Understanding differences in allergen immunotherapy products and practices in North America and Europe

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:143

Review

Mahler, Vera¹  Esch, Robert E.²  Kleine-Tebbe, Joerg³  Lavery, William J.⁴  Vieths, Stefan¹  Bernstein, David I.⁴ 

[1] Paul Ehrlich Inst, Paul Ehrlich Str 51-59, D-63225 Langen, Germany

[2] Lenoir Rhyne Univ, Sch Nat Sci, Hickory, NC USA

[3] Outpatient Clin & Res Ctr, Allergy & Asthma Ctr Westend, Berlin, Germany

[4] Univ Cincinnati, Coll Med, Div Immunol, Allergy Sect, Cincinnati, OH 45267 USA

关键词: Allergen immunotherapy;    allergen;    allergoid;    diagnostic;    European Medicines Agency;    European Union;    extracts;    Food and Drug Administration;    practices;    regulatory;    subcutaneous;    sublingual;    United States;   

DOI  :  10.1016/j.jaci.2019.01.024

来源: Elsevier

【 摘 要 】

Allergen immunotherapy (AIT) is thought to be clinically effective and safe in treating allergic rhinitis, asthma, and stinging insect allergy in Europe and North America. However, there are intercontinental differences in AIT therapeutic products in terms of their application and regulation. In North America unmodified standardized and nonstandardized aqueous aeroallergen extracts are approved and used almost exclusively for subcutaneous immunotherapy, whereas more product options are available in Europe, including adsorbed allergens, chemically modified allergens, or both. Both liquid extracts and tablets are approved for sublingual immunotherapy in Europe. Nevertheless, within the European Union, there are major differences in AIT products approved and used in individual countries. There are major differences in the clinical approach to subcutaneous immunotherapy in polysensitized patients; in the United States mixed extracts containing multiple aeroallergens are used, whereas European allergists preferably administer separate injections of single allergen sources or homologous groups deemed to be clinically relevant. Moreover, the regulatory approach differs between the European Union and United States. In contrast to the United States, where common allergen standards exist based on biologic activity, no common standards exist in Europe. In terms of development of new investigational products, the United States has followed the European example for phase II and III studies; no formal US Food and Drug Administration guidance has been issued.

【 授权许可】

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