunotherapy: current concepts and future needs

“…As such, AIT is the only causal treatment option for allergic patients, as it directly targets the pro‐inflammatory immune response and thus has disease‐modifying properties . Accordingly, AIT has the potential to decrease the neo‐sensitization rate (ie, the development of sensitizations to secondary allergens) and has been shown to reduce the risk of developing allergic asthma in AR patients.…”

Future research trends in understanding the mechanisms underlying allergic diseases for improved patient care

“… Evaluation and validation of possible biomarkers of predictive value for efficacy Further validation of clinical meaningful primary and secondary endpoints Clinically justified definitions of relevant treatment effect sizes Potential of allergen exposure chambers for AIT product development Minimal level of evidence needed for the clinical documentation of efficacy in the pediatric population Better understanding of placebo effects in SCIT and SLIT Defining clinical endpoints and establishing the effectiveness, disease‐modifying properties, and the duration of both in asthmatic patients …”

“…15 However, there is an urgent need for further harmonization and clinical validation of methodological determinants in AIT clinical study design, which can only be achieved by international collaboration of clinical experts, methodologists, and regulatory authorities. 109,110…”