Immunoregulatory T cell epitope peptides for the treatment of allergic disease

Allergic diseases are type 2 inflammatory reactions with an increasing worldwide prevalence, making the search for new therapeutic options pertinent. Allergen immunotherapy is the only disease-modifying approach for allergic rhinitis, though it can result in systemic reactions. Recently, peptide immunotherapy (PIT), involving T-cell epitope peptides that bind to major histocompatibility complexes, have been developed. It is speculated that they can induce T helper cell type 2 anergy, Treg cell upregulation or immune deviation. Promising results in cat dander, honeybee venom, Japanese cedar pollen, grass pollens, ragweed and house dust mite clinical trials have shown safety, efficacy and tolerability to PIT. Hence, PIT may hold the potential to change the treatment algorithm for allergic rhinitis.

Advances in allergen immunotherapy in 2015

The year 2015 saw a significant number of advances in allergen immunotherapy (AIT), and several of these are reviewed in this report. Although AIT has been used for more than 100 years, investigations into optimal treatment approaches and mechanisms are ongoing. Among the highlights was a report by an international group of experts who reviewed AIT guidelines from the major specialty societies and addressed potential unmet needs. Herein, advances in the effectiveness, safety, and mechanisms of sublingual and oral immunotherapy are reviewed. Development of hypoallergenic vaccines to enhance safety, newer routes and regimens to improve efficacy, and biomarkers to monitor immunotherapy are also discussed.

T Cell Epitope Peptide Therapy for Allergic Diseases

Careful selection of dominant T cell epitope peptides of major allergens that display degeneracy for binding to a wide array of MHC class II molecules allows induction of clinical and immunological tolerance to allergen in a refined treatment strategy. From the original concept of peptide-induced T cell anergy arising from in vitro studies, proof-of-concept murine models and flourishing human trials followed. Current randomized, double-blind, placebo-controlled clinical trials of mixtures of T cell-reactive short allergen peptides or long contiguous overlapping peptides are encouraging with intradermal administration into non-inflamed skin a preferred delivery. Definitive immunological mechanisms are yet to be resolved but specific anergy, Th2 cell deletion, immune deviation, and Treg induction seem implicated. Significant efficacy, particularly with short treatment courses, in a range of aeroallergen therapies (cat, house dust mite, grass pollen) with inconsequential non-systemic adverse events likely heralds a new class of therapeutic for allergy, Synthetic Peptide Immuno-Regulatory Epitopes (SPIRE).