Oliver Pfaar, Jean Bousquet, Stephen R. Durham, Jörg Kleine-Tebbe, Mark Larche, Graham C Roberts, Mohamed H Shamji, Roy Gerth Van Wijk

Allergy . 2021 Jul 27. doi: 10.1111/all.15023. Online ahead of print.

It was back in 1911 that Noon has first described the favorable effects of subcutaneous injections with grass pollen extract on himself. Since then, allergen immunotherapy (AIT) has evolved as the most important treatment for allergic patients. AIT constitutes the only disease-modifying treatment available, with consistent efficacy and safety. Worldwide regulatory authorities recognize AIT, which products are subject to thorough assessments before a market authorization is granted.

The disease-modifying effects of AIT are associated with immune modulation of the innate and adaptive immune responses. The recent advances in understanding

the mechanisms supporting AIT will enable the identification of immune monitoring biomarkers as well as biomarkers of efficacy and tolerance. Additionally, this knowledge will be helpful for the development of new therapeutic targets that can be used in conjunction with immunotherapy to shorten treatment duration and improve patient compliance and efficacy.

Recent regulations of allergen products by authorities have positively integrated scientific progress in modern allergology and clinical advances. Definitions of homologous allergen groups based on biological and molecular relationships, manufacturing, and quality aspects have been combined with a framework for the clinical development of allergen products.

Also, a list of in vivo diagnostic and AIT-products is still to be market authorized, including pollen, dust mites, pets, and venoms.

The delivery of cost-effective modern health care is exciting for allergic diseases. Novel solutions – based on mobile health devices- are required to support authorities, and they should promote change of health and care towards integrated care with organizational health literacy.

International guidelines describe and acknowledge the use of AIT.

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