Mechanism of Synthetic Peptide Immuno-Regulatory Epitopes and Their Clinical Efficacy in the Treatment of Allergic Disease

AbstractPurpose of reviewPeptide immunotherapy with synthetic peptide immuno-regulatory epitopes (SPIREs) is a safer alternative to conventional allergen immunotherapy (AIT) owing to the reduced risk of IgE-mediated adverse reactions and shorter treatment schedules. Over the last 5  years, significant advances have been made in evaluating SPIREs for the treatment of allergic rhinitis. This review includes a summary of recent phase II and III clinical trials evaluating the efficacy of SPIREs and a brief discussion on their mechanism of action.Recent findingsTo date, SPIREs have been developed for cat, house dust mite (HDM), ragweed, and grass. Phase II clinical trials showed strong reductions in allergic symptoms, with clinical benefit persisting for up to 2  years after treatment initiation. However, subsequent phase III studies of cat and HDM peptides did not meet their primary endpoint due to significant placebo responses. Mechanistic studies reported a shift from effector T helper 2 (Th2) cells to Th1 and regulatory T cells along with reductions in Th2 cytokines and Th2-associated genes in blood immune cells.SummaryPeptide immunotherapy with SPIREs is efficacious in reducing symptoms after only 12 –14 weeks of treatment. Symptom relief can last up to 2 years after treatment and requires fewer injections compared to subcutaneous AIT. Revised trial designs should be considered to re-evaluate these potentially useful therapies in phase III evaluations to overcome placeb...
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research