The international collaborative study on the first international standard of birch (Betula verrucosa)-pollen extract

The History, Present and Future of Allergen Standardization in the United States and Europe

The topic of standardization in relation to allergen products has been discussed by allergists, regulators, and manufacturers for a long time. In contrast to synthetic medicinal products, the natural origin of allergen products makes the necessary comparability difficult to achieve. This holds true for both aspects of standardization: Batch-to-batch consistency (or product-specific standardization) and comparability among products from different manufacturers (or cross-product comparability). In this review, we focus on how the United States and the European Union have tackled the topic of allergen product standardization in the past, covering the early joint standardization efforts in the 1970s and 1980s as well as the different paths taken by the two players thereafter until today. So far, these two paths have been based on rather classical immunological methods, including the corresponding benefits like simple feasability. New technologies such as mass spectrometry present an opportunity to redefine the field of allergen standardization in the future.

Standardization of Allergen Extracts

Allergens are molecules with the capacity to elicit IgE responses in humans. When stimulated with allergens, most allergic patients respond with production of IgE specific for several proteins/allergens in the source material. The standardization of allergen extracts is essential in order to control variability and to achieve consistency and reproducibility in a clinical setting.Because the IgE binding capacity of an allergen extract is related to the content of one or a few major allergens, it is important that the standardization procedure ensures consistency, not only in the overall IgE binding potency, but also in the content and ratio of individual major allergens. Owing to the complexity of allergen extracts, a key element in standardization of allergen extracts is the use of standards.This chapter describes the principles for standardization of allergen extracts to be used by research laboratories. Other chapters in this volume describe in vitro methods in detail.

Standardization of allergen products: 2. Detailed characterization of GMP-produced recombinant Phl p 5.0109 as European Pharmacopoeia reference standard

BACKGROUND

The Biological Standardization Programme of the European Directorate for Quality of Medicines and Healthcare (EDQM) aims at the establishment of well-characterized reference standards based on recombinant allergens and validated assays for the quantification of major allergen content. The objective of this study was to examine the detailed physicochemical and immunological characterization of recombinant Phl p 5.0109, the second available allergen reference standard.

METHODS

Recombinant Phl p 5.0109 PP5ar06007 was produced under GMP conditions and analyzed by an array of physicochemical and immunological methods for identity, quantity, homogeneity, and folding stability in bulk solution, as well as thermal denaturation, aggregation state, and biological activity when formulated for long-time storage.

RESULTS

PP5ar06007 revealed as a highly homogeneous, monomeric, well-folded preparation of rPhl p 5.0109, as documented by mass spectrometry, SDS-PAGE, isoelectric focusing, size-exclusion chromatography with light scattering, circular dichroism, and infrared spectroscopy. Upon storage at +4°C, PP5ar06007 retained the monomeric state for at least 2 months. A protein quantity of 1.56 ± 0.03 mg/ml was determined by amino acid analysis in PP5ar06007, and its biological activity was shown to be comparable to natural Phl p 5 in terms of basophil activation and T-cell reactivity.

CONCLUSIONS

Recombinant Phl p 5.0109 PP5ar06007 was characterized extensively at the physicochemical and immunological level. It revealed to be a highly stable, monomeric, and immunologically equivalent of its natural counterpart. PP5ar06007 is now available as European Pharmacopoeia allergen reference standard for grass pollen products.

European Academy of Allergy and Clinical Immunology task force report on 'dose-response relationship in allergen-specific immunotherapy'

BACKGROUND

For a century, allergen-specific immunotherapy (SIT) has proven to be an effective treatment for allergic rhinitis, asthma, and insect sting allergy. However, as allergen doses are frequently adapted to the individual patient, there are few data on dose-response relationship in SIT. Allergen products for SIT are being increasingly required to conform to regulatory requirements for human medicines, which include the need to demonstrate dose-dependent effects.

METHODS

This report, produced by a Task Force of the EAACI Immunotherapy Interest Group, evaluates the currently available data on dose-response relationships in SIT and aims to provide recommendations for the design of future studies.

RESULTS

Fifteen dose-ranging studies fulfilled the inclusion criteria and twelve reported a dose-response relationship for clinical efficacy. Several studies also reported a dose-response relationship for immunological and safety endpoints. Due to the use of different reference materials and methodologies for the determination of allergen content, variations in study design, and choice of endpoints, no comparisons could be made between studies and, as a consequence, no general dosing recommendations can be made.

CONCLUSION

Despite recently introduced guidelines on the standardization of allergen preparations and study design, the Task Force identified a need for universally accepted standards for the measurement of allergen content in SIT preparations, dosing protocols, and selection of clinical endpoints to enable dose-response effects to be compared across studies.

