Carbamylated monomeric allergoids for sublingual immunotherapy in pediatric respiratory allergies

Allergen immunotherapy (AIT) is an evidence-based therapy for allergic rhinitis and allergic asthma. AIT is largely recognized as the only causal treatment of allergic diseases that targets the underlying pathophysiology and may have a disease-modifying effect in addition to the antisymptomatic effect. Carbamylated monomeric allergoids (CMAs) are chemically modified allergens with reduced IgE-binding activity (reduced allergenicity) but full immunogenicity. The carbamylation process allows them to be much smaller than other modified allergens, making them ideal for sublingual immunotherapy (SLIT), and reduced allergenicity makes them safe and well tolerated. CMAs have several advantages over other SLIT products: smaller size for easier absorption through mucosa, greater resistance to proteolytic degradation, greater bioavailability, and reduced allergenicity with full immunogenicity. The tablet form allows for accurate dosing and compliance is easy to monitor. Safety is an especially important consideration when treating conditions in pediatric populations, as is patient compliance. This review focused on the efficacy, safety, and clinical application of monomeric allergoid SLIT for allergic disease in children and its suitability as an alternative to subcutaneous immunotherapy.