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ABSTRACT
Introduction: Type-1 allergies are among the most chronic common diseases of humans. Allergen immunotherapy (AIT) is the only causative and disease-modifying treatment option besides allergen avoidance. Severe systemic adverse allergic reactions may be induced by every AIT treatment. Different approaches have been used to provide safer AIT preparations to lower or even totally overcome this risk.
Areas covered: A structured literature recherche in Medline and Pubmed under inclusion of national and international guidelines and Cochrane meta-analyses has been performed aiming at reviewing clinical use of such approaches in AIT.
New allergen preparations may include allergoids, recombinant allergens (recA) and modified recombinant allergens (recA) in subcutaneous as well as in mucosal immunotherapies (application e.g. using bronchial, nasal, oral and sublingual application) with sublingual being the established mucosal application route and new ways of application like intralymphatic and epicutaneous immunotherapy.
Expert commentary: Immune-modifying agents like Virus-like particles and CpG-motifs, adjuvants like MPL and aluminum hydroxide are evaluated and found to increase and direct the immunological response toward immunological tolerance.
New forms of allergen extracts can improve safety and efficacy of AIT and may change our way of performing allergen immunotherapy in the future.
Declaration of interest
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. O Pfaar has received grants and personal fees from ALK-Abelló, Allergopharma, Allergy Therapeutics/Bencard GmbH, Anergis S.A., Biotech Tools S.A., HAL Allergy Holding B.V./HAL Allergie GmbH, Laboratorios LETI/LETI Pharma, Lofarma, Stallergenes Greer and grants from Biomay, Circassia, Nuvo and personal fees from MEDA Pharma, Mobile Chamber Experts (a GA2LEN Partner), Novartis Pharma, Pohl-Boskamp and Sanofi US Services. The authors have no other 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 apart from those disclosed.