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Dwivedi V, Kopanja S, Schmidthaler K, Sieber J, Bannert C, Szépfalusi Z. Preventive allergen immunotherapy with inhalant allergens in children. Allergy 2024. [PMID: 38588176 DOI: 10.1111/all.16115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/09/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
The efficacy and safety of preventive allergen immunotherapy (pAIT) in children are currently under investigation. Here, we provide an overview of pAIT with respiratory allergens concerning the prevention of new sensitizations, allergic disease onset and progression as well as further immunomodulatory effects. Three databases were searched for clinical pAIT studies in children. Selected publications were reviewed for preventive outcomes according to prevention level (primary, secondary, and tertiary), allergen type, administration route, dose, and treatment duration. The primary prevention approach appears safe but showed no allergen-specific effect on new sensitizations. Secondary prevention seems feasible and may induce regulatory T cell-mediated immunotolerance. The number of studies at these prevention levels is limited. Tertiary prevention with grass and/or tree pollen-based pAIT has shown efficacy in preventing disease progression from allergic rhinitis/conjunctivitis to asthma. Data on tertiary pAIT with house dust mites and other allergen types are inconclusive. Subcutaneous and sublingual routes appear similarly effective, but head-to-head comparative paediatric studies are scarce. Additionally, there are fewer placebo-controlled studies. Nevertheless, immunomodulatory outcomes of pAIT are encouraging. Currently, limited but favourably suggestive evidence is available for preventing respiratory allergic diseases in children by pAIT. Primary and secondary prevention have potential and warrant further investigation through well-designed studies.
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Affiliation(s)
- Varsha Dwivedi
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Sonja Kopanja
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Klara Schmidthaler
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Justyna Sieber
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Christina Bannert
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Zsolt Szépfalusi
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
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2
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Yang J, Lei S. Efficacy and safety of sublingual versus subcutaneous immunotherapy in children with allergic rhinitis: a systematic review and meta-analysis. Front Immunol 2023; 14:1274241. [PMID: 38162647 PMCID: PMC10757840 DOI: 10.3389/fimmu.2023.1274241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Aim To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR). Methods PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2, 2023. Outcomes included symptom scores (SSs), medication scores (MSs), symptom and medication scores (SMSs), new sensitizations, development of asthma, improvement, and treatment-related adverse events (TRAEs). The quality of the included studies was assessed by the modified Jadad scale and Newcastle-Ottawa scale (NOS). Meta-regression was carried out to explore the source of heterogeneity. Subgroup analysis was further conducted in terms of study design [randomized controlled trials (RCTs), cohort studies], allergen [house dust mites (HDMs), grass pollen], treatment duration (≥ 24, 12-23 or < 12 months), allergen immunotherapy (AIT) modality (drops or tablets), and AIT protocol [continuous, pre-seasonal, co-seasonal, or after the grass pollen season (GPS)]. Sensitivity analysis was conducted for all outcomes. A Bayesian framework and a Monte Carlo Markov Chain (MCMC) model were developed for indirect comparison. Results Totally 50 studies with 10813 AR children were included, with 4122 treated with SLIT, 1852 treated with SCIT, and 4839 treated with non-SLIT or non-SCIT therapy. For direct comparison, the SLIT group had a similar SS to the SCIT group [pooled standardized mean difference (SMD): 0.41, 95% confidence interval (CI): -0.46, 1.28, P = 0.353]. Comparable MSs were observed in the SLIT and SCIT groups (pooled SMD: 0.82, 95%CI: -0.88, 2.53, P = 0.344). For indirect comparison, no significant differences were found in SSs (pooled SMD: 1.20, 95% credibility interval (CrI): -1.70, 4.10), MSs (pooled SMD: 0.57, 95%CrI: -1.20, 2.30), SMSs (pooled SMD: 1.80, 95%CrI: -0.005, 3.60), new sensitizations [pooled relative risk (RR): 0.34, 95%CrI: 0.03, 3.58], and development of asthma (pooled RR: 0.68, 95%CrI: 0.01, 26.33) between the SLIT and SCIT groups; the SLIT group illustrated a significantly lower incidence of TRAEs than the SCIT group (pooled RR: 0.17, 95%CrI: 0.11, 0.26). Conclusion Considering both efficacy and safety, SLIT might be a more favorable AIT than SCIT in the treatment of pediatric AR, which may serve as a decision-making reference for clinicians. Systematic review registration PROSPERO (CRD42023460693).
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Affiliation(s)
| | - Sihong Lei
- The Department of Otolaryngology-Head and Neck Surgery, Nanchong Central Hospital, Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, China
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3
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Dogan CU, Tuzer C, Turker IC, Alkan AA, Culha D, Demir S. Topical cyclosporine versus allergen specific immunotherapy in perennial allergic conjunctivitis. Int Ophthalmol 2022:10.1007/s10792-022-02612-y. [PMID: 36513916 PMCID: PMC9747541 DOI: 10.1007/s10792-022-02612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Symptom control in the long-term with less side effects is important in perennial allergic conjunctivitis, since would improve quality of life. This study aimed to assess the clinical efficacies of topical cyclosporin A and subcutaneous allergen immunotherapy (SCIT) in terms of sign control in perennial allergic conjunctivitis. METHODS This retrospective study included 20 adult patients with perennial allergic conjunctivitis and confirmed sensitization to house dust mites with skin prick test. Patients were assigned to either topical cyclosporine A treatment or SCIT. The participants were followed for 6 months, and signs scores were recorded at 1, 3 and 6 months. RESULTS Overall, both cyclosporine and immunotherapy groups showed significant improvements in papillary reaction (p = 0.011 and 0.003, respectively), limbal involvement (p = 0.031 and 0.001), and conjunctival hyperemia (p = 0.001 and p < 0.001) scores during the 6-month follow-up. However, only cyclosporine group showed a significant improvement in corneal involvement scores (p = 0.015) during the study period. When scores at different time points were compared, significant improvement in conjunctival hyperemia was evident at 6 months in both groups when compared to baseline (cyclosporine group, 0.7 ± 0.68 vs. 2.4 ± 0.84, 70.8% decrease, p = 0.01; immunotherapy group, 0.3 ± 0.48 vs. 2.3 ± 0.95, 87.0% decrease, p = 0.004), whereas for limbal involvement such an improvement was only evident in the immunotherapy group (0.1 ± 0.32 vs. 1.3 ± 0.95, 92.3% decrease, p = 0.01). CONCLUSIONS Allergen immunotherapy and cyclosporin A treatment may provide effective sign relief in perennial allergic conjunctivitis. It may represent an encouraging treatment option particularly for cases with perennial allergic conjunctivitis refractive to other treatments and positive skin prick test to a specific allergen (house dust in the present study). Long-term relief by SCIT would reduce the side effects of polypharmacotherapy. Larger studies with longer follow-up are warranted to confirm our findings.
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Affiliation(s)
- Ceylan Uslu Dogan
- Department of Ophthalmology, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Cumhuriyet and Demokrasi Avenue, No:1, Istanbul, Turkey
| | - Can Tuzer
- Division of Allergy and Immunology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ibrahim Cagri Turker
- Department of Ophthalmology, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Cumhuriyet and Demokrasi Avenue, No:1, Istanbul, Turkey
| | | | - Damla Culha
- Lotus Eye Aesthetics & Strabismus Clinic, Halaskargazi Street, Sisli/Istanbul, Turkey
| | - Semra Demir
- Division of Allergy and Immunology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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4
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Zinkhan S, Thoms F, Augusto G, Vogel M, Bachmann MF. On the role of allergen-specific IgG subclasses for blocking human basophil activation. Front Immunol 2022; 13:892631. [PMID: 36275723 PMCID: PMC9582512 DOI: 10.3389/fimmu.2022.892631] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Successful treatment of IgE mediated allergies by allergen-specific immunotherapy (AIT) usually correlates with the induction of allergen-specific IgG4. However, it is not clear whether IgG4 prevents the allergic reaction more efficiently than other IgG subclasses. Here we aimed to compare allergen-specific monoclonal IgG1 and IgG4 antibodies in their capacity to inhibit type I allergic reactions by engaging FcγRIIb. We found that IgG1, which is the dominant subclass induced by viruses, binds with a similar affinity to the FcγRIIb as IgG4 and is comparable at blocking human basophil activation from allergic patients; both by neutralizing the allergen as well as engaging the inhibitory receptor FcγRIIb. Hence, the IgG subclass plays a limited role for the protective efficacy of AIT even if IgG4 is considered the best correlate of protection, most likely simply because it is the dominant subclass induced by classical AITs.
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Affiliation(s)
- Simon Zinkhan
- Department of Immunology, University Clinic of Rheumatology and Immunology, Inselspital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | | | - Gilles Augusto
- Department of Immunology, University Clinic of Rheumatology and Immunology, Inselspital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
- Nuffield Department of Medicine, The Henry Wellcome Building for Molecular Physiology, The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Monique Vogel
- Department of Immunology, University Clinic of Rheumatology and Immunology, Inselspital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Martin F. Bachmann
- Department of Immunology, University Clinic of Rheumatology and Immunology, Inselspital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
- Nuffield Department of Medicine, The Henry Wellcome Building for Molecular Physiology, The Jenner Institute, University of Oxford, Oxford, United Kingdom
- *Correspondence: Martin F. Bachmann,
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Farraia M, Paciência I, Castro Mendes F, Cavaleiro Rufo J, Shamji M, Agache I, Moreira A. Allergen immunotherapy for asthma prevention: A systematic review and meta-analysis of randomized and non-randomized controlled studies. Allergy 2022; 77:1719-1735. [PMID: 35342949 DOI: 10.1111/all.15295] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is a disease-modifying treatment for IgE-mediated diseases. Randomized controlled trials (RCTs) support AIT's potential role in asthma prevention but evidence from non-randomized studies of interventions (NRSI) and longitudinal observational studies has been poorly addressed. Therefore, we aimed to conduct a systematic review and meta-analysis to assess clinical data from all study types to evaluate quantitatively the preventive role of AIT in asthma onset. METHODS We search three databases. Studies were screened, selected and evaluated for quality using risk-of-bias (ROB) tools. Data were descriptively summarized and meta-analysed using random effects. We performed a sensitivity, influence and subgroup analyses. Publication bias and heterogeneity were assessed. RESULTS From the 4549 identified studies, 24 (12 RCTs and 12 NRSI) were included in the qualitative synthesis and 18 underwent meta-analysis. One study was at low ROB, seven had moderate ROB, and 15 were proven of high ROB. Random-effects analysis showed a significant decrease in the risk of developing asthma following AIT by 25% (RR, 95% CI: 0.75, 0.64-0.88). This effect was not significant in the sensitivity analysis. Publication bias raised concerns, together with the moderate heterogeneity between studies (I2 = 58%). Subgroup analysis showed a remarkable preventive effect of AIT in children (RR, 95% CI: 0.71, 0.53-0.96), when completing 3 years of therapy (RR, 95% CI: 0.64, 0.47-0.88), and in mono-sensitized patients (RR, 95% CI: 0.49, 0.39-0.61). CONCLUSIONS Our findings support a possible preventive effect of AIT in asthma onset and suggest an enhanced effect when administered in children, mono-sensitized, and for at least 3 years, independently of allergen type.
