Novel vaccines for allergen-specific immunotherapy.

Oluwatoyin Akinfenwa,Rudolf Valenta,Susanne Vrtala,Raffaela Campana,Azahara Rodríguez-Domínguez

doi:10.1097/aci.0000000000000706

Abstract

Purpose of reviewAllergen-specific immunotherapy (AIT) is a highly economic, effective and disease-modifying form of allergy treatment but requires accurate prescription and monitoring. New molecular approaches are currently under development to improve AIT by reducing treatment-related side effects, cumbersome protocols and patients’ compliance. We review the current advances regarding refined diagnosis for prescription and monitoring of AIT and the development of novel molecular vaccines for AIT. Finally, we discuss prophylactic application of AIT.Recent findingsThere is evidence that molecular allergy diagnosis not only assists in the prescription and monitoring of AIT but also allows a refined selection of patients to increase the likelihood of treatment success. New data regarding the effects of AIT treatment with traditional allergen extracts by alternative routes have become available. Experimental approaches for AIT, such as virus-like particles and cell-based treatments have been described. New results from clinical trials performed with recombinant hypoallergens and passive immunization with allergen-specific antibodies highlight the importance of allergen-specific IgG antibodies for the effect of AIT and indicate opportunities for preventive allergen-specific vaccination.SummaryMolecular allergy diagnosis is useful for the prescription and monitoring of AIT and may improve the success of AIT. Results with molecular allergy vaccines and by passive immunization with allergen-specific IgG antibodies indicate the importance of allergen-specific IgG capable of blocking allergen recognition by IgE and IgE-mediated allergic inflammation as important mechanism for the success of AIT. New molecular vaccines may pave the road towards prophylactic allergen-specific vaccination.

Highlights

The burden of allergy is increasing globally and there is need for new therapies that improve the quality of life of allergic patients, reduce economic costs and are suitable for a precision approach [1– 3,4&,5]
Route: subcutaneous AIT (SCIT) Description: DBPC clinical study with nonallergic subjects who were vaccinated with recombinant hypoallergenic derivatives of the major birch pollen allergen, Bet v 1 for 2 years Study: 16 patients, 6 actively treated patients and 10 placebo-treated patients Primary endpoint: development of Bet v 1-specific IgG antibodies Reference: Campana et al [96&&]
This study showed that vaccination with the hypoallergenic derivatives did not induce allergic sensitization in the nonallergic individuals [96&&]

Summary

INTRODUCTION

The burden of allergy is increasing globally and there is need for new therapies that improve the quality of life of allergic patients, reduce economic costs and are suitable for a precision approach [1– 3,4&,5]. AIT is the only treatment that instructs the immune system of the patients for protection by therapeutic vaccination and can prevent the progression of the severity of allergic disease [9]. ADivision of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria, bNRC Institute of Immunology FMBA of Russia, cLaboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia and dKarl Landsteiner University of Health Sciences, Krems, Austria

KEY POINTS

Molecular approaches with recombinant allergen-specific antibodies

Findings

CONCLUSION