New Treatment Modalities for Allergic Disease
Future Directions in Allergy Therapy
Bruce S. Bochner, M.D.
Professor of Medicine, and Director
Division of Allergy and Clinical Immunology
The Johns Hopkins University School of Medicine, Baltimore, Maryland
Upon completion of this session, participants will be able to:
- Understand the rationale for targeting IgE, cytokines, chemokines, adhesion molecules and other immune molecules for therapeutic purposes.
- Review the strategies used to target these molecules.
- Discuss the status of clinical trials of each of these agents as they relate to the treatment of asthma and allergic diseases.
The newest approved drug for the treatment of moderate to severe allergic asthma in patients age 12 and older is omalizumab, a 1-2 time/month sq injection of anti-IgE antibody. Novel therapies selectively targeting mast cells, basophils, eosinophils, T cells, and others are now being tested in humans for the treatment of allergic diseases including asthma. Some of these therapies focus on cytokines (IL-4, IL-5, IL-9, IL-13, TNF?), while others focus on IgE, adhesion molecules (e.g., VLA-4, LFA-1), chemokine and related receptors (e.g., CCR3, CCR4, CCR8, CRTh2), or use of adjuvant molecules to enhance immunization responses (e.g., CpG-containing allergen vaccines). The rationale for each will be discussed.
Among these therapies, some are soluble forms of the natural receptor (sIL-4R); others are monoclonal antibodies (anti-IL-4, anti-IL-5, anti-IgE, anti-VLA-4, anti-CD11a), receptor antagonists (VLA-4, IL-4R, CCR3, CCR4, CCR8, CRTh2), or Th1-promoting immunostimulants (CpG). Because of the nature of each therapeutic agent, some can be given via inhalation; others are delivered orally or via injection. Most of the above agents are in early clinical trials, and where available, data from such studies will be discussed along with the potential strengths and weaknesses of each approach.
- Bochner BS. Verdict in the case of therapies versus eosinophils: the jury is still out. J Allergy Clin Immunol 2004; 113:3-9
- Bochner BS, Schleimer RP. Mast cells, basophils, and eosinophils: distinct but overlapping pathways for recruitment. Immunol. Reviews 2001; 179:5-15. 1
- Bochner BS. Leukocyte recruitment in allergic pulmonary inflammation. In: T.Eissa, Huston D, editors. Therapeutic Targets of Airway Inflammation. New York : Marcel Dekker, Inc.; 2003. p. 223-47.