Current practices and future trends in cockroach allergen immunotherapy

Reginald K, Chew FT. Mol Immunol. 2023 Sep;161:11-24.

Highlights

• Immunotherapy is an appealing long-term solution for treating cockroach allergies as they are difficult to eliminate.

• Using recombinant allergens for allergen immunotherapy improves the reproducibility of treatment outcomes.

• Cockroach allergens can be made even safer for immunotherapy by removing its IgE-epitopes while retaining antigenicity.

• Immunotherapy based on cross-reacting allergen groups should be considered for certain allergens.

• Accurate patient selection via precision allergen testing is the first step towards precision AIT.

Abstract

Purpose of review

This review evaluates the current modes of allergen-specific immunotherapy for cockroach allergens, in terms of clinical outcomes and explores future trends in the research and development needed for a more targeted cockroach immunotherapy approach with the best efficacy and minimum adverse effects.

Summary

Cockroach allergy is an important risk factor for allergic rhinitis in the tropics, that disproportionately affects children and young adults and those living in poor socio-economic environments. Immunotherapy would provide long-lasting improvement in quality of life, with reduced medication intake. However, the present treatment regime is long and has a risk of adverse effects. In addition, cockroach does not seem to have an immuno-dominant allergen, that has been traditionally used to treat allergies from other sources. Future trends of cockroach immunotherapy involve precision diagnosis, to correctly identify the offending allergen. Next, precision immunotherapy with standardized allergens, which have been processed in a way that maintains an immunological response without allergic reactions. This approach can be coupled with modern adjuvants and delivery systems that promote a Th1/Treg environment, thereby modulating the immune response away from the allergenic response.

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