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Abstract
Type I allergy represents an important health problem that is currently affecting approximately 25% of the population in Western countries. Immunotherapy, the only causative treatment of Type I allergy, is currently performed with crude allergen extracts, which contain unpredictable amounts of allergenic, as well as nonallergenic, components. The application of molecular biology for allergen characterization has revealed the molecular nature of the most common allergens and allowed the production of recombinant allergens that equal natural allergens. Based on this knowledge, several different strategies to improve immunotherapy have become available. Until now, T-cell peptides, selected wild-type-like recombinant allergens and genetically modified hypoallergenic allergen derivatives have been evaluated in clinical trials in patients. Immunotherapy based on T-cell peptides has focused on allergen-specific T-cell responses, whereas genetically modified recombinant allergen molecules offer the advantage of combining T-cell and B-cell epitopes. Genetically modified recombinant birch pollen derivatives (Bet v 1-fragments, Bet v 1-trimer) have been evaluated in a double-blind, placebo-controlled, multicenter study. Vaccination with the Bet v 1-derivatives improved symptoms of birch pollen allergy, induced a healthy allergen-specific immunoglobulin G response and led to a significant reduction of seasonally induced boosts of immunoglobulin E.