Preventive Allergen-Specific Vaccination Against Allergy: Mission Possible?

Abstract

Vaccines for infectious diseases have improved the life of the human species in a tremendous manner. The principle of vaccination is to establish de novo adaptive immune response consisting of antibody and T cell responses against pathogens which should defend the vaccinated person against future challenge with the culprit pathogen. The situation is completely different for immunoglobulin E (IgE)-associated allergy, an immunologically-mediated hypersensitivity which is already characterized by increased IgE antibody levels and T cell responses against per se innocuous antigens (i.e., allergens). Thus, allergic patients suffer from a deviated hyper-immunity against allergens leading to inflammation upon allergen contact. Paradoxically, vaccination with allergens, termed allergen-specific immunotherapy (AIT), induces a counter immune response based on the production of high levels of allergen-specific IgG antibodies and alterations of the adaptive cellular response, which reduce allergen-induced symptoms of allergic inflammation. AIT was even shown to prevent the progression of mild to severe forms of allergy. Consequently, AIT can be considered as a form of therapeutic vaccination. In this article we describe a strategy and possible road map for the use of an AIT approach for prophylactic vaccination against allergy which is based on new molecular allergy vaccines. This road map includes the use of AIT for secondary preventive vaccination to stop the progression of clinically silent allergic sensitization toward symptomatic allergy and ultimately the prevention of allergic sensitization by maternal vaccination and/or early primary preventive vaccination of children. Prophylactic allergy vaccination with molecular allergy vaccines may allow halting the allergy epidemics affecting almost 30% of the population as it has been achieved for vaccination against infectious diseases.

Peptide Allergen Immunotherapy: A New Perspective in Olive-Pollen Allergy

“…They induce a regulatory response mediated by IL-35 and IL-10, which is able to reduce the later response against to olive pollen. These data are in agreement with the idea that several authors [ 92 , 93 ] propose, i.e., the prophylactic usefulness of T-cell vaccines. Figure 2 summarizes the potential of Ole e 1-derived T cell epitopes for their use as AIT.…”

Allergic rhinitis

“…Future directions for conventional AIT include use of adjuvants, including vitamin D, Toll-like receptor ligand agonists, biologics 186 or probiotics 187 . Several attempts have been made to increase tolerance and efficacy using molecular allergy vaccines acting on B cells or T cells but none has produced convincing results 188 .…”

The Molecular Allergen Recognition Profile in China as Basis for Allergen-Specific Immunotherapy

“…Only the introduction of preventive measures and in particular of early vaccination holds the promise that they will lead to more effective treatment and thus save huge health care costs. In the case of allergy, preventive strategies include mainly allergen-specific forms of prevention, i.e., allergen avoidance and allergy vaccination, i.e., allergenspecific immunotherapy, AIT (8)(9)(10)(11)(12). Regarding the detection of early asymptomatic IgE sensitization in childhood and the consecutive development of allergic manifestations much has been learned in birth cohort studies conducted in a European Union-funded research program (Mechanisms of the Development of Allergy MeDALL) (1).…”