Novel Routes for Allergen Immunotherapy

Safety, Efficacy and Mode of Action

Philippe Moingeon; Laurent Mascarell

Disclosures

Immunotherapy. 2012;4(2):201-212. 

In This Article

Abstract and Introduction

Abstract

Allergen immunotherapy is the only curative treatment of IgE-mediated type I respiratory allergies. Subcutaneous immunotherapy (SCIT) is used as a reference therapy and has transformed allergic treatments; it improves symptoms (asthma and rhinitis) as well as the quality of life of patients. SCIT requires repetitive administration and carries the risk of severe systemic adverse effects, including anaphylaxis. Sublingual immunotherapy is now a valid noninvasive alternative to SCIT, as a safe and efficacious treatment for respiratory allergies. In this article, we compare various routes of allergen immunotherapy, including SCIT and sublingual immunotherapy, as well as more exploratory routes currently under investigation (i.e., intralymphatic, epicutaneous, intranasal and oral). We discuss their respective advantages, as well as their foreseen modes of action.

Introduction

Last year, we celebrated the 100th anniversary of the first successful studies of allergen immunotherapy (AIT) performed on patients with hayfever.[1,2] Whereas the subcutaneous route is still a reference, tolerance induction via alternative routes has raised considerable interest over the last three decades. Importantly, sublingual immunotherapy (SLIT) is the only approach established as a valid noninvasive alternative to the subcutaneous route for immunotherapy (SCIT). SLIT is safe and efficacious for promoting allergen-specific tolerance,[3–10] as demonstrated by multiple double-blind, placebo-controlled (DBPC) Phase III studies conducted in large cohorts of adults and pediatric patients allergic to grass pollen or house dust mite (HDM). Besides the sublingual route, other routes of administration are being explored, including the intralymphatic, epicutaneous, intranasal and oral routes, with some encouraging results in terms of immunogenicity and clinical efficacy. This review provides an update on those various AIT approaches, with a specific emphasis of their modes of action.

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