Standardization of allergen products: 1. Detailed characterization of GMP-produced recombinant Bet v 1.0101 as biological reference preparation

BACKGROUND

Standardization of allergen extracts requires the availability of well-characterized recombinant allergens, which can be used as reference standards provided by the European regulatory authorities. The objective of this study was the detailed physicochemical and immunological characterization of rBet v 1.0101, which shall be used in a ring trial within the framework of the Biological Standardization Programme BSP090 of the European Directorate for Quality of Medicines and Healthcare.

METHODS

Recombinant Bet v 1.0101 Y0487 was produced under good manufacturing practice conditions and analysed by an array of physicochemical and immunological methods for identity, quantity, homogeneity, folding and denaturation, aggregation state and stability in solution, as well as biological activity.

RESULTS

Batch Y0487 was shown to contain monomeric and well-folded protein being identical with rBet v 1.0101, as determined by mass spectrometry. SDS-PAGE, isoelectric focusing, deamidation analysis and size-exclusion chromatography with light scattering revealed sample homogeneity of >99.9%. Upon storage at +4 degrees C batch Y0487 retained the monomeric state up to 3 months. Protein quantification determined by amino acid analysis was found coinciding with half-maximal inhibition of serum IgE in ELISA. Biological activity of batch Y0487 was shown to be comparable to natural Bet v 1 by IgG and IgE immunoblotting, as well as basophil and T-cell activation.

CONCLUSION

Recombinant Bet v 1.0101 Y0487 was characterized extensively by physicochemical and immunological methods. It was shown highly stable, monomeric and immunologically equivalent to its natural counterpart. Thus, it represents an appropriate candidate reference standard for Bet v 1.

The CREATE project: development of certified reference materials for allergenic products and validation of methods for their quantification

Allergen extracts have been used for diagnosis and treatment of allergy for around 100 years. During the second half of 20th century, the notion increasingly gained foothold that accurate standardization of such extracts is of great importance for improvement of their quality. As a consequence, manufacturers have implemented extensive protocols for standardization and quality control. These protocols have overall IgE-binding potencies as their focus. Unfortunately, each company is using their own in-house reference materials and their own unique units to express potencies. This does not facilitate comparison of different products. During the last decades, most major allergens of relevant allergen sources have been identified and it has been established that effective immunotherapy requires certain minimum quantities of these allergens to be present in the administered maintenance dose. Therefore, the idea developed to introduce major allergens measurements into standardization protocols. Such protocols based on mass units of major allergen, quantify the active ingredients of the treatment and will at the same time allow comparison of competitor products. In 2001, an EU funded project, the CREATE project, was started to support introduction of major allergen based standardization. The aim of the project was to evaluate the use of recombinant allergens as reference materials and of ELISA assays for major allergen measurements. This paper gives an overview of the achievements of the CREATE project.

Standardization of allergen-specific immunotherapy vaccines

In the 1970s and 1980s, scientific methods were introduced in the standardization of allergen vaccines and, in combination with improved documentation of the clinical benefits obtained using standardized vaccines, specific allergy treatment as a scientifically based, reproducible, and safe treatment for allergic disease was established. This article describes important issues in the control of source materials and vaccine preparation as part of the European standardization of allergen vaccines, and also includes a discussion of vaccines that are based on recombinant allergens, which may appear on the market in the near future.

A pre-seasonal birch/hazel sublingual immunotherapy can improve the outcome of grass pollen injective treatment in bisensitized individuals. A case-referent, two-year controlled study

BACKGROUND

The study tests the hypothesis of a reduction of priming due to tree allergy in patients sensitised to both birch/hazel and grass pollen undergoing an associated preseasonal Sublingual/Injective immunotherapy.

METHODS

36 out of 49 bisensitized candidates were pair-matched into 18 case-referent couples. During two years all patients were administered preseasonal grass-SIT and one patient in each couple received also birch/hazel-SLIT. Diary cards were fulfilled for three consecutive grass pollen seasons. Specific Nasal Provocation Test (NPT) for grass and aspecific bronchial challenge were done; sera were analyzed for specific IgE and IgG.

RESULTS

During the peak of the grass pollen season both groups showed a significant improvement in total symptom-score. Conjunctivitis and cough improved significantly more in patients with associated therapies. While antihistamine score decreased significantly in both groups, antiasthmatics did only in the SLIT-SIT group. The follow-up documented a significant increase in grass- and birch-specific IgG and a decrease in grass-specific IgE. Grass-NPT threshold was clearly higher in SLIT-SIT-group (p = 0.01) and only in this group PD20 methacholine improved significantly (p < 0.05).

