[Innovative forms of specific immunotherapy]

The clinical efficacy of allergen-specific immunotherapy depends on tolerance induction. Treatment success is currently limited by treatment-related adverse reactions. Novel approaches mainly target improvement of tolerability in addition to optimized immunogenicity. For epicutaneous immunotherapy (EPIT), commercially available treatment extracts are applied to skin via a patch. The route exhibits excellent tolerability and good clinical efficacy. The first encouraging data on a peanut EPIT were published in 2016. Intralymphatic immunotherapy (ILIT) study results show pronounced immunogenicity and persisting clinical efficacy after only three injections of a small amount of established extracts. New approaches of synthetic vaccine development focus on tolerance induction. These vaccines are genetically engineered with a precisely defined profile and can be manufactured in reproducible quality. Distinct immunogenicity of the antigenic determinants contained in the preparation as well as an optimized safety profile are expected. Grass, birch, cat, and mite vaccines are currently under investigation. Which of these approaches will gain market access is unclear up to date. Results of food immunotherapy studies reveal consistently poor tolerance and limited efficacy without encouraging perspective and are not discussed further.