Aluminium-containing vaccinations against infectious diseases are adjuvanted with comparably low amounts of aluminium and are usually applied only a few times. Nevertheless, these amounts contribute to the cumulative overall human body burden of aluminium. In light of the

growing number of toxicological considerations and as a tribute to the public discussion, research in aluminium-free vaccines should be encouraged and promoted. The prevalence of allergic disease is on the rise, it is estimated that almost half the population will develop some form of allergic disease during the course of their life. Allergen-specific immunotherapy commonly consists of administering subcutaneous injections using preparations of relevant allergens (Fig. 2), with the aim to gradually desensitise the allergic patient to the causative allergen. This may be achieved through the gradual Cell Cycle inhibitor release Epacadostat purchase of natural/modified allergen extracts using a depot mediator (e.g. aluminium salts). By doing so, the natural course of the disease may be altered, being shown to redirect the immune response toward a Th1 immunoglobulin-type G profile and away from a predominant Th2 immunoglobulin-type E profile which is linked to the causative symptoms of allergy. There are various regimens for SCIT treatment (Table 1) [55]. Usually, a phase of titration of the dose upwards is followed by a maintenance

phase at a fixed dose. Some preparations allow for application intervals of up to 8 weeks, monthly injections are the recommended and customary practice. For inhalant allergies, the specified therapy duration is 3 years with up to 5 years for house dust mite allergies [55]. SCIT is usually recommended for a duration of 5 years for hymenoptera venom allergies, whereas life-long monthly therapy may be given to sub-groups of patients who have an increased risk of more severe anaphylactic reactions. These sub-groups may have co-morbidities, or be prone to

increased exposure (e.g. Bee-keepers) [56]. For a typical 3-year therapy, which would usually consist of, approximately 16 up-titration injections followed by monthly injections for a duration of 3 years, a patient will receive over 50 injections within this time-frame [57], [58] and [59]. Five years Thalidomide of therapy as part of a house dust mite SCIT or hymenoptera venom allergy, >70 injections are administered in total [58]. Taking into account the subgroup of risk patients in hymenoptera venom allergy, the number of injections of this lifelong immunotherapy rises infinitely. Unlike the aforementioned vaccines, the manufacturers of SCIT products are not required to specify the amount of aluminium in their SmPCs (summary of product characteristics) or PIs (package leaflets). This is, however, in accordance to the German legislation = § 11 Arzneimittelgesetz (AMG). In Europe, 1.