Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
Volume 9, Issue 5, Pages 1780-1789Publisher
ELSEVIER
DOI: 10.1016/j.jaip.2020.12.008
Keywords
Adjuvant; Allergen immunotherapy; Allergoid; Aluminum hydroxide; Microcrystalline tyrosin; Monophosphoryl lipid A; Vaccine
Categories
Funding
- Austrian Science Fund [SFB F4606-B28]
- Danube Allergy Research Cluster, Lower Austria [08]
Ask authors/readers for more resources
Allergen immunotherapy (AIT) in Europe utilizes allergoid strategy to destroy or mask IgE epitopes and uses adjuvants to precipitate allergens at the injection site for effectiveness and safety, while subcutaneous AIT in the United States mainly uses nonadjuvanted extracts without allergoids.
Allergen immunotherapy (AIT) is the only setting in which a vaccine is applied in patients allergic exactly to the active principle in the vaccine. Therefore, AIT products need to be not only effective but also safe. In Europe, for subcutaneous AIT, this has been achieved by the allergoid strategy in which IgE epitopes are destroyed or masked. In addition, adjuvants physically precipitate the allergen at the injection site to prevent too rapid systemic distribution. The choice of adjuvant critically shapes the efficacy and type of immune response to the injected allergen. In contrast to TH2-promoting adjuvants, others clearly counteract allergy. Marketed products in Europe are formulated with aluminum hydroxide (alum) (66.7%), microcrystalline tyrosine (16.7%), calcium phosphate (11.1%), or the TH1 adjuvant monophosphoryl lipid A (5.6%). In contrast to the European practice, in the United States mostly nonadjuvanted extracts and no allergoids are used for subcutaneous AIT, highlighting not only a regulatory but maybe a historic preference. Sublingual AIT in the form of drops or tablets is currently applied worldwide without adjuvants, usually with higher safety but lower patient adherence than subcutaneous AIT. This article will discuss how AIT and adjuvants modulate the immune response in the treated patient toward immune activation, modulation, or-with new developments in the pipelineimmune resilience. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available