Allergen immunotherapy: progress and future outlook

ABSTRACT

Introduction

Allergy, the immunological hypersensitivity to innocuous environmental compounds, is a global health problem. The disease triggers, allergens, are mostly proteins contained in various natural sources such as plant pollen, animal dander, dust mites, foods, fungi, and insect venoms. Allergies can manifest with a wide range of symptoms in various organs and be anything from just tedious to life-threatening. A majority of all allergy patients are self-treated with symptom-relieving medicines, while allergen immunotherapy (AIT) is the only causative treatment option.

Areas covered

This review will aim to give an overview of the state-of-the-art allergy management, including the use of new biologics and the application of biomarkers, and a special emphasis and discussion on current research trends in the field of AIT.

Expert opinion

Conventional AIT has proven effective, but the years-long treatment compromises patient compliance. Moreover, AIT is typically not offered for food allergies. Hence, there is a need for new, effective, and safe AIT methods. Novel routes of administration (e.g. oral and intralymphatic), hypoallergenic AIT products, and more effective adjuvants hold great promise. Most recently, the development of allergen-specific monoclonal antibodies for passive immunotherapy may also allow the treatment of patients currently not treated or treatable.

KEYWORDS:

• allergen immunotherapy
• allergoids
• allergy
• biomarkers
• hypoallergenic peptides
• intralymphatic immunotherapy
• oral immunotherapy
• passive immunotherapy

Article highlights

• Allergen immunotherapy (AIT) is the only curative treatment option of allergies, but the treatment time typically requires 3-5 years

• Patients with food allergies have few treatment options

• Oral immunotherapy (OIT) may allow to treat food allergies

• Intralymphatic immunotherapy (ILIT) may allow to reduce the number of required treatment session and the overall duration of AIT, thereby improving compliance

• Passive immunotherapy with monoclonal antibodies represents a novel way of treating allergy patients and may enable us to reach more patients and patients currently not offered conventional AIT

• Much allergy research is devoted to the definition of biomarkers that would foresee treatment efficacy and patient selection

Declaration of interest

L Sosic received a travel grant from ATL, which has an adjuvant product mention in the review. P Johansen received financial support from ATL for pre-clinical works on adjuvant MCT mentioned in the review. T Kündig is scientific advisor to ATL, which has an adjuvant product mention in the review. 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 in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was made possible through funding from the University of Zurich.