Environmental and occupational respiratory disorders
Update on the current status of peptide immunotherapy

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The use of synthetic peptide fragments of allergen molecules holds promise for the delivery of effective immunotherapy without IgE-mediated adverse events. Early studies were associated with frequent induction of allergic symptoms after treatment, mostly related to activation of allergen-specific effector T cells with high doses of peptides. More recently, low doses of peptides have been shown to modify clinical and laboratory surrogates without inducing adverse events. Studies are ongoing to define the optimal dose, dose interval, and route of administration. Current results indicate that treatment with peptides modulates the immune response by reducing TH2 responses to allergen and increasing IL-10 production and the activity of allergen-specific regulatory T cells. Further studies are required in larger numbers of subjects and with peptides derived from a variety of allergens.

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Bee venom allergy

Three studies of immunotherapy with peptides derived from the major allergen Api m 1 (phospholipase A2) have been reported. In an open study, 5 subjects with bee venom allergy received divided incremental doses of a mixture of 3 peptides at weekly intervals.13 Patients received 397.1 μg of each of 3 peptides subcutaneously. Patients receiving conventional bee venom immunotherapy were used as controls. After treatment, subcutaneous allergen challenge was tolerated without systemic allergic

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Supported by the Canada Research Chairs Programme, the Canadian Foundation for Innovation, and Asthma UK.

Disclosure of potential conflict of interest: M. Larché has consulting arrangements with, owns stock in, and has patent licensing arrangements with Circassia Holdings LTD.

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