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New Directions in Immunotherapy

  • RHINITIS (JN BARANIUK AND JJ OPPENHEIMER, SECTION EDITORS)
  • Published:
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Abstract

Allergen immunotherapy (AIT) is effective in reducing the clinical symptoms associated with allergic rhinitis, asthma and venom-induced anaphylaxis. Subcutaneous (SCIT) and sublingual immunotherapy (SLIT) with unmodified allergen extracts are the most widely prescribed AIT regimens. The efficacy of these 2 routes appears comparable, but the safety profile with SLIT is more favorable allowing for home administration and requiring less patient time. However, both require that the treatment is taken regularly over several years, e.g., monthly in a supervised medical setting with SCIT and daily at home with SLIT. Despite the difference in treatment settings, poor adherence has been reported with both routes. Emerging evidence suggests that AIT may be effective in other allergic conditions such as atopic dermatitis, venom sting-induced large local reactions, and food allergy. Research with oral immunotherapy (OIT) for food allergies suggest that many patients can be desensitized during treatment, but questions remain about whether this can produce long term tolerance. Further studies are needed to identify appropriate patients and treatment regimens with these conditions. Efforts to develop safer and more effective AIT for inhalant allergies have led to investigations with modified allergens and alternate routes. Intralymphatic (ILIT) has been shown to produce long-lasting clinical benefits after three injections comparable to a 3-year course of SCIT. Epicutaneous (EPIT) has demonstrated promising results for food and inhalant allergies. Vaccine modifications, such as T cell epitopes or the use of viral-like particles as an adjuvant, have been shown to provide sustained clinical benefits after a relatively short course of treatment compared to the currently available AIT treatments, SLIT and SCIT. These newer approaches may increase the utilization and adherence to AIT because the multi-year treatment requirement of currently available AIT is a likely deterrent for initiating and adhering to treatment.

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Abbreviations

AD:

Atopic dermatitis

AE:

Adverse reaction

AIT:

Allergy immunotherapy

DBPC:

Double-blind, placebo-controlled

EPIT:

Epicutaneous immunotherapy

ILIT:

Intralymphatic immunotherapy

LLR:

Large local reaction

LPSR:

Late-phase skin response

OIT:

Oral immunotherapy

SCIT:

Subcutaneous immunotherapy

SLIT:

Sublingual immunotherapy

SPT:

Skin prick test

SR:

Systemic reaction

TRSS:

Total Rhinoconjunctivitis Symptom Score

VIT:

Venom immunotherapy

VLP:

Virus-like particles

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Acknowledgments

Dr. Larche is funded by the Canada Research Chairs program, the Canadian Institutes for Health Research (CIHR), National Institutes for Allergy & Infectious Diseases (NIAID), AllerGen Network of Centres of Excellence, the Canada Foundation for Innovation, Adiga Life Sciences Inc., and the McMaster University/GSK endowed Chair in Lung Immunology at St Joseph's Healthcare. Dr .Kundig’s investigator–initiated studies are financially supported by the Swiss National Science Foundation (SNSF), the University of Zurich, Medanz Medical GmbH (Starnberg, Germany), and Allergy Innovations (Munich, Germany).

Disclosure

Dr. Cox has provided consulting services for Stallergenes and Genentech and has served on a safety data monitoring committee for Circassia and Novartis.

Dr. Compalati is funded by the University of Genoa, Italy, for clinical research and has received a grant for scientific consultancy by Lofarma S.p.A., a manufacturer of products for allergen specific immunotherapy, within the past 2 years.

Dr. Larche is a founder, shareholder and Dr.Kundig is named as the inventor on a patent on intralymphatic immunotherapy and as one of the inventors on a patent on epicutaneous immunotherapy; the patents are owned by the University of Zurich. consultant of/to Circassia Ltd., a company developing peptide-based immunotherapy and is scientific founder of Adiga Life Sciences Inc., a joint venture between Circassia Ltd. and McMaster University.

Dr. Kundig reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Department of Medicine, Nova Southeastern University, Davie, FL, USA

    Linda Cox

  2. Allergy and Respiratory Diseases Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy

    Enrico Compalati

  3. Department of Dermatology, University Hospital Zurich, Zurich, Switzerland

    Thomas Kundig

  4. Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada

    Mark Larche

  5. 5333 North Dixie Highway, Ft. Lauderdale, FL, 33334, USA

    Linda Cox

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Correspondence to Linda Cox.

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Cox, L., Compalati, E., Kundig, T. et al. New Directions in Immunotherapy. Curr Allergy Asthma Rep 13, 178–195 (2013). https://doi.org/10.1007/s11882-012-0335-7

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