Abstract
Subcutaneous allergen immunotherapy (SCIT) is the classic causal treatment method for IgE-mediated allergic respiratory disease. A growing understanding of the fundamentals of immunological mechanisms sets the path for further clinical improvement of this treatment. Innovations in SCIT comprise both treatment schedules and new forms of allergen extracts applied. Nonmodified allergen preparations in the form of aqueous or physically coupled (semidepot) extracts, as well as chemically modified allergens (allergoids) are currently on the market for SCIT in Germany. However, to date the clinical documentation of SCIT products in clinical studies is heterogeneous. A selective literature search was conducted in PubMed and Medline, and recent publications in German-language journals not available in these literature databases were also analyzed. This literature search comprised original and review articles both in German and in English. SCIT is a long-established and well-documented treatment method for inhalant and insect venom allergies, with its efficacy and safety demonstrated in both the adult as well as in the pediatric population. In line with the German Therapy Allergen Ordinance (TAV) several products for SCIT are currently being investigated in clinical trials. Treatment schedules are continuous year-round (perennial), preseasonal, and combined pre-/coseasonal. The initial up-dosing phase can be performed with standard, cluster or rush procedures. SCIT is particularly well established for frequently occurring inhalant allergens such as pollen from grasses, Betula sp. (birch, alder, hazel), house dust mites (Dermatophagoides sp.), and insect venoms (bee and wasp venoms). However, good data are also available for a number of other therapeutic allergens, e.g., weed pollen such as ragweed, mugwort, etc., molds, e.g., Alternaria, Cladosporium, etc., storage mites, and animal dander (e.g., cat). Moreover, further clinical investigations on new indications such as treatment effects on e.g., oral allergy syndrome or atopic dermatitis are currently underway. When adequately administered by physicians with allergological expertise, SCIT preparations are safe, well-tolerated, and clinically effective.
Highlights
Besides allergen avoidance measure, allergen immunotherapy (AIT) remains the only causal treatment options available for immunoglobulin E (IgE)-mediated allergic diseases such as allergic rhinoconjunctivitis or allergic asthma
AU allergy unit, PNU protein nitrogen unit, BU biological unit, standard quality units (SQ-U) standard quality unit, BHR bronchial hyperresponsiveness, SS symptom score, MS medication score, SMS symptom and medication score, NPT nasal provocation test, Visual analogue scales (VAS) visual analogue scale, HEPL histamine equivalent prick leti, PNU protein nitrogen units, DPP depigmented polymerized allergen unit, PD20FEV1 allergen dose producing a 20% drop of FEV1 compared to baseline, FEV1 forced expiratory volume at 1 s
Subcutaneous allergen immunotherapy (SCIT) using olive pollen extract is occasionally recommended in Germany as an option to treat patients with ash pollen allergy
Summary
Allergen immunotherapy (AIT) remains the only causal treatment options available for IgE-mediated allergic diseases such as allergic rhinoconjunctivitis or allergic asthma. Since the pioneering achievements of Noon and Freeman more than 100 years ago, both unmodified (semidepot) extracts as well as chemically modified extracts (allergoids) are currently marketed in Europe by different manufacturers for subcutaneous allergen immunotherapy (SCIT) [1]. Further innovations not marketed already include e.g., CpG-oligodeoxynucleotides (CpG-ODN), a class of synthetically produced singlestrand DNA oligonucleotides with a high CpG-motif content or so-called virus-like particles (VIPs) as capsid proteins of viruses or bacteriophages. The latter do not contain viral RNA or DNA and are unable to replicate, and this principle has already been investigated in preliminary studies [3, 4]. The following outlines some promising achievements and further paths in SCIT development
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