Advances and Highlights in Allergen Immunotherapy: On the way to sustained clinical and immunologic tolerance

Publication date: Available online 20 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Margot Berings, Cagatay Karaaslan, Can Altunbulakli, Philippe Gevaert, Mübeccel Akdis, Claus Bachert, Cezmi A. Akdis
Allergen immunotherapy (AIT) is an effective treatment strategy for allergic diseases and has been used for more than 100 years. In recent years, however, the expectations on concepts, conduct, statistical evaluation and reporting have been significantly developed. Products have undergone dose-response and confirmative studies in adults and children to provide evidence for the optimal dosage, safety and efficacy of AIT vaccines using subcutaneous and sublingual delivery pathways in large patient cohorts, ensuring solid conclusions to be drawn from them for the advantage of patients and societies alike. Those standards should be followed today, and products answering to them should be preferred over others lacking optimization and proof of efficacy and safety. Molecular and cellular mechanisms of AIT include early mast cell and basophil desensitization effects, regulation of T and B cell responses, regulation of IgE and IgG4 production and inhibition of responses from eosinophils, mast cells and basophils in the affected tissues. There were many developments to improve vaccination strategies, demonstration of new molecules involved in molecular mechanisms and demonstration of new biomarkers for AIT during the last few years. The combination of probiotics, vitamins and biologicals with AIT are highlighting current advances. Development of allergoids, recombinant and hypoallergenic vaccines to skew the immune response from IgE to IgG4 and regulation of dendritic cell, mast cell, basophil, innate lymphoid cell, T and B cell responses to allergens are also discussed in detail.



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