For all the extraordinary progress we have seen in basic biological research and in the development of advanced therapies, allergy is an area that seems to be stuck and badly in need of innovation. For some, an allergy may be little worse than an irritant, but for those with severe allergies to certain foods or insect stings, it may be a matter of life and death.

The immunotherapy approaches that are still the basis of many development efforts were originally pioneered by Leonard Noon and John Freeman over a century ago. The basic concept is unchanged – the idea is to first diagnose and then desensitize the patient by exposing them to gradually increasing amounts of allergen.

An informal cottage industry of office-based allergists has developed in Europe and the US based around this idea. Companies like DBV Technologies and Aimmune Therapeutics have attempted to put the field on a more solid evidential footing by conducting randomised controlled trials, but clinical and commercial success have both been difficult to obtain.

Antibody developers long used to developing therapies for conditions such as allergic asthma and atopic dermatitis have entered the fray in more recent times. More than two decades on from its original approval, Xolair (omalizumab), an antibody that binds IgE antibodies, gained approval this year for managing multiple food allergies, and Regeneron Pharmaceuticals is in phase 3 with an antibody cocktail for managing birch allergen. But for those with severe allergies, avoidance remains the best protection. Antibody therapies can lower the risk of anaphylaxis in the event of an accidental exposure – but they can’t eliminate it.

Companies mentioned in this episode:
Aimmune Therapeutics, DBV Technologies, Genentech, Nestlé, Regeneron Pharmaceuticals, Stallergenes Greer

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