Peptide-based vaccination: where do we stand?Francis, James N; Larché, MarkCurrent Opinion in Allergy and Clinical Immunology: December 2005 - Volume 5 - Issue 6 - p 537–543 doi: 10.1097/01.all.0000191234.97760.88 Immunotherapy Abstract Author InformationAuthors Article MetricsMetrics Purpose of review Allergen-specific immunotherapy represents the only causative approach towards allergy treatment. Specific immunotherapy can, however, include allergic reactions and occasionally life-threatening anaphylaxis. Peptides have been evaluated as a potential therapeutic approach in atopic allergic disease because they have the potential to inhibit T-cell function but not induce anaphylaxis. Recent findings Data from early clinical trials of peptide vaccination revealed that therapy was associated with a modest improvement in allergic disease, and was accompanied by a high frequency of adverse reactions. More recent studies have demonstrated improved clinical outcomes, improved safety, and have defined the mechanisms of adverse events observed in earlier studies. Mechanisms of peptide vaccination include the hyporesponsiveness of allergen-specific responses and the induction of regulatory T cells and cytokines. Novel peptide design has allowed the generation of fragments that contain T-cell stimulatory epitopes, lack B cell epitopes, and can induce protective IgG responses in both mice and humans. Other approaches have focused on hypoallergenic B-cell epitopes that induce inhibitory IgG antibodies. Peptides that specifically induce regulatory cytokine production would also enhance peptide vaccines. Several recent studies have described immunodominant epitopes from major allergens that may form candidate peptides for use in peptide vaccination. Summary The manipulation of peptide epitopes may provide a strategy for the rational design of peptide allergy vaccines further improving safety and efficacy. Department of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, London, UK Correspondence to Mark Larché, PhD, Department of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK Tel: +44 (0)20 7594 1673; fax: +44 (0)20 7594 1478; e-mail: firstname.lastname@example.org © 2005 Lippincott Williams & Wilkins, Inc.