Novel strategies for the treatment of grass pollen-induced allergic rhinitis

ABSTRACT

Introduction: Allergic rhinitis (AR) affects over 20% of the population of Europe and the United States. Allergen immunotherapy (AIT) is currently the only form of treatment that affects symptoms and modifies the progression of disease. Established forms of AIT include subcutaneous (SCIT) and sublingual (SLIT) immunotherapy and are widely effective, yet only 2-9% of eligible patients undergo therapy, likely due to the long duration of treatment. As a result, novel, faster forms of AIT are currently under development.

Areas covered: This article provides an overview of AR and summarises the efficacy and mechanisms of established forms of AIT, highlighting the current drawbacks. We discuss novel strategies of AIT that have been developed in an attempt to tackle these limitations, including epicutaneous, intradermal and intralymphatic immunotherapy (ILIT), focusing on ILIT, the treatment that has been most comprehensively assessed.

Expert opinion: Current strategies to treat AR suffer from a poor safety profile and, importantly, lack of adherence. ILIT is a faster and safer form of AIT, with a treatment regime of only 12 weeks. Further validation is required, but ILIT, with its short and comparatively inexpensive protocol, has the potential to offer disease-modifying therapy to a larger number of patients.

KEYWORDS:

• Allergic rhinitis
• allergen immunotherapy
• intralymphatic immunotherapy
• grass pollen
• allergy

Article highlights

• Allergen-immunotherapy (AIT), which currently incorporates subcutaneous (SCIT) and sublingual (SLIT) immunotherapy, is the only allergic rhinitis (AR) treatment that alleviates symptoms and affects disease progression.

• Present forms of AIT are effective but suffer from a poor safety profile and lack of adherence

• Intralymphatic immunotherapy (ILIT) is a novel form of immunotherapy, in which allergen is targeted to the lymph nodes, and requires only 3 injections over a period of 12 weeks

• Current studies on ILIT are limited in number and not definitive, but suggest that ILIT is safe, reduces allergic symptoms and induces peripheral tolerance

• The authors’ opinion is that ILIT, with its short, safe and comparatively inexpensive protocol, may constitute the next generation of AIT, having the potential to offer AIT to a larger number of patients

This box summarizes key points contained in the article.

Declaration of interest

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.