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Affiliation(s)
- Mariana Farraia
- EPIUnit ‐ Institute of Public Health University of Porto Porto Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR) Porto Portugal
- Basic and Clinical Immunology Unit Department of Pathology Faculty of Medicine University of Porto Porto Portugal
| | - Inês Paciência
- EPIUnit ‐ Institute of Public Health University of Porto Porto Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR) Porto Portugal
| | - Francisca Castro Mendes
- EPIUnit ‐ Institute of Public Health University of Porto Porto Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR) Porto Portugal
- Basic and Clinical Immunology Unit Department of Pathology Faculty of Medicine University of Porto Porto Portugal
| | - João Cavaleiro Rufo
- EPIUnit ‐ Institute of Public Health University of Porto Porto Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR) Porto Portugal
| | - Mohamed Shamji
- National Heart and Lung Institute Imperial College London London UK
- NIHR Imperial Biomedical Research Centre London UK
| | - Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - André Moreira
- EPIUnit ‐ Institute of Public Health University of Porto Porto Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR) Porto Portugal
- Basic and Clinical Immunology Unit Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- São João University Hospital Center Porto Portugal
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6
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Arshad SH. Does allergen immunotherapy for allergic rhinitis prevent asthma? Ann Allergy Asthma Immunol 2022; 129:286-291. [PMID: 35500864 DOI: 10.1016/j.anai.2022.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022]
Abstract
Asthma and allergic rhinitis (AR) have overlapping clinical and pathologic features, sustained by an underlying T helper 2 bias, resulting in airway inflammation that extends from the nose to the lung. Children who are monosensitized often develop polysensitization over time, and they are at high risk of developing asthma. The effect of allergen immunotherapy (AIT) is allergen specific, resulting in symptom improvement and reduction in medication requirement. It is the only known treatment that alters the natural history of allergic disease and induces long-term remission. A bystander or allergen-nonspecific effect of AIT has also been proposed-that AIT to 1 allergen might reduce the risk of development of sensitization to other allergens. Furthermore, several observational studies and clinical trials, in seasonal (pollen) and perennial (house dust mite) AR, have investigated a protective effect of AIT to prevent asthma. The overall evidence favors an asthma preventive effect of AIT in AR to grass and birch tree pollen. Fewer studies have investigated the use of AIT in children with perennial AR due to house dust mite allergy to prevent asthma, and the results are less convincing. The use of AIT to reduce the risk of progression to asthma, in children with AR, potentially has high impact, and it will make AIT more attractive and cost-effective. However, most studies have been of small sample size or of poor design, using different allergens and AIT methodology, making it challenging to draw firm conclusions. There is a need to do adequately powered studies with optimal design and assess cost-effectiveness of this strategy.
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Affiliation(s)
- Syed Hasan Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; The David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom.
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7
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Allergen Immunotherapy in Pediatric Asthma: A Pragmatic Point of View. CHILDREN-BASEL 2020; 7:children7060058. [PMID: 32521598 PMCID: PMC7346201 DOI: 10.3390/children7060058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 01/29/2023]
Abstract
To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting effect after the end of the course. The recent clinical trials evidenced AIT effectiveness and safety in allergic asthma. Consequently, the current version of the GINA (Global Initiative for Asthma) guidelines recommend AIT as an add-on therapy for asthma. There is also evidence that AIT may exert preventive activity on the possible progression from allergic rhinitis to asthma in children and the onset of new sensitizations. The present review provides a pragmatic summary of the clinical indications of AIT in pediatric asthma, including the immunological mechanisms, the predictive biomarkers, and the safety issues in clinical practice.
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8
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Alvaro-Lozano M, Akdis CA, Akdis M, Alviani C, Angier E, Arasi S, Arzt-Gradwohl L, Barber D, Bazire R, Cavkaytar O, Comberiati P, Dramburg S, Durham SR, Eifan AO, Forchert L, Halken S, Kirtland M, Kucuksezer UC, Layhadi JA, Matricardi PM, Muraro A, Ozdemir C, Pajno GB, Pfaar O, Potapova E, Riggioni C, Roberts G, Rodríguez Del Río P, Shamji MH, Sturm GJ, Vazquez-Ortiz M. EAACI Allergen Immunotherapy User's Guide. Pediatr Allergy Immunol 2020; 31 Suppl 25:1-101. [PMID: 32436290 PMCID: PMC7317851 DOI: 10.1111/pai.13189] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Allergen immunotherapy is a cornerstone in the treatment of allergic children. The clinical efficiency relies on a well-defined immunologic mechanism promoting regulatory T cells and downplaying the immune response induced by allergens. Clinical indications have been well documented for respiratory allergy in the presence of rhinitis and/or allergic asthma, to pollens and dust mites. Patients who have had an anaphylactic reaction to hymenoptera venom are also good candidates for allergen immunotherapy. Administration of allergen is currently mostly either by subcutaneous injections or by sublingual administration. Both methods have been extensively studied and have pros and cons. Specifically in children, the choice of the method of administration according to the patient's profile is important. Although allergen immunotherapy is widely used, there is a need for improvement. More particularly, biomarkers for prediction of the success of the treatments are needed. The strength and efficiency of the immune response may also be boosted by the use of better adjuvants. Finally, novel formulations might be more efficient and might improve the patient's adherence to the treatment. This user's guide reviews current knowledge and aims to provide clinical guidance to healthcare professionals taking care of children undergoing allergen immunotherapy.
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Affiliation(s)
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Cherry Alviani
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.,Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elisabeth Angier
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Stefania Arasi
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy
| | - Lisa Arzt-Gradwohl
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - Domingo Barber
- School of Medicine, Institute for Applied Molecular Medicine (IMMA), Universidad CEU San Pablo, Madrid, Spain.,RETIC ARADYAL RD16/0006/0015, Instituto de Salud Carlos III, Madrid, Spain
| | - Raphaëlle Bazire
- Allergy Department, Hospital Infantil Niño Jesús, ARADyAL RD16/0006/0026, Madrid, Spain
| | - Ozlem Cavkaytar
- Department of Paediatric Allergy and Immunology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Pasquale Comberiati
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Stephen R Durham
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Aarif O Eifan
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospitals NHS Foundation Trust, London, UK
| | - Leandra Forchert
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Max Kirtland
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - Umut C Kucuksezer
- Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul University, Istanbul, Turkey
| | - Janice A Layhadi
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.,Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - Paolo Maria Matricardi
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Antonella Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Women and Child Health, University of Padua, Padua, Italy
| | - Cevdet Ozdemir
- Institute of Child Health, Department of Pediatric Basic Sciences, Istanbul University, Istanbul, Turkey.,Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology, Istanbul University, Istanbul, Turkey
| | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Ekaterina Potapova
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Carmen Riggioni
- Pediatric Allergy and Clinical Immunology Service, Institut de Reserca Sant Joan de Deú, Barcelona, Spain
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Allergy and Respiratory Medicine (MP803), Clinical & Experimental Sciences & Human Development in Health Academic Units University of Southampton Faculty of Medicine & University Hospital Southampton, Southampton, UK
| | | | - Mohamed H Shamji
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Gunter J Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
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9
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Entwicklung der subkutanen Allergen-Immuntherapie (Teil 2): präventive Aspekte der SCIT und Innovationen. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Development of subcutaneous allergen immunotherapy (part 2): preventive aspects and innovations. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40629-019-0097-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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Harrill WC, Setzen G, Farquhar D, Pillsbury HC. Contemporary analysis of otolaryngic allergy. Laryngoscope 2019; 130:283-289. [PMID: 30982993 DOI: 10.1002/lary.28002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Investigate the current trends in otolaryngic allergy (OA). STUDY DESIGN Cross-sectional survey. METHODS Survey of active AAOA membership. RESULTS Response rate was 27.3%. Regional response distribution rates were proportional to the AAOA membership distribution within the United States (R2 = 0.95; P < 0.001), with no significant regional response bias demonstrated (P = 0.428). Self-reported duration to OA competency was 5.8 years. Physicians reporting OA competency were more likely to be board-certified (P < 0.001) and have AAOA fellowship status (P < 0.001). The AAOA was reported to be the most valuable educational resource toward achieving OA competency, with residency training being least valuable (P < 0.001). 91.5% of respondents' practices offered OA services. Subcutaneous injections predominated at twice the utilization of sublingual immunotherapy. Allergy immunotherapy tablets were rarely utilized. Home allergy shots were offered by 45.2% of respondents. In-office immunotherapy vial compounding was preferred (95.8%) to third-party vendors. 94% of AAOA respondents identified patient compliance to be an issue within OA. Non-inhalant allergy service integration included food allergy (63.5%), asthma (44.9%), allergic fungal sinusitis (43.8%), penicillin allergy (18%), stinging insect allergy (12.6%), and aspirin desensitization (3.9%). CONCLUSION Reported duration to OA competency after residency was surprisingly long. Further investigation of current and future educational/clinical training is warranted given clinical integration reported for OA. Otolaryngology is in the unique position to develop a comprehensive sino-allergy evidence-based strategy integrating the extensive diagnostic and medical treatment arms alongside the surgical expertise of the specialty within a clinical sino-allergy home concept. LEVEL OF EVIDENCE 5 Laryngoscope, 130:283-289, 2020.
