Mold allergy immunotherapy update since 2017

This is an important area of practice. The German, Austrian, and Swiss Societies of Allergy published a guideline in 2022 entitled, "On allergen immunotherapy in IgE-mediated allergic diseases" (1). The guideline gives an update regarding mold immunotherapy development. For allergy to spores of seasonal outdoor molds, evidence of clinical efficacy is limited to a few SCIT studies with Alternaria alternate and Cladosporium herbarum extracts. A 3-year DBPC trial in children with Alternaria allergy demonstrated efficacy of SCIT beginning in the 2nd year of treatment (2). The difficulty in producing mold allergen extracts is that molds grown in a bioreactor produce differing allergens from the spores inhaled by patients. To overcome this problem, a multicenter Spanish study in 111 adolescents and adults shows promising results with SCIT using recombinant Alt a1 (3). However, it will be some time before an approved compound will have been developed.

In total there are only seven controlled trial of allergen immunotherapy to Alternaria, one to Cladosporium and single case reports or uncontrolled studies for Candida albicans or Aspergillus fumigatus which are not sufficient for their recommendation.

1. Pfaar et al. Guideline on allergen immunotherapy in IgE-mediated allergic diseases: S2K Guideline of the German Society of Allergology and Clinical Immunology (DGAKI), Society of Pediatric Allergology and Environmental Medicine (GPA), Medical Association of German Allergologists (AeDA), Austrian Society of Allergology and Immunology (ÖGAI), Swiss Society for Allergology and Immunology (SSAI), German Dermatological Society (DDG), German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), German Society of Pediatrics and Adolescent Medicine (DGKJ), Society of Pediatric Pulmonology (GPP), German Respiratory Society (DGP), German Professional Association of Otolaryngologists (BVHNO), German Association of Paediatric and Adolescent Care Specialists (BVKJ), Federal Association of Pneumologists, Sleep and Respiratory Physicians (BdP), Professional Association of German Dermatologists (BVDD). Allergol Select. 2022 Sep 6;6:167-232. doi: 10.5414/ALX02331E. PMID: 36178453; PMCID: PMC9513845.

2. Kuna P, Kaczmarek J, Kupczyk M. Efficacy and safety of immunotherapy for allergies to Alternaria alternata in children. J Allergy Clin Immunol. 2011; 127: 502-508 e501-506

3. Tabar AI, Prieto L, Alba P, Nieto A, Rodríguez M, Torrecillas M, Huertas B, Gómez E, Fernández FJ, Blanca M, Rodríguez D, Palacios R. Double-blind, randomized, placebo-controlled trial of allergen-specific immunotherapy with the major allergen Alt a 1. J Allergy Clin Immunol. 2019 Jul;144(1):216-223.e3. doi: 10.1016/j.jaci.2019.02.029. Epub 2019 Mar 14. PMID: 30879998.

Carla M. Davis