A new rush immunotherapy method initiated at Lausanne University Hospital (CHUV) is being tested in multiple centres in Europe. Initial results are promising and point to the possibility of new strategies for allergy management.
“It’s too early to cry victory yet, but we’re on the right track,” came Prof. François Spertini’s voice over the phone enthusiastically from the CHUV’s Immunology and Allergy Service. Indeed, the mounting good news finally confirms more than ten years of research into allergies and their complex mechanisms to drastically reduce the length of desensitisation treatments.
How does it work? “It all started back when I completed a research project on how the immune system reacts to peptides – fragments of allergens which themselves are proteins of varying lengths,” explained Prof. Spertini. “Whether it’s birch pollen, bee venom (which we originally started working on) or any other source, allergens actually all function in the same way. They induce excessive production of immunoglobulin E (IgE), causing the body to start fighting what it wrongly believes to be an invader, which in turn causes the discomfort and sometimes serious complications that allergy sufferers might experience."
Early on in the project, Prof. Spertini and his team discovered that by cutting the allergen into enough small fragments (our famous peptides), the IgE no longer recognised the allergen and could be tricked. Despite everything, the cells of the immune system could still be stimulated by these allergen fragments and, when coming into contact, would end up being desensitised (a process known medically as ‘tolerance induction’). The next step was thus to assess whether or not this immunological tolerance might translate to a clinical use by suppressing allergic reactions.
To make further development we would need what we call ‘translational research’, which establishes links between fundamental research and medical application. It is a costly step in terms of both time and money, requiring campaigns to raise funds and form suitable teams of researchers and clinicians. Of course, there is also a risk of deep disappointment as proving something once in vitro or in mice does not necessarily mean you will discover a miracle treatment… “I was fortunate enough to receive encouragement and support not only from my colleagues, but also from PACTT, CHUV, EPFL and the Federal Commission for Technology and Innovation (CTI) in Bern. Today, I realise just how important that was, as far too many studies never progress beyond the hypothesis stage, gathering dust in a drawer somewhere due to fear of failure or lack of motivation,” added Prof. Spertini.
To make further development we would need what we call ‘translational research’, which establishes links between fundamental research and medical application. It is a costly step in terms of both time and money, requiring campaigns to raise funds and form suitable teams of researchers and clinicians.
For the first attempt at demonstrating safety and efficacy, the researchers focused on birch pollen allergy. A few years later, a product is now ready at last, based on the peptides described above. “Before moving on to real efficacy trials with actual allergic people, we first had to conduct a series of tests on mice and then on volunteers to prove that the product was not harmful and that it really does have an immunological effect. We were then able to carry out an efficacy study (known to specialists as a Phase 2b trial) with 240 patients spread across different centres in Europe. We could only select volunteers who were exclusively allergic to birch, and there aren’t many in Switzerland. In Poland, on the other hand, it was much easier to find some,” said the doctor, smiling.
In this type of study, volunteers do not know if what they receive during the autumn is the active treatment or a placebo. Then, from April to June, each volunteer keeps a log of any allergy symptoms and their intensity via a smartphone app. The results are astonishing: “They prove that, with this method, we can conceivably achieve significant allergy relief in five injections over two months, instead of weekly and then monthly injections for three years!” The study was published online in the Journal of Allergy and Clinical Immunology this month.
But the adventure isn’t over yet: “The next step will be Phase III trials with even broader populations,” explained Prof. Spertini. “This type of study costs around 50 million Swiss francs! That’s why we needed to create a company capable of setting up the project and find funding outside of academic circles.” It will take another two to three years, but, listening to Prof. Spertini, it is clear the doctor was vaccinated against impatience a long, long time ago.