Allergy Immunotherapy in Review: New Developments in Immune Therapy

Allergy immunotherapy (AIT) is really a therapeutic area in its own right. The treatment approach leverages the body’s own immune system to produce a defense against a known allergen. AIT tends to provide relief where pharmacotherapy fails. It is usually cost-effective and symptom-reducing (sometimes, symptom-eliminating). This combination of benefits has driven new research in the realm of allergy immunotherapy.

Understanding Mechanisms of Action and Cross-Reactivity

Emerging technology is shaping how we look at asthma and allergies. There are a variety of risks and protective factors involved in the development of asthmatic symptoms as well as specific molecular mechanisms that may influence asthma; these truths are well-established. Recently, there has been a shift toward looking at the exposome paradigm. Microbial dysbiosis, personal genetics, and individual environments are becoming areas of concentrationng in reviewing the development of asthma as well as the treatments for those symptoms as disease endotyping evolves and the correct understanding of morbidities improves.

Developments in Food Allergy Immunotherapy

Allergen immunotherapy has been evolving for over a century. Discoveries of different immunoglobulin kicked off a new wave of understanding 50 years ago and now that development continues as novel vaccination strategies progress. Sublingual and subcutaneous immunotherapies are being applied to venomous reactions, food allergies, and atopic dermatitis to good effect while sublingual and epicutaneous approaches evolve. The use of adjuvant therapies to reduce side effects from allergy immunotherapy and improve the efficacy of those approaches is promising.

Patient Adherence to Allergy Immunotherapy

In a study of over 2.3 million allergic rhinitis patients, just over 100,000 had an allergy immunotherapy claim in the period from January 1, 2014 to March 31, 2017. Those who did were generally . Tthe ones who needed therapeutic intervention the most, as is typical with AIT. Of these, roughly 44% achieved a maintenance phase. For the ones who did not reach maintenance, adherence was an issue. Increasing patient awareness of the efficacy of AIT treatment is critical to improving health outcomes for people with the worse allergies.

Impact of COVID on Allergy Immune Therapy Research

No article on allergy research could ignore the involvement and implication of the COVID-19 pandemic. The SARS-CoV-2 outbreak sparked a worldwide crisis that impacted millions. Research in this therapeutic area produces up to 9,000 publications per year. Before COVID-19, the most novel developments included precision medicine and biomarkers.

Initially, asthma was identified as a COVID-19 risk factor. While its subsequent classification was inconsistent and unclear, researchers working with asthma subjects had to be careful in how any research would be continued during the outbreak. To-date, most COVID-19 research centers on older populations or patients who were hospitalized, and many asthma/allergy studies were delayed, which postponed the entire therapeutic pipeline. Asthma research and allergy management adapted where possible, but the impact is undeniable on both patients and research.

While asthma and allergies are no longer considered a risk factor, patients with those conditions may have scarred lungs and reduced capacity that only exacerbates symptoms should they develop COVID-19. Likewise, while asthma/allergy research didn’t stop because of COVID-19, it didn’t progress like it would have.

Resources:

• Cevhertas, L., et al. (2020). Advances and recent developments in asthma in 2020. Allergy, 75(12), 3124–3146. https://doi.org/10.1111/all.14607
• Cox, L. S. (2020). Allergy Immunotherapy: Are We Making Progress or Just Standing Still? Immunology and Allergy Clinics, Volume 40, Issue 1, xiii – xiv. https://www.immunology.theclinics.com/article/S0889-8561(19)30079-7/fulltext
• Kim, E. H., & Burks, A. W. (2020). Food allergy immunotherapy: Oral immunotherapy and epicutaneous immunotherapy. https://onlinelibrary.wiley.com/doi/pdf/10.1111/all.14220
• Kleine‐Tebbe, J., Zuberbier, T., Werfel, T., Krüll, M., Wagenmann, M., Johansen, N., . . . Biedermann, T. (2020). Is allergy immunotherapy with birch sufficient to treat patients allergic to pollen of tree species of the birch homologous group? https://onlinelibrary.wiley.com/doi/pdf/10.1111/all.14130
• Nelson, H. (2020). Allergy immunotherapy: Future directions for the 2020s. Allergy and Asthma Proceedings, 41(5), 314–325. https://doi.org/10.2500/aap.2020.41.200041
• Nicolaides, R. E., Parrish, C. P., & Bird, J. A. (2020). Food Allergy Immunotherapy with Adjuvants. Immunology and allergy clinics of North America, 40(1), 149–173. https://doi.org/10.1016/j.iac.2019.09.004
• Stone, B., Rance, K., Waddell, D., Aagren, M., Hammerby, E., & Tkacz, J. P. (2021). Real-world mapping of allergy immunotherapy in the United States: The argument for improving adherence. Allergy and asthma proceedings, 42(1), 55–64. https://doi.org/10.2500/aap.2021.42.200114
• Tesch, F. (2020). The moderating role of allergy immunotherapy in asthma progression: Results of a population‐based cohort study. Allergy, 75(3), 596–602. https://doi.org/10.1111/all.14020