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Affiliation(s)
- Willard C Harrill
- Carolina Ear, Nose & Throat/Sinus and Allergy Center, PA, Hickory, North Carolina, U.S.A.,Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, U.S.A
| | - Douglas Farquhar
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
| | - Harold C Pillsbury
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
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13
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Allergenspezifische Immuntherapie bei IgE-vermittelten Erkrankungen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-018-0448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Virus-like particles in der Prophylaxe und Immuntherapie allergischer Erkrankungen. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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16
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Bozek A, Jąkalski M, Jonska-Golus M, Filipowska-Gronska A, Jarząb J, Walter Canonica G. Prolonged effect of allergen sublingual immunotherapy to grass pollen. Hum Vaccin Immunother 2018; 14:2842-2847. [PMID: 30183483 DOI: 10.1080/21645515.2018.1496770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background: The prolonged effect of allergen immunotherapy is unknown, especially in older patients. Objective: The three-year effect of sublingual allergen-specific immunotherapy (AIT) to grass pollen on elderly patients with allergic rhinitis was analyzed. Methods: Thirty-eight elderly patients (63.18 ± 3.12 yrs.) underwent AIT to grass pollen, were monitored for three years and were compared to a placebo group. AIT was performed with the use of an oral Staloral 300 SR grass extract (Stallergens Greer, London, UK) or a placebo. Symptoms and medication scores, represented by the average adjusted symptom score (AAdSS), the serum level of IgG4 to Phl p5 and the quality of life were assessed immediately after AIT and three years later. Results: After AIT, the AAdSS was significantly decreased and remained lower than in the placebo group during the three years after AIT. Serum-specific IgG4 against Phl p5 increased during the AIT trial in the study group. For the three years of observation after AIT, there were no significant changes in specific IgG4 levels against the analyzed allergens in comparison to the results immediately after AIT. The quality of life, based on the Rhinoconjunctivitis Quality of Life Questionnaire, was significantly decreased in patients who received AIT, from 1.83 (95%CI: 1.45-1.96) to 0.74 (95%CI: 0.39-1.92) (p < 0.05) to 0.82 (95%CI: 0.45- 1.04) three years after AIT. Conclusion: A prolonged positive effect after AIT to grass pollen was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect.
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Affiliation(s)
- Andrzej Bozek
- a Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze , Medical University of Silesia , Katowice , Poland
| | - Marek Jąkalski
- a Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze , Medical University of Silesia , Katowice , Poland
| | - Monika Jonska-Golus
- a Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze , Medical University of Silesia , Katowice , Poland
| | - Agata Filipowska-Gronska
- a Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze , Medical University of Silesia , Katowice , Poland
| | - Jerzy Jarząb
- a Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze , Medical University of Silesia , Katowice , Poland
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Rudman Spergel AK, Minnicozzi M, Wheatley LM, Togias A. Is Allergen Immunotherapy in Children Disease Modifying? A Review of the Evidence. Curr Allergy Asthma Rep 2018; 18:47. [PMID: 29995257 DOI: 10.1007/s11882-018-0801-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Although evidence supports a beneficial effect of allergen immunotherapy on the symptoms of allergic respiratory disease and food allergy, it is not clear whether immunotherapy modifies the natural history of these conditions. RECENT FINDINGS In aeroallergen immunotherapy, studies suggest that prevention of asthma can be attained. Less evident is the ability of immunotherapy to prevent new allergen sensitizations and more studies are needed to test whether immunotherapy can continue suppressing airway symptoms after treatment discontinuation. In food allergen immunotherapy, there is evidence that unresponsiveness to a food challenge can be sustained in some treatment recipients, but little knowledge exists as to the dose and duration of treatment that can optimize this effect. Suggestive evidence exists that allergen immunotherapy can modify allergic disease in children, but definitive studies are lacking. More research in the field is required.
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Affiliation(s)
- Amanda K Rudman Spergel
- Division of Allergy, Immunology and Transplantation, Allergy, Asthma and Airway Biology Branch, National Institute of Allergy and Infectious Diseases, NIH, 5601 Fishers Lane, Rockville, MD, 20892, USA.
| | - Michael Minnicozzi
- Division of Allergy, Immunology and Transplantation, Allergy, Asthma and Airway Biology Branch, National Institute of Allergy and Infectious Diseases, NIH, 5601 Fishers Lane, Rockville, MD, 20892, USA
| | - Lisa M Wheatley
- Division of Allergy, Immunology and Transplantation, Allergy, Asthma and Airway Biology Branch, National Institute of Allergy and Infectious Diseases, NIH, 5601 Fishers Lane, Rockville, MD, 20892, USA
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, Allergy, Asthma and Airway Biology Branch, National Institute of Allergy and Infectious Diseases, NIH, 5601 Fishers Lane, Rockville, MD, 20892, USA
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18
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Klimek L, Kündig T, Kramer MF, Guethoff S, Jensen-Jarolim E, Schmidt-Weber CB, Palomares O, Mohsen MO, Jakob T, Bachmann M. Virus-like particles (VLP) in prophylaxis and immunotherapy of allergic diseases. ALLERGO JOURNAL INTERNATIONAL 2018; 27:245-255. [PMID: 30546996 PMCID: PMC6267129 DOI: 10.1007/s40629-018-0074-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/17/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Apart from active allergen avoidance, immunotherapy is regarded as the most effective form of treatment available for type I allergies. Such treatments involve the administration of allergen preparations in various forms and by various routes. Virus-like particles (VLPs) offer a very effective platform for immunization with the allergen and are characterized by high immunogenicity, low allergenicity and high clinical efficacy. Formulations that include Toll-like receptor ligands, T cell stimulatory epitopes and/or depot-forming adjuvants appear to enhance activation of the relevant immune cells. Short nucleotide sequences including CpG motifs have also been intensively explored as potent stimulators of dendritic cells and B cells. METHODS The present paper is based on a systematic literature search in PubMed and MEDLINE, and focuses on the pertinent immunological processes and on clinical data relating to use of VLPs and CpG motifs for the treatment of allergic rhinitis (AR). RESULTS Many published studies have reported positive clinical results following administration of VLPs, either alone or in combination with CpG motifs and, in some cases, even in the absence of the allergen-specific allergen. CONCLUSIONS These results indicate that VLPs modulate immune responses in ways which underline their exceptional promise as a platform for the immunotherapy of allergic disorders. However, clinical evaluations remain limited, and further large-scale and longer-term studies will be necessary to substantiate the efficacy and safety of these novel therapies.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology & Allergology, Wiesbaden, Germany
| | - Thomas Kündig
- Department for Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Matthias F. Kramer
- Bencard Allergie GmbH, Munich, Germany
- Allergy Therapeutics plc, Worthing, UK
| | - Sonja Guethoff
- Bencard Allergie GmbH, Munich, Germany
- Allergy Therapeutics plc, Worthing, UK
| | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Inter-University Messerli Science Institute, Veterinary University Vienna, Vienna, Austria
| | - Carsten B. Schmidt-Weber
- Center for Allergy and Environmental Resarch (ZAUM), Technical University and Helmholtz-Center, Munich, Germany
| | - Oskar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | | | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Gießen, Justus-Liebig-University, Gießen, Germany
| | - Martin Bachmann
- Jenner Institute, University of Oxford, Oxford, UK
- Inselspital, University Department for Rheumatology, Immunology and Allergology, Sahlihaus 1, 3010 Bern, Switzerland
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19
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Kurzfassung zur allergenspezifischen Immuntherapie bei IgE-vermittelten Erkrankungen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Abstract
PURPOSE OF REVIEW The progression of atopic disorders from atopic dermatitis in infants to allergic rhinitis and asthma in children, adolescents, and adults defines the allergy march. Allergen immunotherapy is the only causal treatment altering the immunological mechanism underlying the allergic diseases. The sublingual administration route is more acceptable than the subcutaneous one in pediatric age. RECENT FINDINGS Several studies show the efficacy and safety profile of sublingual immunotherapy (SLIT) for the treatment of respiratory allergy diseases, but few data are available on its effect of primary and secondary prevention of allergic disease. The purpose of this manuscript is to review the latest studies addressing the effect of SLIT on the development of new sensitizations in not sensitized or already sensitized patients and progression of the allergy march.
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Affiliation(s)
- Federica Porcaro
- Respiratory Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127, Palermo, Italy
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21
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Zielen S, Gabrielpillai J, Herrmann E, Schulze J, Schubert R, Rosewich M. Long-term effect of monophosphoryl lipid A adjuvanted specific immunotherapy in patients with grass pollen allergy. Immunotherapy 2018; 10:529-536. [PMID: 29562801 DOI: 10.2217/imt-2018-0004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ultra-short course pollen immunotherapy adjuvanted with monophosphoryl lipid A (MPL) is attractive to conventional allergen-specific immunotherapy (AIT). Long term efficacy of MPL-AIT has not been evaluated. METHODS 68 patients (age 16.75 ± 5.3 years) with allergic rhinitis to grass pollen were investigated. Group 1: 21 controls; Group 2: 19 after complete AIT, and Group 3: 28 with AIT and treatment cessation: 4 years range 3-6 years ago. RESULTS The clinical symptoms (running nose, sneezing, conjunctivitis and the weekly overall score) were significantly reduced in patients group 2 and 3 compared with controls without AIT p < 0.0001. T-regulatory cells and TH1/TH2 cytokine pattern did not differ between patient groups. CONCLUSION The patients in our trial with grass pollen allergy exhibited significant and long-lasting improvements after MPL-AIT, however larger trials are needed to support this finding.