CONCLUSIONS

Combined birch/hazel-SLIT and grass-SIT are safe and improve clinical outcomes of SIT alone in young bisensitized patients. Priming reduction is supported by specific NPT and bronchial hyperresponsiveness.

Recombinant allergens/allergen standardization

Recombinant allergens are genetically engineered isoforms representing allergen molecules from allergen extracts. Immunologic responses of allergic patients toward allergen extracts define the major allergens. For the average allergic patient, the diagnostic sensitivity and treatment efficacy correlate with the concentration of major allergen. Standardization of allergen products (extracts or genetically engineered allergens) can therefore advantageously be performed using a selected recombinant major allergen as a standard. The standardization will furthermore require reagents for which both monospecific, monoclonal, or preferably, recombinant antibodies can be used. Due to differences in the allergenic activity of individual isoallergens and the naturally occurring mixture of isoallergens found in an allergen extract, and due to additional contribution to the allergenic activity from other molecules in the extract, a biologic potency assessment must always be performed as a supplement. This is also the case for a genetically engineered allergen product.

Aerobiologic and immunochemical studies on Borassus flabellifer pollen: evidence for a 90-kD allergen

BACKGROUND

The pollen grains of Arecaceae have been proved to be a very common aeroallergen in India. Except for the pollen grains of Cocos nucifera, detailed information about the allergenicity of other dominant Indian palm pollen is not available.

OBJECTIVES

To explore the aerobiologic and allergenic significance of the pollen of palmyra palm (Borassus flabellifer Linn.), one of the important and common palm trees in India, with a view to isolate and purify its major allergenic components.

METHODS

The aerobiologic survey was performed continuously using Burkard volumetric and Rotorod samplers from July, 1994 to June, 1996 in a northern suburb of greater Calcutta. The allergenic potential of the pollen extract and different fractions were studied by skin prick tests (SPT). ELISA and ELISA inhibition experiments were performed with individual and pooled patient sera to detect the specific IgE level. By 2-step ammonium sulphate fractionation and gel filtration study, the allergic fraction Fr.IIA1 was isolated. Its molecular weight was determined by SDS-PAGE and homogeneity was confirmed by rocket and crossed immunoelectrophoresis using rabbit antisera.

RESULTS

Pollen grains of B. flabellifer were found to be present in air from February to May and June contributing more than 7% of the total airborne pollen load of the study area. The pollen elicited maximum concentration at 19 to 20 hours in the evening and at a height of 4 m from ground level. Skin prick testing of 455 respiratory allergic patients with whole pollen extract exhibited 31.64% positive response. After 2-step ammonium sulphate fraction and gel filtration, a fraction (Fr.IIA1) having remarkable allergenicity was isolated. In native and SDS-PAGE, it was found as a single protein component of 90 kD and as homogeneous in RIE and CIE. The soluble protein-carbohydrate analysis indicated the probability of the component to be a glycoprotein.

CONCLUSION

The aerobiologic, clinical, and immunochemical, studies demonstrated that the pollen of B. flabellifer is a dominant aeroallergen to cause respiratory trouble in the area where these trees grow. The isolated 90-kD component is one of the major allergens present in the pollen extract.

Effect of dilution, temperature, and preservatives on the long-term stability of standardized inhalant allergen extracts

BACKGROUND

Although documented stability of allergens used for diagnosis is important, research in this area has been limited. Most studies on extract stability have been of limited duration and discrepancies have been reported between stability test results of in vivo and in vitro methods.

OBJECTIVE

In this study we determined the stability of allergenic extracts, comparing the intracutaneous test and enzymallergosorbent test inhibition method and determining the effect of temperature, dilution, and preservatives.

METHODS

Three formulations of timothy pollen, birch pollen, house dust mite (D. pteronyssinus) and cat dander extracts, as used for bronchoprovocation, skin prick testing and intracutaneous testing, were stored for 24 months at 6 degrees C. The influence of temperature on various formulations was determined using the enzymallergosorbent test inhibition technique during storage for up to 36 months.

RESULTS

Most formulations were found to be stable for 24 (intracutaneous test) or 36 (enzymallergosorbent test inhibition) months at 6 degrees C. At 25 degrees C, most formulations showed a decrease in relative potency, which remained above the limit of 0.3 times the in-house-reference for the bronchoprovocation formulation of timothy pollen, birch pollen, and house dust mite and for the skin prick test formulation of cat dander.

