The role of allergoids in allergen immunotherapy: from injective to sublingual route

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Authors Information

1Scientific and Medical Department, Lofarma S.p.A., Milan, Italy
2Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy
3Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
4Department of Sense Organs, Sapienza University, Rome, Italy
5Regulatory Department, Lofarma S.p.A., Milan, Italy
6Research Department, Lofarma S.p.A., Milan, Italy


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.

Allergen immunotherapy; safety; efficacy; allergoids; monomeric allergoids.

Table of Content: Vol. 52 (No. 5) 2020 September

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