On the 8th of July, World Allergy Day aims to raise awareness for allergies, their therapies, and the future of medication 

Allergies are complex and have become an increasingly common problem for millions worldwide. In fact, more than 150 million people in Europe already experience chronic allergy illness, and according to current projections, half of all Europeans will have an allergic disease by 2025. 

But what is the future outlook for allergies?

We sat down with our Nutraceutical Market Manager for EMEA, Liz Connor Kenworthy, Director of Business Development for APIs, Gilles Hofstetter and our International Product Manager, Hedwig Koopmans, to talk about their insights in regards to the current and future therapies for allergies.

What are some of the more natural-based solutions/ingredients?

Liz: Consumers have long since looked for supporting allergic responses with natural products and foods, incorporating these into their daily routine, often used alongside conventional medicine. Many consumers choose to incorporate a natural product in anticipation, especially when the allergen is seasonal, such as hayfever.

For example, in allergic subjects, eosinophils (type of immune cells) can be mistakenly activated and can survive for two weeks with a large expansion in their numbers and a release of inflammatory mediators (such as in allergic asthma, eczema, and allergic rhinitis). One of the most prominent natural solutions lately is using a full spectrum salmon oil, that is known to reduce eosinophil activation. In fact, fish oil, in general, is well recognised to offer many health benefits and full spectrum fish oil would be a good inclusion for any consumer with allergy issues.

Other interesting ingredients are Palmitoylethanolamide (PEA) and Shiso extracts. The anti-inflammatory effects of PEA have been for a long time related to its ability to regulate mast cell activation and degranulation. There are also many botanicals that can be beneficial in supporting individuals, acting as a natural anti-histamine and working to reduce the allergic response by inhibiting the release of histamine from the immune cells. These include Albizia lebbeck commonly known as the Lebbeck tree, Armoracia rusticana (Horseradish), and Quercetin.

What are the more commonly used or novel therapies available?

Gilles: There are many facets of allergy treatment that include allergen avoidance, medications, immunotherapy (desensitisation), or even emergency adrenergic agonists. The choice of allergy medications that can help reduce the immune system reaction and alleviate symptoms is startling -  from the conventional wildly used therapy from conventional therapy in the form of tablets, capsules, nasal sprays, eye drops, skin lotions, and creams, to more modern and individualised treatment such as inhalers and injections.

The main allergy medications include:

· Antihistaminics - to avoid the allergic reaction e.g., cetirizine, desloratadine, fexofenadine, levocetirizine,

· Corticosteroids -to counteract the allergic reaction or to be used in severe allergies e.g., betamethasone, fluticasone, mometasone, prednisolone, prednisone, triamcinolone

· Decongestants -  e.g. pseudoephedrine

Occasionally, you can benefit from some auxiliary therapies that might include bronchodilators like salbutamol and salmeterol or even alpha and beta-adrenergic agonists (like epinephrine/adrenaline) that are given in life-threatening conditions. 

Hedwig: With the rise of inhalatory therapy, there is increased importance related to the role of the excipient in the formulation. Looking at both praxis and literature, the majority of dry powder inhalers (DPI) contain a carrier, which is most commonly lactose. This would mean that the lactose can take up to 99% of the DPI formulation. The role of the inactive ingredient is quite straightforward – it carries and facilitates the entry of the active into the lungs. The main challenge of the inhaler is achieving a homogenous mixture with the right adheration of the API to the carrier/lactose. That adhesion strength is vital for the carrying capacity of the drug, but also its release and ultimately pharmacological effect. Therefore, the correct choice of lactose, and its particle size and surface design is a critical parameter that impacts not only the compliance of the patient, but the entire effectiveness of the therapy. 

The interplay between the correct choice of API, appropriate carrier, and the medical device makes up for the holy triangle on which the success of the inhalation therapy gravely depends.

What are the challenges in current therapies?

At IMCD, we continue to work with our partners to support their developments and search for the best APIs and formula optimisation.

If you want to discover our product offering, please visit our solution centre.

References:

1. https://www.veroval.info/-/media/diagnostics/files/knowledge/eaaci_advocacy_manifesto.pdf

2. https://www.bsaci.org/patients/most-common-allergies/allergy-in-children/