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Affiliation(s)
- Stefan Zielen
- Department for Children & Adolescents, Division of Allergology, Pulmonology & Cystic fibrosis, Children's Hospital, Goethe University, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Jennis Gabrielpillai
- Department for Children & Adolescents, Division of Allergology, Pulmonology & Cystic fibrosis, Children's Hospital, Goethe University, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Eva Herrmann
- Department of Biostatistics, Goethe University, Frankfurt am Main, Germany
| | - Johannes Schulze
- Department for Children & Adolescents, Division of Allergology, Pulmonology & Cystic fibrosis, Children's Hospital, Goethe University, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Ralf Schubert
- Department for Children & Adolescents, Division of Allergology, Pulmonology & Cystic fibrosis, Children's Hospital, Goethe University, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Martin Rosewich
- Department for Children & Adolescents, Division of Allergology, Pulmonology & Cystic fibrosis, Children's Hospital, Goethe University, Theodor Stern Kai 7, 60590 Frankfurt, Germany
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22
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Tosca MA, Licari A, Olcese R, Marseglia G, Sacco O, Ciprandi G. Immunotherapy and Asthma in Children. Front Pediatr 2018; 6:231. [PMID: 30186823 PMCID: PMC6110847 DOI: 10.3389/fped.2018.00231] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/30/2018] [Indexed: 01/29/2023] Open
Abstract
Allergen immunotherapy (AIT) is still the only disease-modifying treatment strategy for IgE-mediated allergic diseases, with consolidated evidence both in adults and children. AIT is effective in determining clinical improvement of allergic rhinitis and asthma, such as reduced symptoms, medication use, and improvement of quality of life, with a long-lasting effect after cessation of treatment. Results from recent clinical studies have implemented the evidence of effectiveness and safety of allergen immunotherapy for the treatment of allergic asthma, so that the current asthma guidelines now recommend sublingual immunotherapy as an add-on therapy for asthma in adults and adolescents with house dust mite allergy, allergic rhinitis, and exacerbations despite low-to-moderate dose ICS, with forced expiratory volume in 1 second more than 70% predicted. AIT may also reduce the risk of progression from allergic rhinitis to asthma in children and prevent the onset of new sensitizations, thus representing a potentially preventive method of treatment. The aim of this review is to present an updated overview of the clinical indications of AIT, with particular reference to pediatric asthma, of the mechanisms of clinical and immunological tolerance to allergens, and of the potential biomarkers predicting clinical response.
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Affiliation(s)
- Maria A Tosca
- Department of Pediatrics, Allergy Center, Istituto Giannina Gaslini (IRCCS), Genoa, Italy
| | - Amelia Licari
- Department of Pediatrics, Ospedale San Matteo (IRCCS), Pediatrics Clinic, University of Pavia, Pavia, Italy
| | - Roberta Olcese
- Department of Pediatrics, Allergy Center, Istituto Giannina Gaslini (IRCCS), Genoa, Italy
| | - Gianluigi Marseglia
- Department of Pediatrics, Ospedale San Matteo (IRCCS), Pediatrics Clinic, University of Pavia, Pavia, Italy
| | - Oliviero Sacco
- Pediatric Pulmonology and Endoscopy, Istituto Giannina Gaslini (IRCCS), Genoa, Italy
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23
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Halken S, Larenas-Linnemann D, Roberts G, Calderón MA, Angier E, Pfaar O, Ryan D, Agache I, Ansotegui IJ, Arasi S, Du Toit G, Fernandez-Rivas M, Geerth van Wijk R, Jutel M, Kleine-Tebbe J, Lau S, Matricardi PM, Pajno GB, Papadopoulos NG, Penagos M, Santos AF, Sturm GJ, Timmermans F, van Ree R, Varga EM, Wahn U, Kristiansen M, Dhami S, Sheikh A, Muraro A. EAACI guidelines on allergen immunotherapy: Prevention of allergy. Pediatr Allergy Immunol 2017; 28:728-745. [PMID: 28902467 DOI: 10.1111/pai.12807] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 12/15/2022]
Abstract
Allergic diseases are common and frequently coexist. Allergen immunotherapy (AIT) is a disease-modifying treatment for IgE-mediated allergic disease with effects beyond cessation of AIT that may include important preventive effects. The European Academy of Allergy and Clinical Immunology (EAACI) has developed a clinical practice guideline to provide evidence-based recommendations for AIT for the prevention of (i) development of allergic comorbidities in those with established allergic diseases, (ii) development of first allergic condition, and (iii) allergic sensitization. This guideline has been developed using the Appraisal of Guidelines for Research & Evaluation (AGREE II) framework, which involved a multidisciplinary expert working group, a systematic review of the underpinning evidence, and external peer-review of draft recommendations. Our key recommendation is that a 3-year course of subcutaneous or sublingual AIT can be recommended for children and adolescents with moderate-to-severe allergic rhinitis (AR) triggered by grass/birch pollen allergy to prevent asthma for up to 2 years post-AIT in addition to its sustained effect on AR symptoms and medication. Some trial data even suggest a preventive effect on asthma symptoms and medication more than 2 years post-AIT. We need more evidence concerning AIT for prevention in individuals with AR triggered by house dust mites or other allergens and for the prevention of allergic sensitization, the first allergic disease, or for the prevention of allergic comorbidities in those with other allergic conditions. Evidence for the preventive potential of AIT as disease-modifying treatment exists but there is an urgent need for more high-quality clinical trials.
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Affiliation(s)
- Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK.,NIHR Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Moises A Calderón
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Elisabeth Angier
- Department of Immunology and Allergy, Northern General Hospital, Sheffield, UK
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Dermot Ryan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Asthma UK Centre for Applied Research, The University of Edinburgh, Edinburgh, UK
| | - Ioana Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University Brasov, Brasov, Romania
| | - Ignacio J Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia, Erandio, Spain
| | - Stefania Arasi
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.,Department for Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - George Du Toit
- Department of Paediatric Allergy, MRC & Asthma Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, King's College London and Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | | | - Roy Geerth van Wijk
- Department of Internal Medicine, Section of Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland.,ALL-MED Medical Research Institute, Wroclaw, Poland
| | | | - Susanne Lau
- Department for Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Paolo M Matricardi
- Department for Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Giovanni B Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Nikolaos G Papadopoulos
- Institute of Human Development, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Martin Penagos
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Alexandra F Santos
- Department of Paediatric Allergy, MRC & Asthma Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, King's College London and Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Gunter J Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.,Outpatient Allergy Clinic Reumannplaz, Vienna, Austria
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk - European Anaphylaxis Taskforce, Dordrecht, The Netherlands
| | - R van Ree
- Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva-Maria Varga
- Department of Pediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria
| | - Ulrich Wahn
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University Brasov, Brasov, Romania
| | - Maria Kristiansen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Aziz Sheikh
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Woman and Child Health, Padua University Hospital
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Bożek A, Krupa-Borek I, Jarzab J. Twenty years' observation of subcutaneous pollen allergoid immunotherapy efficacy in adults. Postepy Dermatol Alergol 2017; 34:561-565. [PMID: 29422821 PMCID: PMC5799760 DOI: 10.5114/ada.2017.72462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/07/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION It is valuable to determine the long-term efficacy of allergen-specific immunotherapy (SIT) and whether it can cure allergy. AIM For this study, patients were prospectively observed for 20 years after completion of SIT to determine its effectiveness. MATERIAL AND METHODS A total of 1006 patients who underwent SIT for pollen allergy were observed for 20 years to assess the efficacy of SIT. The rhinitis symptom score (RSS) and asthma symptom score (ASS) were measured after SIT completion. The possibility of allergy cure was estimated based on three sets of criteria: group A - neither symptoms nor intake of medication during the analysis period, group B - no symptoms during the analysis period (but possible medication intake), and group C - at most one mild symptom during the analysis period. RESULTS After SIT, approximately 25% of patients showed complete relief of allergy symptoms and had no need for symptomatic drug treatment during the pollen season. The level of effectiveness of SIT was similar throughout the treatment period. During the observation period after SIT, RSS ranged from 1.51 to 1.82, and ASS ranged from 1.22 to 1.29. The treatment effect at 10 and 20 years after SIT was comparable, regardless of whether criterion A or B was used. However, the effect of SIT using criterion C was lower than those using criteria A and B for the analyzed time points. CONCLUSIONS For this study cohort, SIT had a long-term effect that did not depend significantly on the duration of immunotherapy against pollen.
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Affiliation(s)
- Andrzej Bożek
- Clinical Department of Internal Disease, Dermatology and Allergology in Zabrze, Medical University of Silesia in Katowice, Poland
| | | | - Jerzy Jarzab
- Clinical Department of Internal Disease, Dermatology and Allergology in Zabrze, Medical University of Silesia in Katowice, Poland
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25
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Bozek A, Starczewska-Dymek L, Jarzab J. Prolonged effect of allergen sublingual immunotherapy for house dust mites in elderly patients. Ann Allergy Asthma Immunol 2017; 119:77-82. [PMID: 28668244 DOI: 10.1016/j.anai.2017.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/20/2017] [Accepted: 05/12/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prolonged effect of allergen immunotherapy is unknown, especially in older patients. OBJECTIVE To analyze the 3-year effect of sublingual allergen-specific immunotherapy (SLIT) to house dust mites in elderly patients with allergic rhinitis. METHODS Forty-seven elderly patients (65.78 ± 4.89 years old) underwent SLIT to house dust mites and were monitored for 3 years and compared with a placebo group. SLIT was performed with the use of oral Staloral 300 SR Der p and Der f 50/50% extract (Stallergens Greer, London, United Kingdom) or placebo. Symptoms and medication score, represented by the average adjusted symptom score (AAdSS), serum level of immunoglobulin (Ig) G4 to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Der p 1, and Der p 2, and quality of life, were assessed immediately after SLIT and 3 years later. RESULTS The AAdSS was significantly decreased after SLIT, and the level remained low during the 3 years after SLIT compared with placebo. Serum-specific IgG4 against D pteronyssinus, D farinae, Der p 1, and Der p 2 increased during the SLIT trial in the study group. For the 3 years of observation after SLIT, there were no significant changes of specific IgG4 levels against the analyzed allergens compared with results just after SLIT. Quality of life based on the Rhinoconjunctivitis Quality of Life Questionnaire score was significantly decreased in patients who received SLIT, from 1.48 (95% confidence interval 1.33-1.79) to 0.98 (95% confidence interval 0.67-1.07; P < .05) compared with 0.94 (95% confidence interval 0.55-1.04) 3 years after SLIT. CONCLUSION The prolonged positive effect after SLIT to house dust mites was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01605760.
