Recombinant allergens for immunotherapy. Where do we stand?

Allergome: the characterization of allergens based on a 2D gel electrophoresis approach

Type I hypersensitivity reactions are in constant progression in industrialized countries. The physiopathologic mechanism of these diseases implicates the production of specific immunoglobulin (Ig)E to allergenic molecules, their binding to the Fcepsilon receptor on the surface of mast cells and basophils, and the release of inflammatory mediators when allergens are introduced into the body and crosslink with the IgE bound to the cell surface. An allergen is defined as a molecule that induces the production of, and binds to, IgE. The identification of the allergenic molecules is an important goal to improve diagnosis and treatment of allergy. This characterization aims to extract proteins from the allergenic source, to analyze IgE specificity by immunoblotting and to identify the proteins that bind IgE.

Modern approaches to therapeutic vaccination as treatment for Type 1 respiratory hypersensitivity (allergy) treatment

The incidence of respiratory and other allergies has increased dramatically in many countries over the last few decades. Drug treatment is symptomatic and has a minimal effect on the underlying immunological dysfunction. This disease process may, however, be modified by allergy vaccination, which is typically applied by injecting increasing strengths of the offending allergens. Its use has been fairly limited owing to long injection schedules involving many visits to the physician, occasional local or systemic side effects, perceived limited efficacy and poor compliance. A greater understanding of the immunological mechanisms involved in allergy vaccination has led recently to the development of new generations of products with properties that address some of these issues, and these advances are likely to increase the successful use of the therapy.

Improving pollen immunotherapy: minor allergens and panallergens

Multiple sensitizations to pollens are common clinical situations in Spain, and alter the efficacy of allergen-specific immunotherapy. We now know that optimization of the diagnosis is required to define the best suited treatment for each patient. All pollen allergens belong to 29 families of proteins - the most abundant being the expansins, prophyllins and polcalcins. The ubiquitous nature of proteins such as the prophyllins and polcalcins defines them as panallergens, and explains the cross-reactivity that is erroneously interpreted by clinicians as constituting multi-sensitization. Other families of allergens, such as the calcium transporting proteins (LTPs) are more restricted, but are associated to severe types of allergic disease - this being particularly useful to decide upon the indication of immunotherapy. Although recombinant allergens can be produced for in vitro diagnostic purposes, current legislation only allows the use of natural proteins for immunotherapy. However, the same technology can be applied to the study of extracts for vaccines, and it seems that allergen quantification by the manufacturers is a no return trip which clinicians are obliged to follow.

Looking ahead at the potential benefits of biotechnology-derived allergen therapeutics

While biotechnology-derived allergen therapeutics show promise in improving the safety of immunotherapy, they may prove to have additional benefits in comparison to conventional allergenic extracts that deserve commentary. These issues range from product stability and compatibility to medical practice issues, which will be the focus of this article.

Suspension-cultured BY-2 tobacco cells produce and mature immunologically active house dust mite allergens

The replacement of crude allergen extracts by selected allergens currently represents a major goal for the improvement of allergy diagnosis and immunotherapy. Indeed, the development of molecularly defined vaccines would facilitate both standardization and enhance batch-to-batch reproducibility as well as treatment specificity. In this study, we have investigated the potential of tobacco plant cells to produce biologically active forms of the two major allergens from the house dust mite. A detailed characterization of these plant-made allergens has shown similar proteolytic maturation and folding as well as comparable immunoreactivity to their natural counterparts. Altogether, our results exemplify that suspension-cultured BY-2 tobacco cells represent a low cost and environmentally safe expression system suitable to produce recombinant allergens from Dermatophagoides pteronyssinus under a form appropriate for diagnostic and therapeutic purposes.

Standardization of allergen extracts for immunotherapy: where do we stand?

PURPOSE OF REVIEW

The current state of the art in allergen standardization and recent progress in the field is summarized, and future developments are discussed.

RECENT FINDINGS

The main focus of recent research in allergen standardization was on sandwich enzyme-linked immunosorbent assays or competitive tests for the quantification of individual allergens in extracts. New assays for quantifying major or minor allergens have been developed for tree and weed pollens from the Mediterranean area, grass pollens, and foods such as peanut and apple. In several cases, a good correlation with allergenic activity, measured by inhibition tests, was obtained. In addition, the potential of cellular mediator release assays in allergen standardization was evaluated in one study.

SUMMARY

Several new tests have been developed to make more major and minor allergens from various allergen sources accessible to allergen standardization programmes such as the CREATE project. It is expected that assays to determine the majority of all clinically relevant major allergens from aeroallergen sources will be available in the near future. Standardized and validated mediator release assays may be a complementary tool for evaluating the biological potency of reference allergens and for correlating allergen concentrations to biological potency.

Advances in development of hypoallergenic latex immunotherapy

PURPOSE OF REVIEW

The characterization of clinically relevant latex allergens and the production of recombinant allergens is now well advanced, but this knowledge needs to be translated into new strategies for the safe and effective specific treatment of latex allergic diseases including asthma and anaphylaxis.

RECENT FINDINGS

The current status of latex allergy is discussed indicating a changing demographic paradigm. A new wave of latex allergy is emerging outside the healthcare setting with the widespread use of latex products. An increased prevalence in developing countries is also reported. Limited studies on current specific immunotherapy for latex allergy are reviewed, confirming the feasibility but demonstrating an unacceptable risk of adverse events. The characterization of latex allergens and the identification of B and T-cell epitopes point to rational strategies for the generation of hypoallergenic preparations for specific immunotherapy. Results to date for latex allergens are reviewed, including recombinant, chemical modification and synthetic peptide approaches. Candidate hypoallergenic preparations for targeting sensitization to the major allergens Hev b 1, Hev b 3, Hev b 5 and Hev b 6.01 have been identified. Further investigations of optimal regimens for the delivery of specific immunotherapy to induce regulatory T-cell function are warranted.

SUMMARY

The findings point to the selection of suitable hypoallergenic preparations for clinical trials of effective and safe latex allergy immunotherapy.