International Consensus on Allergen Immunotherapy II: Mechanisms, standardization, and pharmacoeconomics

Abstract

This article continues the comprehensive international consensus (ICON) statement on allergen immunotherapy (AIT). The initial article also recently appeared in the Journal. The conclusions below focus on key mechanisms of AIT-triggered tolerance, requirements in allergen standardization, AIT cost-effectiveness, and regulatory guidance. Potential barriers to and facilitators of the use of AIT are described in addition to future directions. International allergy specialists representing the European Academy of Allergy and Clinical Immunology; the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the World Allergy Organization critically reviewed the existing literature and prepared this summary of recommendations for best AIT practice. The authors contributed equally and reached consensus on the statements presented herein.

Nanoparticle–allergen complexes for allergen immunotherapy

“…86 However, some questions still remain regarding the safety of these treatments and the need to reduce the dose and time of administration to improve patient compliance. In recent years, nanotechnologies have strongly emerged in vaccinology and, more currently, in the allergen immunotherapy field, with several studies in animals showing very promising future perspectives.…”

Der f 34, a Novel Major House Dust Mite Allergen Belonging to a Highly Conserved Rid/YjgF/YER057c/UK114 Family of Imine Deaminases

“…Seven clones positively bound with anti-HM2 fraction pAb, and a positive clone was named der f 34 (initially named mag133). 6 The sequence for der f 34 was determined by sequencing one positive clone. The sequencing, the construction of plasmid using pGEX-4T-1, transfection into E. coli BL21, protein expression of GST-tagged Der f 34 (GST-Der f 34) induced by 0.1 mg/ml isopropyl 1-thio-␤-D-galactopyranoside, and purification of rGST-Der f 34 using a glutathione-Sepharose 4B column (GE Healthcare Japan, Tokyo, Japan) were performed by methods described previously, with slight modifications (8).…”

“…The two-dimensional immunoblotting analysis in the allergenomics study was carried out using plasma samples from 40 patients allergic to HDM. 6 The HM2 fraction, the enriched nDer f 34 fraction, rDer f 34, and nDer f 34 were immunostained with 20,000-fold-diluted rabbit anti-rDer f 34 pAb, followed by 20,000-fold-diluted peroxidase-conjugated goat anti-rabbit IgG (Cell Signaling Technology, Danvers, MA), and visualized with ECL Plus Western blotting detection reagents (GE Healthcare Japan). The area of PVDF membrane corresponding to the protein weight marker was cut after protein transfer and then stained with Coomassie Brilliant Blue.…”

“…AIT induces antigen-specific immunomodulatory cells or the anergic response of T cells specific to major allergens included in an allergen extract as an AIT vaccine. Therefore, the standardization of AIT vaccines using important major allergens and the characterization of major component allergens in an allergen source are important issues for the development of an effective AIT (5,6). …”

Chinese Guideline on allergen immunotherapy for allergic rhinitis

“…Confirmation of sensitization to specific allergens in allergic patients and subsequent successful and safe outcome of specific AIT depend on the use of high quality allergen extracts (140). An allergen extract is prepared from natural source materials; e.g., mites, pollen, animal dander, molds; and mainly contain active substances (i.e., proteins or glycoproteins, and non-allergenic molecules).…”