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Affiliation(s)
- Andrzej Bozek
- Clinical Department of Internal Disease, Dermatology and Allergology in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland.
| | | | - Jerzy Jarzab
- Clinical Department of Internal Disease, Dermatology and Allergology in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
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26
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Kristiansen M, Dhami S, Netuveli G, Halken S, Muraro A, Roberts G, Larenas-Linnemann D, Calderón MA, Penagos M, Du Toit G, Ansotegui IJ, Kleine-Tebbe J, Lau S, Matricardi PM, Pajno G, Papadopoulos NG, Pfaar O, Ryan D, Santos AF, Timmermanns F, Wahn U, Sheikh A. Allergen immunotherapy for the prevention of allergy: A systematic review and meta-analysis. Pediatr Allergy Immunol 2017; 28:18-29. [PMID: 27653623 DOI: 10.1111/pai.12661] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a need to establish the effectiveness, cost-effectiveness, and safety of allergen immunotherapy (AIT) for the prevention of allergic disease. METHODS Two reviewers independently screened nine international biomedical databases. Studies were quantitatively synthesized using random-effects meta-analyses. RESULTS A total of 32 studies satisfied the inclusion criteria. Overall, meta-analysis found no conclusive evidence that AIT reduced the risk of developing a first allergic disease over the short term (RR = 0.30; 95% CI: 0.04-2.09) and no randomized controlled evidence was found in relation to its longer-term effects for this outcome. There was, however, a reduction in the short-term risk of those with allergic rhinitis developing asthma (RR = 0.40; 95% CI: 0.30-0.54), with this finding being robust to a pre-specified sensitivity analysis. We found inconclusive evidence that this benefit was maintained over the longer term: RR = 0.62; 95% CI: 0.31-1.23. There was evidence that the risk of new sensitization was reduced over the short term, but this was not confirmed in the sensitivity analysis: RR = 0.72; 95% CI: 0.24-2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08-2.77. AIT appeared to have an acceptable side effect profile. CONCLUSIONS AIT did not result in a statistically significant reduction in the risk of developing a first allergic disease. There was, however, evidence of a reduced short-term risk of developing asthma in those with allergic rhinitis, but it is unclear whether this benefit was maintained over the longer term. We are unable to comment on the cost-effectiveness of AIT.
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Affiliation(s)
- Maria Kristiansen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Gopal Netuveli
- Institute for Health and Human Development, University of East London, London, UK
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Antonella Muraro
- Department of Mother and Child Health, The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Padua, Italy
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.,NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Moises A Calderón
- Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Martin Penagos
- Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - George Du Toit
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, MRC & Asthma Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.,St Thomas NHS Foundation trust, London, United Kingdom
| | - Ignacio J Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | | | - Susanne Lau
- Clinic for Pediatric Pneumonology and Immunology, Charité Medical University Berlin, Berlin, Germany
| | | | - Giovanni Pajno
- Department of Pediatrics, University of Messina, Messina, Italy
| | - Nikolaos G Papadopoulos
- Institute of Human Development, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Alexandra F Santos
- Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Ulrich Wahn
- Department for Ped Pneumology and Immunology, Charite, Berlin, Germany
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Rodríguez Del Río P, Vidal C, Just J, Tabar AI, Sanchez-Machin I, Eberle P, Borja J, Bubel P, Pfaar O, Demoly P, Calderón MA. The European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI): A paediatric assessment. Pediatr Allergy Immunol 2017; 28:60-70. [PMID: 27637414 DOI: 10.1111/pai.12660] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Safety data on 'real-life' allergen immunotherapy (AIT) in children and adolescents is usually extrapolated from studies in adults. METHODS Patients aged 18 or under initiating aeroallergen AIT were evaluated in a prospective European survey. Patient profiles and systemic reactions (SRs) were recorded. Descriptive, univariate and multivariate analyses were used to identify risk factors for SRs. RESULTS A total of 1563 patients (mean ± SD age: 11.7 ± 3.9 years; rhinitis: 93.7%; asthma: 61.5%; polysensitization: 62.5%) and 1578 courses of AIT were assessed. Single-allergen AIT was administered in 89.5% of cases (n = 1412; mites: 49%; grass pollen: 25.8%; tree pollen: 8.7%; Alternaria: 4.6%; dander: 0.8%; weed pollen: 0.6%). Subcutaneous AIT (SCIT) was used in 71.4% (n = 1127) of the treatments, including 574 (50.9%) with natural extracts. Sublingual AIT (SLIT) was used for the remaining 451 treatments (drops: 73.8%; tablets: 26.2%). The mean ± SD follow-up period was 12.9 ± 3.3 months. The estimated total number of doses was 19,669 for SCIT and 131,550 for SLIT. Twenty-four patients (1.53%) experienced 29 SRs. Respiratory (55.7%) and skin symptoms (37.9%) were most frequent. Anaphylaxis was diagnosed in 3 SRs (10.3%), and adrenaline was administered in 2 of these cases. In a univariate analysis, the risk of SRs was lower in mite-sensitized patients and higher in cases of pollen polysensitization (>3), grass pollen extracts and the use of natural extracts (vs. allergoids). CONCLUSIONS In a real-life paediatric setting, AIT is safe. SRs are infrequent and generally not severe. Pollen polysensitization, grass pollen extracts and natural extracts (vs. allergoids) were risk factors for AIT-associated SRs.
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Affiliation(s)
| | - Carmen Vidal
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Jocelyne Just
- Centre de l'Asthme et des Allergies, Hôpital d'enfant Armand Trousseau, Paris, France
| | - Ana I Tabar
- Allergy Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - Jesus Borja
- Allergy Section, Hospital General Universitario, Ciudad Real, Spain
| | - Petra Bubel
- Ear, Nose and Throat Practice, Lutherstadt, Eisleben, Germany
| | - Oliver Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany.,Department of Otorhinolaryngology and Head and Neck Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Pascal Demoly
- Département de Pneumologie et Addictologie, UMR-S 1136, IPLESP, Equipe EPAR, Hôpital Arnaud de Villeneuve, UPMC Paris 06, University Hospital of Montpellier, Sorbonne Universités, Paris, France
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28
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Cardona V, Luengo O, Labrador-Horrillo M. Immunotherapy in allergic rhinitis and lower airway outcomes. Allergy 2017; 72:35-42. [PMID: 27439141 DOI: 10.1111/all.12989] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 11/29/2022]
Abstract
Allergic rhinitis and asthma constitute two clinical expressions of a single-condition, respiratory allergy. Allergen immunotherapy (AIT) is a form of treatment specifically aimed at modifying the response to sensitizing allergens. The inherent potential benefit of AIT is the simultaneous treatment of all clinical expressions of respiratory allergy. Current data support the effectiveness of subcutaneous and sublingual immunotherapy in rhinitis. Studies also provide proof for a beneficial effect in allergic asthma. Even more, substantial evidence points to the preventive effect on the progression from rhinitis to asthma. Despite the current knowledge on the basic mechanisms underlying the immunological effect of AIT is vast, the specific mechanisms for the preventive effect of primary sensitization or new sensitizations are poorly understood. This review aimed to provide a critical overview of the current knowledge on the effectiveness of AIT and its potential role in secondary prevention of respiratory allergy progression.
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Affiliation(s)
- V. Cardona
- Allergy Section; Department of Internal Medicine; Hospital Vall d'Hebron; Barcelona Spain
- Allergy Research Group; Institut de Recerca Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona Spain
| | - O. Luengo
- Allergy Section; Department of Internal Medicine; Hospital Vall d'Hebron; Barcelona Spain
- Allergy Research Group; Institut de Recerca Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona Spain
| | - M. Labrador-Horrillo
- Allergy Section; Department of Internal Medicine; Hospital Vall d'Hebron; Barcelona Spain
- Allergy Research Group; Institut de Recerca Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona Spain
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29
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Kim YH, Lee SM, Kim MA, Yang HJ, Choi JH, Kim DK, Yoo Y, Kim BS, Kim WY, Kim JH, Park SY, Song K, Yang MS, Lee YM, Lee HJ, Cho JH, Jee HM, Park Y, Bae WY, Koh YI. Clinical diagnostic guidelines of allergic rhinitis: comprehensive treatment and consideration of special circumstances. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.3.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Young Hyo Kim
- Department of Otorhinolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University College of Medicine, Seoul, Korea
- SCH Biomedical Informatics Research Unit, Seoul, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Allergy Immunology Center, Korea University, Seoul, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | | | - Jeong Hee Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | | | - Keejae Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong Universtiy College of Medicine, Incheon, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | | | | | | | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Yang Park
- Department of Pediatrics, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | - Woo Yong Bae
- Department of Otorhinolaryngology, Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Young-Il Koh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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30
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Aissa S, Ben Jazia R, Ayachi J, Ben Salem C, Hayouni A, Abdelghani A, Ben Saad H, Boussarsar M. Critical appraisal of the clinical utility of sublingual immunotherapy in allergy. Contemp Clin Trials Commun 2016; 4:1-8. [PMID: 29736465 PMCID: PMC5935903 DOI: 10.1016/j.conctc.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022] Open
Abstract
Since it was introduced by Noon in 1911, allergen-specific immunotherapy or desensitization has been widely prescribed in the management of allergic diseases. Aimed at the etiology, it represents the only effective treatment for allergy. The basic mechanisms of immunotherapy are becoming better understood and allow us to improve this technique in the future. The sublingual immunotherapy as an alternative to subcutaneous route has been widely studied. Several clinical trials confirmed that sublingual immunotherapy is efficient in reducing allergic respiratory symptoms. The sublingual immunotherapy reduces the risk of developing serious side effects due to desensitization. We performed a literature review in order to remind the mechanisms of action and to demonstrate efficacy and tolerability of the sublingual immunotherapy in the treatment of allergic rhinoconjunctivitis and asthma and its impact on the quality of life.
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Affiliation(s)
- S. Aissa
- Pulmonology Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - R. Ben Jazia
- Pulmonology Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - J. Ayachi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - C. Ben Salem
- Department of Clinical Pharmacology, Faculty of Medicine of Sousse, Tunisia
| | - A. Hayouni
- Pulmonology Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - A. Abdelghani
- Pulmonology Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - H. Ben Saad
- Laboratory of Physiology, Farhat Hached University Hospital, Sousse, Tunisia
| | - M. Boussarsar
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
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31
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Tortajada-Girbés M, Mesa Del Castillo M, Larramona H, Lucas JM, Álvaro M, Tabar AI, Jerez MJ, Martínez-Cañavate A. Evidence in immunotherapy for paediatric respiratory allergy: Advances and recommendations. Allergol Immunopathol (Madr) 2016; 44 Suppl 1:1-32. [PMID: 27776895 DOI: 10.1016/j.aller.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/05/2016] [Indexed: 01/26/2023]
Abstract
Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy (AIT). AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT.
