The role of allergoids in allergen immunotherapy:from injective to sublingual routeE. Compalati1, C. Incorvaia2, C. Cavaliere3, S. Masieri4, A. Gargiulo5, G. Mistrello6, F. Frati firstname.lastname@example.orgShow more: Authors information and Publication history
Scientific and Medical Department, Lofarma S.p.A., Milan, Italy2
Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy3
Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy4
Department of Sense Organs, Sapienza University, Rome, Italy5
Regulatory Department, Lofarma S.p.A., Milan, Italy6
Research Department, Lofarma S.p.A., Milan, ItalyHistory
Published online: 24 April 2020
Accepted: 26 March 2020
Received: 5 February 202
Allergen immunotherapy (AIT) is aimed at inducing tolerance to allergens, such as pollens, dust mites or moulds, by administering increasing amounts of the causative allergen through subcutaneous or sublingual route. The evidence of efficacy of AIT is high, but the issue of safety, especially for the subcutaneous route, must be taken into account. The search for safer AIT products aimed at reducing the allergenicity, and thus adverse reactions, while maintaining the immunogenicity, that is essential for effectiveness, gave rise to the introduction of allergoids, which were conceived to fulfill these requirements. In the first allergoids glutaraldehyde or formaldehyde were used as cross-linking agent to polymerize allergens, this resulting in high molecular weight molecules (200,000 to 20,000,000 daltons) which were significantly less allergenic due to a decreased capacity to bridge IgE on its specific receptor, while maintaining the immunogenicity and thus the therapeutic efficacy. In recent years further agents, acting as adjuvants, were added to polymerized extracts. Moreover, a carbamylated monomeric allergoid was developed and, once adsorbed on calcium phosphate matrix, used by subcutaneous route. At the same time, in virtue of its peculiarities, such allergoid revealed particularly suitable for sublingual administration. A lot of clinical evidences show that it is well tolerated, largely safer and effective. Importantly, the higher safety of allergoids allows faster treatment schedules that favor patient compliance and, according to pharmaco-economic studies, they might be more cost-effective than other AIT options.Key words
Allergen immunotherapy; safety; efficacy; allergoids; monomeric allergoids.
Cite this article as
Compalati E, Incorvaia C, Cavaliere C, Masieri S, Gargiulo A, Mistrello G, Frati F, The role of allergoids in allergen immunotherapy: from injective to sublingual route, Eur Ann Allergy Clin Immunol., 2020;52(5): 195-204. doi:10.23822/EurAnnACI.1764-1489.142.