The use of nasal allergen vs allergen exposure chambers to evaluate allergen immunotherapy

ABSTRACT

Introduction

Allergen-specific immunotherapy (AIT) is the only disease-modifying treatment option for allergic rhinitis (AR) patients with persistent moderate-severe AR for whom traditional pharmacotherapies are ineffective. The nasal allergen challenge (NAC) and allergen exposure chamber (AEC) are two translational models of AR that can be used to investigate the properties, safety, and efficacy of AIT.

Areas Covered

Peer-reviewed, human-centered articles utilizing AEC or NAC models to investigate AIT between 2010 and 2020 were curated from PubMed, EMBASE, and OVID Medline databases. AECs have been used to evaluate traditional subcutaneous and sublingual administrations of AIT, including cross-protective effects and different dosing regimens. More recently, the effectiveness of novel AIT formulations has been evaluated. NACs are another model used to study AIT, including using novel intralymphatic routes of administration. It is an especially powerful and versatile tool to determine if basic science and animal model findings are clinically translatable.

Expert opinion

The AEC and NAC models both produce clinically relevant and reproducible results. AECs are more effective for studying many participants but are limited because they require a specialized facility. As more AIT therapies and new formulations are developed over time, the versatility of the NAC will be especially useful.

KEYWORDS:

• Allergen immunotherapy
• allergic rhinitis
• environmental exposure chamber
• nasal allergen challenge

Article highlights

• AEC and NAC are translational models of AR used in the study of AIT therapies.

• These models are well-established and standardization efforts have ben undertaken.

• Clinical findings from AECs have shown that sublingual (SLIT) and subcutaneous (SCIT) routes of administration are effective methods of treating AR, though do not render cross-protection in polysensitized participants.

• Different dosing regimens and novel peptide and allergoid formulations have also been successfully evaluated using AECs.

• The NAC model has also been used to assess efficacy and safety of AIT, including in cases of local AR.

• Intralymphatic AIT administration was found to be safe and better-tolerated than conventional SCIT using NACs, which proves to be a versatile and powerful tool.

• Comparisons between the NAC and AEC models reveal unique benefits and limitations between the two. Together they encourage a well-rounded understanding of AIT therapies and AR pathophysiology.

Declaration of interest

AKE has participated in advisory boards and ALK Abello, AstraZeneca, Aralez, Bausch Health, LEO Pharma, Merck, Novartis and Pfizer, has been a speaker for ALK Abello, Aralez, AstraZeneca, Medexus and Mylan. Her institute has received research grants from ALK Abello, Aralez, AstraZeneca, Bayer LLC, Medexus, Novartis and Regeneron. She has also served as an independent consultant to Bayer LLC and Regeneron. 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.