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Affiliation(s)
- M Tortajada-Girbés
- Paediatric Allergology and Pulmonology Unit, Dr. Peset University Hospital, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain.
| | - M Mesa Del Castillo
- Paediatric Allergology and Neumology Unit, Hospital El Escorial, Madrid, Spain
| | - H Larramona
- Paediatric Allergology and Pulmonology Unit, Department of Paediatrics, University Autonoma of Barcelona, and Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - J M Lucas
- Pediatric Allergy and Immunology Unit, Virgen Arrixaca Clinic Universitary Hospital, Murcia, Spain
| | - M Álvaro
- Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - A I Tabar
- Servicio de Alergología. Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Pamplona, Spain
| | - M J Jerez
- Publications Office of the European Union, Luxembourg
| | - A Martínez-Cañavate
- Paediatric Allergology and Neumology Unit, Complejo Hospitalario Universitario de Granada, Spain
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32
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Blume SW, Yeomans K, Allen-Ramey F, Smith N, Kim H, Lockey RF, Nichol MB. Administration and Burden of Subcutaneous Immunotherapy for Allergic Rhinitis in U.S. and Canadian Clinical Practice. J Manag Care Spec Pharm 2016; 21:982-90. [PMID: 26521110 PMCID: PMC10397750 DOI: 10.18553/jmcp.2015.21.11.982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Allergy immunotherapy (AIT) is the only available treatment that alters the natural course of allergies and has possible disease-modifying effects. AIT is administered primarily via subcutaneous injection delivered in a physician's office. Few studies have been conducted in the United States or Canada to evaluate the costs of subcutaneous immunotherapy (SCIT). OBJECTIVES To (a) describe SCIT administration processes, resources, and costs and (b) characterize the patient population receiving SCIT. METHODS A multisite, prospective, observational time and motion study was conducted. Injection and wait times were collected by a third-party observer on 1 visit for each patient. Extract preparation processes were also observed. Site staff reported on treatment protocols, administrative time, supplies, and patient medical history. Patients responded to questionnaires on demographics, reasons for treatment, medication use, productivity, and travel time. Costs were estimated by applying unit costs to the time observations and the patient- and staff-reported data. RESULTS A total of 670 SCIT patients were enrolled at 6 sites in the United States and 6 sites in Canada. Average age in the United States was 41 years (SD = 18) and 44 years (15) in Canada, with 10% of the patients aged ≥ 65 years. Annual incomes were over $100,000 for 40% of U.S. patients and 30% of Canadian patients. U.S. patients had over 4 times as many different allergens in their SCIT treatments as Canadian patients, with a mean of 18 versus 4. The most common reasons reported for starting SCIT was a "desire to cure allergies once and for all" (73%) and that "symptoms are not improved by allergy medications" (60%). Percentages of patients taking allergy medications in the 4 weeks prior to observation were 86% in the United States and 66% in Canada: antihistamines 75% United States, 54% Canada; inhaled corticosteroids 32% United States, 22% Canada. The predominant comorbidity was asthma, 43% United States, 24% Canada. Site protocols for build-up treatment phases were 1 to 2 injections per week for an average of 25 weeks (range 12-52). Maintenance phases were 1 injection every 3 to 4 weeks for an average of 4 years (range 2.5-5). Eight of the sites had total mean staff times per injection visit of 7 to 22 minutes; 1 site averaged fewer minutes, and 3 sites averaged more. Total direct medical costs were an average of $30 for Canadian patients per visit and $32 per visit for U.S. patients, half accounted for by the cost of the extract. Pre- and postinjection administrative tasks were the second largest driver of direct costs. Total injection visit-related time for patients, including round-trip travel time, averaged about 80 minutes per visit in the United States and in Canada. CONCLUSIONS Analyses revealed substantial variation in SCIT regimens among sites, but the sites had commonalities in the injection process components. SCIT requires patient commitment to a long-term treatment regimen involving numerous clinic visits and resources for administration.
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Affiliation(s)
- Steven W Blume
- Evidera, 7101 Wisconsin Ave., #1400, Bethesda, MD 20814.
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33
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Rosewich M, Girod K, Zielen S, Schubert R, Schulze J. Induction of Bronchial Tolerance After 1 Cycle of Monophosphoryl-A-Adjuvanted Specific Immunotherapy in Children With Grass Pollen Allergies. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:257-63. [PMID: 26922936 PMCID: PMC4773214 DOI: 10.4168/aair.2016.8.3.257] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/14/2015] [Accepted: 08/28/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Subcutaneous allergen-specific immunotherapy (SCIT) is a well-established and clinically effective method to treat allergic diseases, such as rhinitis and asthma. It remains unclear how soon after initiation of an ultra-short course of grass pollen immunotherapy adjuvanted with monophosphoryl lipid A (MPL)-specific bronchial tolerance can be induced. METHODS In a prospective study of 69 children double-sensitized to birch and grass pollens (51 males, average age 11.1 years), development of bronchial tolerance after 1 cycle of SCIT for grass was evaluated. In all the patients, the bronchial allergen provocation test (BAP) was performed before and after treatment. According to the results of the first BAP, the patients were divided into 2 groups: those showing a negative BAP with a decrease in FEV1 of <20% (seasonal allergic rhinitis [SAR] group, n=47); and those showing a positive BAP with a decrease in FEV1 of ≥20% (SAR with allergic asthma [SAR and Asthma] group, n=22). All the patients received MPL-adjuvanted, ultra-short course immunotherapy for birch, but only those with a positive BAP to grass received MPL-SCIT for grass. RESULTS After the pollen season, the BAP in the SAR group remained unchanged, while it was improved in the SAR and Asthma group (decrease in FEV1 of 28.8% vs 12.5%, P<0.01). The IgG4 levels increased after SCIT (median before SCIT 0.34 to 11.4 after SCIT), whereas the total and specific IgE levels remained unchanged. CONCLUSIONS After 1 cycle of MPL-SCIT, specific bronchial tolerance may be significantly induced, whereas in patients without SCIT, bronchial hyperactivity may remain unchanged.
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Affiliation(s)
- Martin Rosewich
- Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany.
| | - Katharina Girod
- Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - Stefan Zielen
- Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - Ralf Schubert
- Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - Johannes Schulze
- Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany
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34
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Himly M, Nandy A, Kahlert H, Thilker M, Steiner M, Briza P, Neubauer A, Klysner S, van Ree R, Buchheit KH, Vieths S, Ferreira F. Standardization of allergen products: 2. Detailed characterization of GMP-produced recombinant Phl p 5.0109 as European Pharmacopoeia reference standard. Allergy 2016; 71:495-504. [PMID: 26687027 DOI: 10.1111/all.12824] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- M. Himly
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | - A. Nandy
- Research and Development; Allergopharma GmbH & Co. KG; Reinbek Germany
| | - H. Kahlert
- Research and Development; Allergopharma GmbH & Co. KG; Reinbek Germany
| | - M. Thilker
- Research and Development; Allergopharma GmbH & Co. KG; Reinbek Germany
| | - M. Steiner
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | - P. Briza
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | | | - S. Klysner
- Research and Development; Allergopharma GmbH & Co. KG; Reinbek Germany
| | - R. van Ree
- Academic Medical Center; Amsterdam The Netherlands
| | - K.-H. Buchheit
- European Directorate for Quality of Medicines and Healthcare; Strasbourg France
| | - S. Vieths
- Department of Allergology; Paul-Ehrlich-Institut; Langen Germany
| | - F. Ferreira
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
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35
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Gendelman SR, Lang DM. Sublingual immunotherapy in the treatment of atopic dermatitis: a systematic review using the GRADE system. Curr Allergy Asthma Rep 2015; 15:498. [PMID: 25504262 DOI: 10.1007/s11882-014-0498-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Controversy exists regarding the role of allergen immunotherapy as a therapeutic intervention for patients with atopic dermatitis and aeroallergen sensitivity. Our aim was to critically appraise the evidence supporting the use of sublingual immunotherapy for patients with atopic dermatitis and aeroallergen sensitivity. We performed a literature search using the terms "sublingual immunotherapy" and "atopic dermatitis" and "sublingual immunotherapy" and "eczema." We used the same terms to search PubMed, Ovid, and Scopus. Our limits were "Humans" and "English." We excluded articles that were not in English. These articles were analyzed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Many studies reported improvement in clinical symptoms of atopic dermatitis. Serious methodological shortcomings were noted including but not limited to lack of control group, lack of randomization, incomplete descriptions of randomization and/or allocation concealment, many enrolled subjects not completing participation, and/or data analysis not by intention to treat.
