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While adjuvants play a major role in European AIT, they have been less well studied. In this Position Paper, we summarize current unmet needs of adjuvants in AIT citing current evidence. Four adjuvants are used in products marketed in Europe: aluminium hydroxide (Al(OH)\n                    <jats:sub>3<\/jats:sub>\n                    ) is the most frequently used adjuvant, with microcrystalline tyrosine (MCT), monophosphoryl lipid A (MPLA) and calcium phosphate (CaP) used less frequently. Recent studies on humans, and using mouse models, have characterized in part the mechanisms of action of adjuvants on pre\u2010existing immune responses. AIT differs from prophylactic vaccines that provoke immunity to infectious agents, as in allergy the patient is presensitized to the antigen. The intended mode of action of adjuvants is to simultaneously enhance the immunogenicity of the allergen, while precipitating the allergen at the injection site to reduce the risk of anaphylaxis. Contrasting immune effects are seen with different adjuvants. Aluminium hydroxide initially boosts Th2 responses, while the other adjuvants utilized in AIT redirect the Th2 immune response towards Th1 immunity. After varying lengths of time, each of the adjuvants supports tolerance. Further studies of the mechanisms of action of adjuvants may advise shorter treatment periods than the current three\u2010to\u2010five\u2010year regimens, enhancing patient adherence. Improved lead compounds from the adjuvant pipeline are under development and are explored for their capacity to fill this unmet need.\n                  <\/jats:p>","DOI":"10.1111\/all.14134","type":"journal-article","created":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T05:40:22Z","timestamp":1574833222000},"page":"746-760","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["State\u2010of\u2010the\u2010art in marketed adjuvants and formulations in Allergen Immunotherapy: A position paper of the European Academy of Allergy and Clinical Immunology (EAACI)"],"prefix":"10.1111","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4019-5765","authenticated-orcid":false,"given":"Erika","family":"Jensen\u2010Jarolim","sequence":"first","affiliation":[{"name":"Institute of Pathophysiology &amp; Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria"},{"name":"The Interuniversity Messerli Research Institute University of Veterinary Medicine Vienna Medical University of Vienna University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4370-2099","authenticated-orcid":false,"given":"Martin F.","family":"Bachmann","sequence":"additional","affiliation":[{"name":"Institute of Immunology Inselspital University of Berne Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Bonini","sequence":"additional","affiliation":[{"name":"Institute of Translational Pharmacology Italian National Research Council Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Jacobsen","sequence":"additional","affiliation":[{"name":"ALC, Allergy Learning &amp; Consulting Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6974-5700","authenticated-orcid":false,"given":"Marek","family":"Jutel","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology Wroclaw Medical University Wroc\u0142aw Poland"},{"name":"ALL\u2010MED Medical Research Institute Wroclaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludger","family":"Klimek","sequence":"additional","affiliation":[{"name":"Center of Rhinology and Allergology Wiesbaden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6471-1811","authenticated-orcid":false,"given":"Vera","family":"Mahler","sequence":"additional","affiliation":[{"name":"Division of Allergology Paul\u2010Ehrlich\u2010Institut Federal Institute for Vaccines and Biomedicines Langen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1928-810X","authenticated-orcid":false,"given":"Ralph","family":"M\u00f6sges","sequence":"additional","affiliation":[{"name":"CRI\u2010Clinical Research International Ltd Hamburg Germany"},{"name":"Institute of Medical Statistics and Bioinformatics University of Cologne Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Moingeon","sequence":"additional","affiliation":[{"name":"Center for Therapeutic Innovation \u2013 Immuno\u2010Inflammatory Disease Servier Suresnes France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3489-7595","authenticated-orcid":false,"given":"Robyn E.","family":"O\u00b4Hehir","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Allergy and Clinical Immunology (Research) Central Clinical School Monash University and Alfred Hospital Melbourne Vic. 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