Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria; The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University of Vienna, University Vienna, Vienna, Austria.
Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria; The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University of Vienna, University Vienna, Vienna, Austria.
J Allergy Clin Immunol Pract. 2021 May;9(5):1780-1789. doi: 10.1016/j.jaip.2020.12.008. Epub 2021 Mar 19.
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 T2-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 T1 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 pipeline-immune resilience.
变应原免疫疗法（AIT）是唯一在患者对疫苗中活性成分过敏的情况下应用疫苗的情况。因此，AIT 产品不仅需要有效，而且需要安全。在欧洲，对于皮下 AIT，通过变应原策略实现了这一点，该策略破坏或掩盖了 IgE 表位。此外，佐剂通过物理方式将过敏原沉淀在注射部位，以防止其过快地全身分布。佐剂的选择对注入过敏原的疗效和免疫反应类型具有重要影响。与 T2 促进佐剂相反，其他佐剂显然可以对抗过敏。在欧洲上市的产品采用了氢氧化铝（明矾）（66.7%）、微结晶酪氨酸（16.7%）、磷酸钙（11.1%）或 T1 佐剂单磷酰脂质 A（5.6%）。与欧洲的做法相反，在美国，大多数非佐剂的提取物和变应原都没有用于皮下 AIT，这不仅突显了监管方面的差异，也许还突显了一种“历史偏好”。舌下 AIT 以滴剂或片剂的形式在全球范围内应用，无需佐剂，通常具有比皮下 AIT 更高的安全性，但患者依从性较低。本文将讨论 AIT 和佐剂如何调节接受治疗的患者的免疫反应，使其向免疫激活、调节或——随着新的研发进展——免疫弹性转变。
