Clinical use of adjuvants in allergen-immunotherapy

ABSTRACT

Introduction: Allergen-specific Immunotherapy (AIT) is the only available treatment aimed to tackle the underlying causes of allergy. The active components of subcutaneous vaccines traditionally consist of natural or modified allergen extracts which can be combined with adjuvant platforms. In recent years new targets have been further developed in an attempt to raise the safety and efficacy profile of AIT.

Areas covered: In this review, we discuss the desirable attributes of adjuvants and delivery systems from empiricism to rational design, for current and future clinical applications in AIT.

Expert commentary: The introduction of novel adjuvants, in combination with active targets, has been demonstrated to reduce symptoms of AIT, increase clinical efficacy of allergy treatment and reduce the number of doses. The evolution of vaccine development for AIT is entering a phase of scientific progress that challenges dogmas. Over the past century the traditional concept of immunotherapy, entailing long-course administration of native extract preparations and first generation adjuvants, has seen evolution in the past decade from proof-of-concept to clinical development pipelines encompassing the advent of second generation adjuvants and delivery systems forming essential components of modern AIT development.

KEYWORDS:

• Allergic rhinitis
• adjuvant
• vaccine
• Monophosphoryl Lipid A
• CpG-motifs
• nanoparticles
• microcrystalline tyrosine
• subcutaneous

Declaration of interest

L Klimek and C Schmidt-Weber both received assistance from Allergy Therapeutics to write the manuscript. MD Heath is a principal scientist at Allergy Therapeutics Plc. MF Kramer is the international medical director at Allergy Therapeutics Plc. MA Skinner is the chief scientific officer at Allergy Therapeutics Plc. L Klimek has received research grants from ALK-Abelló, Denmark; Allergopharma, Germany; Bionorica, Germany; Biomay, Austria, Boehringer Ingelheim, Germany, Circassia, USA; Stallergenes, France; HAL, Netherlands; Allergy Therapeutics/Bencard, Great Britain/Germany; Hartington, Spain; Lofarma, Italy; MEDA, Sweden; Novartis, Switzerland, Leti, Spain; ROXALL, Germany; GlaxoSmithKline (GSK), Great Britain; Cytos, Switzerland; Curalogic, Denmark; and/or has served on the speaker’s bureau or was consulting for the above mentioned pharmaceutical companies. C Schmidt-Weber has/had board memberships or consultant contracts with LETI Pharma, PLS Design and Bencard; has grants with LETI Pharma, Allergopharma as well as multiple non-profit organizations; and has received payments for educational presentations from Allergopharma, Sanofi and LEO Pharma. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

Allergy Therapeutics Plc sponsored the manuscript compilation.