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Affiliation(s)
- Samantha R Gendelman
- Department of Clinical Immunology & Allergy, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA,
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McDonell AL, Wahn U, Demuth D, Richards C, Hawes C, Andreasen JN, Allen-Ramey F. Allergy immunotherapy prescribing trends for grass pollen-induced allergic rhinitis in Germany: a retrospective cohort analysis. Allergy Asthma Clin Immunol 2015; 11:19. [PMID: 26085832 PMCID: PMC4470112 DOI: 10.1186/s13223-015-0085-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Allergy immunotherapy is an effective treatment for patients with allergic rhinitis whose symptoms are unresolved with pharmacotherapy. Allergy immunotherapy for grass pollen-induced allergic rhinitis is available in three modalities: subcutaneous immunotherapy and sublingual immunotherapy as a tablet or drop. This study aimed to understand trends in allergy immunotherapy prescribing and practice patterns for grass allergies in adult and paediatric patients in Germany. Methods A retrospective cohort study was conducted using IMS Disease Analyzer in Germany. Patients with an allergy immunotherapy prescription for grass pollen (Anatomical Therapeutic Chemical [ATC] classification code V01AA02) from September 2005 to December 2012 were included in the study. General Practitioners (GPs), dermatologists, Ear, Nose and Throat (ENT)-specialists, paediatricians and pneumologists were included as the allergy immunotherapy prescribing physicians in the study. Descriptive analyses were conducted on patient characteristics at index and prescribing physician specialty; a test for trend was conducted for timing of initiation of first allergy immunotherapy prescription in each annual prescribing season. Results Eighteen thousand eight hundred fifty eligible patients were identified during the study period. The majority of patients received subcutaneous immunotherapy; however, the proportion of patients receiving sublingual immunotherapy tablets increased from 8 % in 2006/2007 to 29 % in 2011/2012 (p < 0.001). Initiation of subcutaneous immunotherapy and Oralair® generally peaked during each prescribing year in two seasons (September-October and January) while GRAZAX® prescriptions peaked in autumn (September-October). ENT-specialists and dermatologists were the largest allergy immunotherapy prescribers in adults, while paediatricians and ENT-specialists were the largest prescribers of allergy immunotherapy in paediatric patients. Conclusions Subcutaneous immunotherapy remained the dominant allergy immunotherapy modality for grass pollen-induced allergic rhinitis in Germany for adult and paediatric patients; however, there was a marked increase in proportion of patients receiving sublingual immunotherapy tablets from 2006/2007 to 2011/2012, after their introduction to the market in 2006. ENT-specialists, dermatologists and paediatricians were responsible for the majority of prescribing. The predominance of particular modalities within certain physician specialties likely reflects different treatment goals or needs.
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Affiliation(s)
- Amanda L McDonell
- Real-World Evidence Solutions and Health Economics & Outcomes Research, IMS Health, 210 Pentonville Road, London, N1 9JY UK
| | - Ulrich Wahn
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - Dirk Demuth
- Real-World Evidence Solutions and Health Economics & Outcomes Research, IMS Health, 210 Pentonville Road, London, N1 9JY UK
| | - Catrina Richards
- Real-World Evidence Solutions and Health Economics & Outcomes Research, IMS Health, 210 Pentonville Road, London, N1 9JY UK
| | - Charlie Hawes
- Worked at IMS Health at time of study, Real-World Evidence Solutions and Health Economics & Outcomes Research, London, UK
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Papadopoulos NG, Bernstein JA, Demoly P, Dykewicz M, Fokkens W, Hellings PW, Peters AT, Rondon C, Togias A, Cox LS. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy 2015; 70:474-94. [PMID: 25620381 DOI: 10.1111/all.12573] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 12/29/2022]
Abstract
Rhinitis is an umbrella term that encompasses many different subtypes, several of which still elude complete characterization. The concept of phenotyping, being the definition of disease subtypes on the basis of clinical presentation, has been well established in the last decade. Classification of rhinitis entities on the basis of phenotypes has facilitated their characterization and has helped practicing clinicians to efficiently approach rhinitis patients. Recently, the concept of endotypes, that is, the definition of disease subtypes on the basis of underlying pathophysiology, has emerged. Phenotypes/endotypes are dynamic, overlapping, and may evolve into one another, thus rendering clear-cut definitions difficult. Nevertheless, a phenotype-/endotype-based classification approach could lead toward the application of stratified and personalized medicine in the rhinitis field. In this PRACTALL document, rhinitis phenotypes and endotypes are described, and rhinitis diagnosis and management approaches focusing on those phenotypes/endotypes are presented and discussed. We emphasize the concept of control-based management, which transcends all rhinitis subtypes.
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Affiliation(s)
- N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK; Allergy Department, 2nd Paediatric Clinic, University of Athens, Athens, Greece
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Guibas GV, Megremis S, West P, Papadopoulos NG. Contributing factors to the development of childhood asthma: working toward risk minimization. Expert Rev Clin Immunol 2015; 11:721-35. [PMID: 25873298 DOI: 10.1586/1744666x.2015.1035649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Asthma is the most common chronic disease in childhood, and considerable research has been undertaken to find ways to prevent its development and reduce its prevalence. For such interventions to be successful, risk factors for asthma emergence should be identified and clearly defined. Data are robust for some of them, including atopy, viral infections and exposure to airborne irritants, whereas it is less conclusive for others, such as aeroallergen exposure and bacterial infections. Several interventions for asthma prevention, including avoidance and pharmacotherapy, have been attempted. However, most of them have furnished equivocal results. Various issues hinder the establishment of risk factors for asthma development and reduce the effectiveness of interventions, including the complexity of the disease and the fluidity of the developing systems in childhood. In this review, we revisit the evidence on pediatric asthma risk factors and prevention and discuss issues that perplex this field.
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Affiliation(s)
- George V Guibas
- Centre for Pediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
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Abstract
PURPOSE OF REVIEW Given the widespread prevalence of allergic disease, its substantially associated clinical and economic burden, the unique disease-modifying benefits of allergy immunotherapy (AIT), and increased availability of sublingual immunotherapy (SLIT), a critical update of the evidence for AIT-related cost savings [for both subcutaneous immunotherapy (SCIT) and SLIT] is particularly relevant and timely. The present article reviews the evidence for SCIT-related and SLIT-related cost savings derived from a systematic review of the published literature. RECENT FINDINGS Examined were 24 publications pertaining to the health economics of AIT. Except for one early study comparing the costs of AIT to symptomatic drug treatment (SDT), the remainder provide compelling evidence for AIT cost savings (whether SCIT or SLIT) over SDT. Furthermore, of the six studies comparing cost outcomes of SLIT to SCIT, four reported cost savings favoring SLIT. SUMMARY This review, spanning research from Southern Europe, Scandinavia, Northern Europe, North America, and the Czech Republic, encompasses a range of perennial and seasonal allergic conditions, including allergic asthma, allergic rhinitis with or without asthma, and rhinoconjunctivitis with or without allergic rhinitis due to house dust mite, grass or ragweed pollen, or a mixture of various allergens. All but one study compellingly demonstrate cost savings conferred by AIT over SDT.
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Kennedy JL, Robinson D, Christophel J, Borish L, Payne S. Decision-making analysis for allergen immunotherapy versus nasal steroids in the treatment of nasal steroid-responsive allergic rhinitis. Am J Rhinol Allergy 2015; 28:59-64. [PMID: 24717886 DOI: 10.2500/ajra.2014.28.3998] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of the study was to determine the age at which initiation of specific subcutaneous immunotherapy (SCIT) becomes more cost-effective than continued lifetime intranasal steroid (NS) therapy in the treatment of allergic rhinitis, with the use of a decision analysis model. METHODS A Markov decision analysis model was created for this study. Economic analyses were performed to identify "break-even" points in the treatment of allergic rhinitis with the use of SCIT and NS. Efficacy rates for therapy and cost data were collected from the published literature. Models in which there was only incomplete improvement while receiving SCIT were also evaluated for economic break-even points. The primary perspective of the study was societal. RESULTS Multiple break-even point curves were obtained corresponding to various clinical scenarios. For patients with seasonal allergic rhinitis requiring NS (i.e., fluticasone) 6 months per year, the age at which initiation of SCIT provides long-term direct cost advantage is less than 41 years. For patients with perennial rhinitis symptoms requiring year-round NS, the cut-off age for SCIT cost-effectiveness increases to 60 years. Hypothetical subjects who require continued NS treatment (50% reduction of previous dosage) while receiving SCIT also display break-even points, whereby it is economically advantageous to consider allergy referral and SCIT, dependent on the cost of the NS prescribed. CONCLUSION The age at which SCIT provides economic advantages over NS in the treatment of allergic rhinitis depends on multiple clinical factors. Decision analysis models can assist the physician in accounting for these factors and customize patient counseling with regard to treatment options.
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Affiliation(s)
- Joshua L Kennedy
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Leitlinie zur (allergen-)spezifischen Immuntherapie bei IgE-vermittelten allergischen Erkrankungen. ALLERGO JOURNAL 2014. [DOI: 10.1007/s15007-014-0707-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kündig TM, Klimek L, Schendzielorz P, Renner WA, Senti G, Bachmann MF. Is The Allergen Really Needed in Allergy Immunotherapy? CURRENT TREATMENT OPTIONS IN ALLERGY 2014; 2:72-82. [PMID: 25722959 PMCID: PMC4335088 DOI: 10.1007/s40521-014-0038-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Immunotherapy for type I allergies is well established and is regarded to be the most efficient treatment option besides allergen avoidance. As of today, different forms of allergen preparations are used in this regard, as well as different routes of application. Virus-like particles (VLPs) represent a potent vaccine platform with proven immunogenicity and clinical efficacy. The addition of toll-like receptor ligands and/or depot-forming adjuvants further enhances activation of innate as well as adaptive immune responses. CpG motifs represent intensively investigated and potent direct stimulators of plasmacytoid dendritic cells and B cells, while T cell responses are enhanced indirectly through increased antigen presentation and cytokine release. This article will focus on the function of VLPs loaded with DNA rich in nonmethylated CG motifs (CpGs) and the clinical experience gained in the treatment of allergic rhinitis, demonstrating clinical efficacy also if administered without allergens. Several published studies have demonstrated a beneficial impact on allergic symptoms by treatment with CpG-loaded VLPs. Subcutaneous injection of VLPs loaded with CpGs was tested with or without the adjuvant alum in the presence or absence of an allergen. The results encourage further investigation of VLPs and CpG motifs in immunotherapy, either as a stand-alone product or as adjuvants for allergen-specific immunotherapy.
