Considerations for Combining High-Protease Extracts in Immunotherapy Vaccines

Carol M Lilley,Donna J Rekkerth,Brian F Teske

doi:10.4236/ojn.2014.44029

Abstract

Current practice parameters state that extracts rich in proteases, such as fungal and insect extracts, can be combined during preparation of allergy immunotherapy vaccines. However, until recently, this guideline has not been the subject of investigation. Scientists now have data that shed light on high-protease allergenic extract mixtures used in allergy immunotherapy. A study published in Annals of Allergy, Asthma & Immunology in 2012 reports on the compatibility of combining fungal and insect extracts and emphasizes the importance of understanding how protease activities and total glycerin levels in allergy extracts can affect the stability of allergy immunotherapy vaccine mixtures. This research provides a critical assessment of the mixing compatibilities of several well-characterized high-protease extracts and may influence future immunotherapy practice parameters and immunotherapy extract preparation guidelines.

Highlights

IntroductionIn 1911, Leonard Noon and John Freeman were the first to use subcutaneous immunotherapy (SCIT) in humans for the treatment of “hay fever” [1]
Allergy immunotherapy has been in practice for over a century
Some patients are diagnosed with immunoglobulin E (IgE)-mediated hypersensitivities to a variety of allergens and require treatment with multiple allergenic extracts

Summary

Introduction

In 1911, Leonard Noon and John Freeman were the first to use subcutaneous immunotherapy (SCIT) in humans for the treatment of “hay fever” [1]. Controlled, gradual introduction of a known allergen allows the immune system to build up tolerance over time—a process that desensitizes the patient to the allergen [3]. This disease-modifying approach is often implemented when patients are no longer able to control their allergies with pharmacotherapy or avoidance measures, but it can be discussed with patients early on in treatment, if patients are affected by the adverse events that accompany chronic therapy with antihistamines or prefer to reduce the use of these medications

Degradation of Allergens in Mixtures

Insights into High-Protease Extracts

Putting It into Practice

Findings

Conclusion