CONCLUSIONS

Cat dander was remarkably stable at 6 and 25 degrees C in glycerine and birch pollen was very susceptible to phenol. This destructive effect of phenol could be prevented by adding human serum albumin. The discrepancy between in vivo and in vitro tests reported by others was confirmed for house dust mite and timothy pollen.

Influence of the pH of the extraction medium on the composition of birch (Betula verrucosa) pollen extracts

Extracts from birch (Betula verrucosa) pollen were prepared at different pH, with constant pH monitoring and adjustment to preset values in the range 5.5-8.5. The total protein content of these extracts was directly correlated with the pH. Coomassie brilliant blue-stained isoelectric focusing and SDS-PAGE gels and immunoblot analysis demonstrated qualitative differences: some proteins were lost while others appeared when pH was changed. At pH 8.5, formerly unknown birch pollen allergens were detected with pI 9, 9.10, and 9.30 by about 30% of birch pollen-sensitive sera. Birch pollen extracts prepared at a pH close to neutrality, namely, 6.5 and 7.5, showed the greatest protein and different allergen diversity. Thus, extraction pH values are necessary to analyze the whole pattern of allergenic components in an extract.

Detection and characterization of atopic allergens

The aim of the research of atopic allergens is to gather knowledge in order to be able to identify and to characterize environmental allergens and to develop better allergen preparations for diagnosis and treatment of IgE-mediated hypersensitivity diseases. Allergens or allergen activity can be detected and characterized with several in vivo and in vitro methods. In vivo tests measure the biological allergen activity, which is the most important characteristic of allergen preparations. Chemical and some immunochemical methods do not directly measure allergen activity, unless human IgE antibodies have been utilized. Since all these methods have their advantages and disadvantages, more than one method would be favourable in characterization of an allergen or an allergen preparation.

Isolation and characterization of two IgE-reactive proteins from Azadirachta indica pollen

Two allergenically active components present in the Azadirachta indica whole pollen extract have been isolated by sequential ammonium sulfate precipitation (0-90%), DEAE-Sephadex A-50 ion-exchange chromatography followed by gel filtration through Sephadex G-200. The allergenicity of fractionated materials has been tested by skin prick test and ELISA inhibition which reveal that AIaI and AIaIVb are the major allergens. Immunoblot confirms the IgE-binding activity of the proteins. Although both fractions are found to be homogeneous by SDS-PAGE, isoelectric focusing produces more than one isoelectric point in AIaI (pI = 3.15, 3.3 and 3.5) and AIaIVb (pI = 6.0 and 6.2). Amino acid analyses of the two allergens, the effect of pH on them and cross-reactivity between them have been discussed.

Standardization of pollen allergens of Parthenium hysterophorus and selection of an in-house reference extract

A standardized in-house reference extract from the pollen of Parthenium hysterophorus, which is responsible for the high incidence of allergic rhinitis in India, was generated and examined by skin test, radio-allergosorbent test inhibition and isoelectric focusing. Parthenium reference allergen discs and positive reference serum were also generated. These reference reagents could not only be used for the quantitation of Parthenium-specific IgE in the sera of rhinitis patients but also for the evaluation of allergenic activity (relative potency and lot-to-lot variation) of different batches of Parthenium pollen.

Aeroallergen analyses and their clinical relevance. II. Sampling by high-volume airsampler with immunochemical quantification versus Burkard pollen trap sampling with morphologic quantification

A comparison was made between the amount of airborne pollen collected by Burkard airsampler and the allergenic activity of particles trapped on glass fibre filters in an Accu-Vol high-volume airsampler. The comparison was made throughout the pollen seasons 1986 to 1989. Both airsamplers were operated 24 h a day. They were placed less than 5 m apart, and estimation of the pollen amount was made on a day-to-day basis during the pollen seasons, and on a weekly basis outside the seasons. The occurrence of the 3 clinically most important allergenic types of pollen, birch, grass, and mugwort, was analysed, and close correlations between the 2 sampling techniques were found (rs 0.5-0.8, p < 0.001). The detected range of counted pollens/m3 was: birch 0-1075, grass 0-156, and mugwort 0-44. By immunochemical analysis we found the corresponding amounts to be 0-80, 0-8, and 0-1 SQ-U/m3, respectively. Pollen counts and immunochemical estimation were compared with the symptom score recordings of allergic persons for birch season 1989 and for grass seasons 1986, 1988, and 1989. A close correlation was found for both sampling techniques for the grass seasons in 1986 and 1989 (rs 0.51-0.61, p < 0.001-0.0001), but a less significant correlation was found for the 1988 grass season, and for birch in 1989 (rs 0.24-0.34, p < 0.001-0.05).