Current advances in house dust mite allergen immunotherapy (AIT): Routes of administration, biomarkers and molecular allergen profiling

• Published in: Molecular immunology Vol. 155; pp. 124 - 134
• Main Authors: Batard, Thierry, Canonica, Walter G., Pfaar, Oliver, Shamji, Mohamed H., O’Hehir, Robyn E., van Zelm, Menno C., Mascarell, Laurent
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2023
• Subjects: Administration routes; Allergen immunotherapy; Allergens; Animals; Antigens, Dermatophagoides - therapeutic use; Asthma - drug therapy; Biomarkers; Desensitization, Immunologic; House dust mite; Humans; Hypersensitivity - drug therapy; Molecular reactivity profiling; Pyroglyphidae; Quality of Life; Rhinitis, Allergic - drug therapy; ILC; TU; TRMS; VAS; HDM; SCIT; AASS; SLIT; TE/RAE; AE; Administration routes; IR; House dust mite; AIT; ILIT; DBPC; T(C)RS; BAU; EPIT; Biomarkers; ICS; FEV1; Allergen immunotherapy; TDIT; Molecular reactivity profiling; ATCS; AUeq; AR(/C); DC; JAU
• ISSN: 0161-5890; 1872-9142
• DOI: 10.1016/j.molimm.2023.02.004

Allergy to house dust mites (HDM) is a perennial respiratory disease that affect more than half a billion people worldwide. Dermatophagoides pteronyssinus and D. farinae, two HDM species, are major sources of indoor allergens triggering allergic inflammation. Although symptomatic drugs are widely used to block the allergic reaction, allergen immunotherapy is the only curative treatment of IgE-mediated type I respiratory allergies. In this article, we review recent advances in various routes of allergen immunotherapy. We particularly focus on subcutaneous (SCIT) and sublingual (SLIT) immunotherapy, used as a reference therapy since they have transformed allergic treatments by improving symptoms (asthma and rhinitis) as well as the quality of life of patients. We also highlight recent data in more exploratory routes (i.e., oral, intralymphatic, epicutaneous and intradermal) and discuss respective advantages of various route, as well as their foreseen modes of action. Finally, we provide an update on biomarkers as well as on the relevance of the molecular profiling of allergic individuals related to treatment efficacy or asthma prediction. •SCIT and SLIT are efficacious in HDM-induced allergic rhinitis (> 5 years) and SLIT in mild to moderate asthma (> 18 years).•Other promising AIT routes and allergen presentation platforms (adjuvants or delivery systems) need to be further explored.•Innate and adaptive immune candidate biomarkers related to regulatory and type-2 responses have been identified during AIT.•Evaluating HDM-specific IgE, IgG2 and IgG4 in serum could help in the decision to continue and/or adapt AIT.•Molecular profile of IgE sensitization should help to establish the risk of asthma and to foster personalized medicine.