The principle of Allergen Cross-Reactivity (X-Reactivity) is one of the cornerstones of prescribing effective sublingual immunotherapy (SLIT) and is universally accepted by every major allergy specialist society. In the development of its web platform, Serologix carefully considered allergen X-Reactivity and built an algorithm to automate this part of the prescription process.
Understanding Allergen X-Reactivity
Allergen cross-reactivity occurs when IgE antibodies originally created against a given allergen, respond to a different but structurally or biologically similar allergen. The immune system is able to recognize similarities in different allergens (such as commonly shared proteins) and produce antibodies that react against both.
Close attention should be given to allergen cross-reactivity for both allergy testing and immunotherapy formulations.
In-depth knowledge of allergen cross-reactivity is particularly critical when selecting specific allergens for immunotherapy. Someone lacking a clear understanding of cross-reactivity may be prompted to use essentially all allergens to which a patient is sensitized. However, understanding cross-reactivity can minimize redundant allergens in a formulation of SLIT drops.
Limiting the number of allergens in immunotherapy preparations is often necessary in order to achieve an optimal therapeutic dose. Limiting non-essential allergens leads to a greater concentration of individual allergens, and thus more efficacious dosing.
When there is extensive cross-reactivity among pollens for example, selecting a single pollen within a specific genus or family that has the most potential to create the therapeutic benefit may be sufficient.
If cross-reactivity is ignored, sub-therapeutic dosing may occur and the patient may not see the desired results of sublingual immunotherapy.
Serologix Offers a Built-In seroSLIT Allergen X-Reactivity Calculator
An Allergen X-Reactivity Calculator is built-in to the seroSLIT© web platform to avoid redundancies with X-Reactive allergens. This helpful tool guides the physician through the prescription process and helps to optimize the SLIT dosage.
In addition to allergen cross-reactivity, the concept of Antigen Biocompatibility is critical for a streamlined prescription process and efficacious dosing of sublingual immunotherapy (SLIT). One of Serologix’s priorities during its development stage was to provide algorithms that take the guesswork out of determining which allergen extracts can and cannot be mixed together-Antigen Biocompatibility.
The “Universal Mix” Approach
There are SLIT products in the marketplace that take unusual short-cuts by mixing together large “master mixes” or “universal mixes” of allergens, often times in excess of 50 allergens, and used as a “one size fits all” therapy regardless of whether a patient is allergic to a single allergen or multiple allergens. This approach is not supported by any of the allergy specialist societies and is considered to be an antiquated and ineffective approach.
Accounting for Antigen Biocompatibility is a basic and fundamental principle that is ignored by the “universal mix” approach, and is contrary to the allergen extract mixing principles described in the 2010 updated allergen immunotherapy practice parameters published by the AAAAI & ACAAI.
Furthermore, including non-relevant allergens in a SLIT formulation poses a risk of sensitizing patients to allergens to which they were not previously sensitized.
Many extracts contain caustic proteases that are capable of degrading the therapeutic allergenic proteins contained in other extracts. Grier et al., 2007 demonstrated that protease activity in fungal extracts can dramatically degrade grass allergen potency by greater than 60 percent, even when refrigerated and suspended in high glycerin concentrations (50 percent). Under these conditions, it is difficult to achieve an efficacious dose of grass allergen.
A Customized Approach to Immunotherapy
Optimizing the therapeutic efficacy of immunotherapy formulations requires an understanding of the biochemical compatibilities of the antigens being mixed.
To ensure maximum potency/stability and maintain accurate dosing, immunotherapy formulations should only contain antigens that are biochemically compatible… NO SHORT-CUTS. It is not advisable to initiate immunotherapy with formulations that prescribes to the universal or master mix approach.
Serologix Offers a Built-In seroSLIT Antigen Biocompatibility Calculator
Antigen biocompatibility algorithms are built-in to the seroSLIT© web platform to ensure that non-compatible antigens are not mixed together. This simplifies the prescription process for the physician and enhances the efficacy of the patient’s immunotherapy formulation.