The Future of Allergen-Specific Immunotherapy
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The Future of Allergen-Specific Immunotherapy
Drug Information Journal 46(6) 683-687 ª The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0092861512456283 http://dij.sagepub.com
Marek Jutel, MD, PhD, Prof.1, Katarzyna Solarewicz-Madejek, MD, PhD1, and Sylwia Smolin´ska, MSc1
Abstract Allergen-specific immunotherapy (SIT) is the only known causal treatment of allergic diseases. The safety and efficacy of SIT have been demonstrated in humans in many clinical trials, which showed the essential role of SIT in preventing new allergies and asthma. However, SIT is not effective in all allergic individuals and is not equally effective in the treatment of various hypersensitivities to different allergens. For this reason, there is a strong need for research in the field of new SIT modalities to increase its effectiveness and safety. They include recombinant allergens or hypoallergenic variants that show the ability to activate T lymphocytes but decrease IgE binding, diminishing the anaphylaxis risk of the treatment. Growing evidence on different T cell subset functions provides new concepts on the safer and more effective vaccination strategies. Keywords allergy, allergen-specific immunotherapy, recombinant allergens
Introduction Currently, only allergen-specific immunotherapy (SIT) has been demonstrated to be a disease-modifying or curative treatment of allergic diseases. Moreover, it has been shown that SIT can reduce sensitizations to other allergens1 as well as prevent development of asthma,2 which is a basic requirement for an allergen vaccine in achieving clinical efficacy without the risk of anaphylaxis. It has been extremely difficult to develop novel classes of therapy for allergies probably due to the complexity of underlying pathology.3 There are several essential requirements underlying novel strategies for the development of safe and more efficient SIT vaccines. However, a number of clinical trials in SIT have demonstrated that a shift in the nature of the immune response in the direction of allergen tolerance represents a key step in the development of a healthy immune response against allergens.4 Promising studies are being performed to improve the efficacy and safety of SIT, such as the use of recombinant proteins, peptides, allergen fragments or hybrid allergens, and novel adjuvants or novel routes of vaccination such as intralymphatic SIT. Except for recombinant protein vaccines, they are only in an early stage of human clinical trials.
Recombinant Allergens for SIT The allergen extracts are standardized in terms of total allergenic activity, or potency, and possibly the concentration
of one individual major allergen, while product consistency is assessed in terms of protein and allergen profiles determined by various techniques including electrophoresis and immunoblotting. An extract may contain numerous proteins, only some of which are allergens. The composition is determined to a large extent by the quality of the raw material and the method of extraction
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