From IgE to clinical trials of allergic rhinitis

Abstract

The current scientific research is continuously aiming at identifying new therapeutic targets with the purpose of modifying the immune response to allergens. The evolution in immunological methods has led to the identification of immunoglobulin E (IgE) as both a diagnostic biomarker and potential therapeutic target in allergic diseases, such as allergic rhinitis. Allergen immunotherapy has been used for more than 100 years to treat allergic diseases and it is today considered the only disease-modifying treatment capable of inducing a long-lasting immunological and clinical tolerance toward the causal allergen. During the past 20 years, major advances have been made in understanding the molecular and cellular mechanisms of allergen tolerance in humans. Moreover, there has been considerable progress in allergen extract modifications and additions to standard extracts. The recognition that IgE plays a pivotal role in basic regulatory mechanisms of allergic inflammation has recently stimulated research into the therapeutic potential of directly targeting this antibody. Omalizumab, the most advanced humanized anti-IgE monoclonal antibody, is currently approved for the treatment of uncontrolled allergic asthma and chronic spontaneous urticaria. Interesting results also arise from studies in which omalizumab was administered in patients with allergic rhinitis. The aim of this review is to provide an update on current findings on immunological and clinical effects of allergen immunotherapy and anti-IgE therapy, which have been shown to have synergistic modes of action for the treatment of allergic rhinitis.

Keywords:

• allergen immunotherapy
• allergic rhinitis
• IgE
• omalizumab
• sublingual immunotherapy

Financial & competing interests disclosure

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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• As the major trigger of acute allergic reactions, immunoglobulin E has long been considered an ideal target for anti-allergy treatments.

• At present, allergen immunotherapy is the only treatment for allergic rhinitis that is capable of modifying the course of the underlying disease and, thus, potentially preventing the progression from rhinitis to asthma.

• The mechanism of action of allergen immunotherapy is based on restored T-regulatory function and re-direction of immune response to a physiological Th1-oriented pathway.

• Many robust clinical trials have shown the beneficial effect of SLIT tablets on pollen-induced allergic rhinitis symptoms right from the first treatment season.

• Omalizumab has been reported to be effective for the treatment of patients with seasonal and persistent allergic rhinitis.

Notes