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Affiliation(s)
- Thomas M Kündig
- Dermatology Department, Zurich University Hospital, Gloriastr. 31, 8091 Zurich, Switzerland
| | - Ludger Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden, Germany
| | | | | | | | - Martin F Bachmann
- Dermatology Department, Zurich University Hospital, Gloriastr. 31, 8091 Zurich, Switzerland ; National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Dutau G. Allergie aux acariens domestiques : du diagnostic à la prise en charge. REVUE FRANCAISE D ALLERGOLOGIE 2014. [DOI: 10.1016/j.reval.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Szépfalusi Z, Bannert C, Ronceray L, Mayer E, Hassler M, Wissmann E, Dehlink E, Gruber S, Graf A, Lupinek C, Valenta R, Eiwegger T, Urbanek R. Preventive sublingual immunotherapy in preschool children: first evidence for safety and pro-tolerogenic effects. Pediatr Allergy Immunol 2014; 25:788-95. [PMID: 25406682 PMCID: PMC6597351 DOI: 10.1111/pai.12310] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prevention of new IgE sensitizations has been described during allergen-specific immunotherapy. However, prospective data using a preventive approach in very young children who would benefit most are missing. We initiated a prospective pilot study investigating the safety, immunomodulatory, and sensitization-preventive effect of sublingual immunotherapy (SLIT) in mono/oligoclonally sensitized, clinically asymptomatic children 2-5 yr of age. METHODS In this double-blinded, randomized, placebo-controlled pilot study, 31 mono-/oligosensitized children to house-dust mite or grass pollen were included. SLIT with the respective source (n = 15) or placebo (n = 16) was applied. After dose-up-phase therapy was continued for 2 yr. Parents recorded clinical events, vaccinations, and drug intake in a diary. Skin prick testing and specific IgE and IgG measurements were recorded at baseline, 12 and 24 months. At the same time, allergen-specific proliferation and IL10- and TGFβ-dependent Treg function were measured. RESULTS Preventive application of SLIT in young children was safe (no relevant side effects in 21,170 single applications). After 12 and 24 months of treatment, the rate of allergen-specific sensitization (specific IgE and SPT reactivity) was comparable in the treatment and the placebo group. However, verum-treated patients displayed a significant up-regulation of allergen-specific IgG (p < 0.05). Furthermore, IL10-dependent inhibition (p < 0.05) was observed in vitro in the treatment group but not in the placebo group. CONCLUSION Preventive SLIT is safe in children 2-5 yr of age and induces regulatory mechanisms involving allergen-specific IgG and IL10. Based on this pilot study, large-scale trials will need to investigate the modulation of sensitization and clinically relevant allergy.
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Affiliation(s)
- Zsolt Szépfalusi
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
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Cingi C, Muluk NB, Hanci D, Ulusoy S, Sahin F. Updating the role played by immunotherapy for allergic rhinitis: meta-analysis. Int Forum Allergy Rhinol 2014; 5:132-42. [DOI: 10.1002/alr.21447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Cemal Cingi
- Department of Otorhinolaryngology; Medical Faculty, Eskisehir Osmangazi University; Eskisehir Turkey
| | - Nuray Bayar Muluk
- Department of Otorhinolaryngology; Medical Faculty, Kirikkale University; Kirikkale Turkey
| | - Deniz Hanci
- Ear Nose and Throat (ENT) Department; Liv Hospital; Istanbul Turkey
| | - Seckin Ulusoy
- ENT Clinics; Gaziosmanpaşa Taksim Education and Research Hospital; Istanbul Turkey
| | - Fezan Sahin
- Department of Biostatistics, Medical Faculty; Eskisehir Osmangazi University; Eskisehir Turkey
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Klimek L, Bachmann MF, Senti G, Kündig TM. Immunotherapy of type-1 allergies with virus-like particles and CpG-motifs. Expert Rev Clin Immunol 2014; 10:1059-67. [PMID: 24898577 DOI: 10.1586/1744666x.2014.924854] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Immunotherapy of type-I-allergies is regarded as the most efficient treatment option besides allergen avoidance. Different forms of allergen preparations are used as well as different routes of application. Virus-like particles represent a potent vaccine platform with proven immunogenicity and clinical efficacy. The addition of toll-like receptor ligands and/or depot-forming adjuvants further enhances immune cell activation. This article will focus on the function of virus-like particles loaded with DNA rich in CpG-motifs and discuss clinical experience in treatment of allergic rhinitis. Evidence will be presented that clinically effective treatment can be obtained even in the absence of allergens. Results encourage further investigation of virus-like particles and CpG-motifs in immunotherapy, either as a stand alone product, or as adjuvants for allergen-specific immunotherapy.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology and Allergology, An den Quellen 10, D-65183 Wiesbaden, Germany
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47
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Cox LS, Hankin C, Lockey R. Allergy immunotherapy adherence and delivery route: location does not matter. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:156-60. [PMID: 24607042 DOI: 10.1016/j.jaip.2014.01.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Linda S Cox
- Allergy and Asthma Center, Ft Lauderdale, Fla.
| | | | - Richard Lockey
- University of South Florida Morsani College of Medicine, Tampa, Fla
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Baris S, Kiykim A, Ozen A, Tulunay A, Karakoc-Aydiner E, Barlan IB. Vitamin D as an adjunct to subcutaneous allergen immunotherapy in asthmatic children sensitized to house dust mite. Allergy 2014; 69:246-53. [PMID: 24180595 DOI: 10.1111/all.12278] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND We aimed to investigate the efficacy, safety, and T regulatory cell response of vitamin D as an adjunct to allergen-specific immunotherapy (IT). METHODS Fifty children with asthma and receiving pharmacotherapy were randomized into three groups as: subcutaneous IT (SCIT) along with vitamin D supplementation (650 U/day; n: 17), SCIT alone (n: 15), and pharmacotherapy alone (n: 18). All patients were evaluated at baseline, 6th and 12th months for scorings of symptoms and medication, skin prick testing, total IgE, specific IgE, and Der p 1-specific IgG4. In addition, D. pteronyssinus-induced CD4(+) CD25(+) FOXP3(+) T regulatory cell percentage, intracellular Foxp3 expression, and peripheral blood mononuclear cell IL-10 and TGF-β responses were assessed. RESULTS In the SCIT + vitamin D and SCIT alone groups, total asthma symptom score (TASS), total symptom score (TSS), and total medication scores (TMS) were significantly lower than pharmacotherapy group at the end of 1 year. While the comparison of delta values (Δ 6th and Δ 12th month - baseline) of those scores revealed no significant differences between the two IT groups, TASS at the 6th month was lower in the SCIT + vitamin D group compared with others. There was a significant and positive trend in the levels of Der p 1-specific IgG4 in both IT groups throughout the study period. Whereas the levels of Der p 1-induced IL-10 and TGF-β were similar between IT groups, the mean fluorescence intensity of Foxp3 was highest in the SCIT + vitamin D group compared with others at the 12th month. The rate of discontinuation of inhaled corticosteroid (ICS) was 6/17 in SCIT + vitamin D, 3/15 in SCIT, and 0/18 in the pharmacotherapy group (P = 0.02). CONCLUSION Both SCIT groups fared better than pharmacotherapy alone at the end of 1 year. Although the clinical and immunologic outcomes were mostly similar between the two IT groups, some favorable outcomes of vitamin D warrant further investigation in more selected populations with varying doses as adjunct to IT.
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Affiliation(s)
- S. Baris
- Division of Pediatric Allergy and Immunology; Research and Training Hospital; Marmara University; Istanbul Turkey
| | - A. Kiykim
- Division of Pediatric Allergy and Immunology; Research and Training Hospital; Marmara University; Istanbul Turkey
| | - A. Ozen
- Division of Pediatric Allergy and Immunology; Research and Training Hospital; Marmara University; Istanbul Turkey
| | - A. Tulunay
- Division of Immunology; Research and Training Hospital; Marmara University; Istanbul Turkey
| | - E. Karakoc-Aydiner
- Division of Pediatric Allergy and Immunology; Research and Training Hospital; Marmara University; Istanbul Turkey
| | - I. B. Barlan
- Division of Pediatric Allergy and Immunology; Research and Training Hospital; Marmara University; Istanbul Turkey
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Okamoto Y, Ohta N, Okano M, Kamijo A, Gotoh M, Suzuki M, Takeno S, Terada T, Hanazawa T, Horiguchi S, Honda K, Matsune S, Yamada T, Yuta A, Nakayama T, Fujieda S. Guiding principles of subcutaneous immunotherapy for allergic rhinitis in Japan. Auris Nasus Larynx 2014; 41:1-5. [DOI: 10.1016/j.anl.2013.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/11/2013] [Accepted: 09/27/2013] [Indexed: 12/01/2022]
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Luyt D, Bravin K, Luyt J. Implementing specific oral tolerance induction to milk into routine clinical practice: experience from first 50 patients. J Asthma Allergy 2014; 7:1-9. [PMID: 24511241 PMCID: PMC3913504 DOI: 10.2147/jaa.s53281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Although the natural history of cow’s milk allergy is to resolve during childhood or adolescence, a small but significant proportion of children will remain allergic. Specific oral tolerance induction to cow’s milk (CM-SOTI) provides a treatment option in these children with continuing allergy with high success rates. However current sentiment limits widespread availability as existing reports advise that it is too soon to translate CM-SOTI into routine clinical practice. Methods In January 2007 we implemented a slow up-dosing CM-SOTI program. Eligible subjects were identified at routine visits to our children’s allergy clinic. Persisting cow’s milk allergy was confirmed from recent contact symptoms or a positive baked milk challenge. As allergic symptoms are common during CM-SOTI, families were provided with ready dietetic access for advice on dosing and symptom treatment. Subjects were continuously monitored at subsequent clinic visits or telephonically, where no longer followed, for a median of 49 months. Results The first 50 subjects (35 males) treated ranged in age from 5.1 to 15.8 years (median 10.3 years). Full tolerance (250 mL) was achieved in 23 subjects, 9 without any symptoms, and a further 9 achieved partial tolerance with continued ingestion. Eighteen children failed to achieve any regular milk ingestion; 11 because of persistent or significant symptoms whilst 8 withdrew against medical advice. Allergic symptoms were predominantly mild to moderate in severity, although 2 cases needed treatment with inhaled salbutamol and a further 2 required intramuscular adrenaline. Clinical tolerance, both full and partial, persists beyond 5 years. Conclusion We have demonstrated that a CM-SOTI program can be successfully and safely implemented as routine clinical practice with acceptable compliance during prolonged home up-dosing, despite frequent allergic symptoms, and for up to 4 years after starting treatment. CM-SOTI can thus be put into practice more widely where there is appropriate support.
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Affiliation(s)
- David Luyt
- Children's Allergy Service, University Hospitals of Leicester, Leicester, UK
| | - Kristian Bravin
- Children's Allergy Service, University Hospitals of Leicester, Leicester, UK
| | - Jessica Luyt
- Children's Allergy Service, University Hospitals of Leicester, Leicester, UK
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