Reconsider the Art of Allergen Immunotherapy

Abstract

This symposium took place during the European Academy of Allergy and Clinical Immunology (EAACI) Hybrid Congress, held in Prague, Czechia, in July 2022. Stephanie Dramburg, Medical Doctor at Charité Universitätsmedizin, Berlin, Germany, explained that the traditional diagnostic work-up for allergic rhinoconjunctivitis (AR) comprises retrospective clinical history and allergen exposure assessment, extract-based diagnostics, component-resolved diagnostics (CRD), which enables markers of genuine sensitisation to be distinguished from markers of cross-reactivity, and confirmation of clinical relevance. She highlighted that molecular IgE assessment supports the diagnostic work-up and personalised risk assessment in complex cases and that confirmation of clinical relevance of IgE results is key. Furthermore, broadening of a serum IgE response is indicative of ‘molecular spreading’. Dramburg considered that digital technologies have the potential to enhance medical decisions at the point-of-care via targeted patient information, guideline- and evidence-based clinical knowledge, and prospectively collected patient- and sensor-generated data. Marek Jutel, Medical Professor at Wroclaw Medical University, Poland, and the ALL-MED Medical Research Institute, Wroclaw, Poland, described that patients with allergies show different clinical pictures due to differing sensitisation profiles assessed at the molecular level. He noted that patients with allergies react differently to different allergen doses and allergen immunotherapy (AIT) preparations, and minor/intermediate allergens are necessary, in addition to major allergens, for optimal clinical efficacy. Jutel described that allergens that are decisive for AIT efficacy are defined in grass pollen but are not yet determined for other allergen sources such as birch and house dust mite (HDM). Petra Zieglmayer, Medical Professor at Karl Landsteiner University, Krems, Austria, and Head of Vienna Challenge Chamber, Austria, discussed that patients with allergies show complex molecular sensitisation profiles and that extract preparations from different manufacturers vary in terms of allergen composition, with major and intermediate allergens not always detectable. She clarified that optimal efficacy of AIT may only be expected from preparations containing all relevant allergen components in sufficient amounts. Zieglmayer proposed that the target should be to find a match between the patient molecular sensitisation profile and the allergen preparation and that this can be achieved.