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Lei Z, Feng G, Wang Z, Ning Z. Noncoding RNAs and Virus and Treatment in Allergic Rhinitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1979447. [PMID: 36285160 PMCID: PMC9588333 DOI: 10.1155/2022/1979447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/31/2022] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
Allergic rhinitis (AR) is a type I hypersensitivity reaction disease caused by inhaled allergens and immunoglobulin E (IgE)-mediated. Noncoding RNA (ncRNA) is an important regulator involved in gene expression and can be detected in the cytoplasm or extracellular fluid, which mainly includes microRNAs (miRNA, length 22-24 nucleotides), long noncoding RNAs (lncRNA, length >200 nucleotides), and circRNAs. LncRNA and miRNA both participate in the regulation of immune function. Some respiratory viral infections can aggravate allergic rhinitis, such as a respiratory syncytial virus (RSV) and human metapneumovirus (hMPV). However, the interaction between viral infection and allergy is complex and the mechanism is still unclear. In this review, we summarized the interactions of noncoding RNAs and viruses in the occurrence and development of AR, along with the treatments focusing on the noncoding RNAs in the past five years.
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Affiliation(s)
- Zhu Lei
- Otolaryngology Department, Xianning First People's Hospital, Xianning 437100, Hubei, China
| | - Guangrui Feng
- Cardiovascular Medicine Department, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, Hubei, China
| | - Zhiguo Wang
- Dermatology Department, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, Hubei, China
| | - Zhifeng Ning
- Human Anatomy Department, Basic Medicine College, Hubei University of Science and Technology, Xianning 437100, Hubei, China
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Hu Y, Wang Y, Lin J, Wu S, Muyldermans S, Wang S. Versatile Application of Nanobodies for Food Allergen Detection and Allergy Immunotherapy. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:8901-8912. [PMID: 35820160 DOI: 10.1021/acs.jafc.2c03324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The unique characteristics of camelid heavy-chain only antibody (HCAb) derived nanobodies (Nbs) have facilitated their employment as tools for research and application in extensive fields including food safety inspection, diagnosis and therapy of diseases, etc., to develop immune detecting techniques or alternative candidates of conventional antibodies as diagnostic and therapeutic reagents. The wide application in the fields of food allergen inspection and immunotherapy has not been addressed as not much results published in the literature. The robust properties and straightforward selecting strategy of Nbs impel the advantageous employment compared with monoclonal antibodies (mAbs) to establish immunoassay and serve as blocking antibodies to compete immunoglobulin E (IgE) binding epitopes on food allergens. More and more efforts have been invested to develop specific Nbs against food allergen proteins, such as macadamia allergen of Mac i 1, peanut allergen of Ara h 3, and lupine allergen of Lup an 1, which demonstrated the potential of Nbs for research and application in food allergen surveillance. Meanwhile, the paratopes of Nbs preferably targeting the unique epitopes of food allergens can provide more possibilities to serve as blocking antibodies to shield IgE binding epitopes for food allergy immunotherapy. Regardless, the research and application of Nbs in the field of food allergen and allergic reactions are expected to attract dramatic focus and produce promising research outputs.
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Affiliation(s)
- Yaozhong Hu
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Yi Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Jing Lin
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Sihao Wu
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Serge Muyldermans
- Cellular and Molecular Immunology, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Shuo Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China
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Ahlbeck L, Ahlberg E, Björkander J, Aldén C, Papapavlou G, Palmberg L, Nyström U, Retsas P, Nordenfelt P, Togö T, Johansen P, Rolander B, Duchén K, Jenmalm MC. Intralymphatic immunotherapy with one or two allergens renders similar clinical response in patients with allergic rhinitis due to birch and grass pollen. Clin Exp Allergy 2022; 52:747-759. [PMID: 35332591 PMCID: PMC9325375 DOI: 10.1111/cea.14138] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/10/2022] [Accepted: 03/20/2022] [Indexed: 01/05/2023]
Abstract
Introduction There is a need for a fast, efficient and safe way to induce tolerance in patients with severe allergic rhinitis. Intralymphatic immune therapy has been shown to be effective. Methods Patients with severe birch and timothy allergy were randomized and received three doses of 0.1 ml of birch and 5‐grass allergen extracts (10,000 SQ units/ml, ALK‐Abelló), or birch and placebo or 5‐grass and placebo by ultrasound‐guided injections into inguinal lymph nodes at monthly intervals. Rhinoconjunctivitis total symptom score, medication score and rhinoconjunctivitis quality of life questionnaire were evaluated before treatment and after each birch and grass pollen season during three subsequent years. Circulating proportions of T helper subsets and allergen‐induced cytokine and chemokine production were analysed by flow cytometry and Luminex. Results The three groups reported fewer symptoms, lower use of medication and improved quality of life during the birch and grass pollen seasons each year after treatment at an almost similar rate independently of treatment with one or two allergens. Mild local pain was the most common adverse event. IgE levels to birch decreased, whereas birch‐induced IL‐10 secretion increased in all three groups. IgG4 levels to birch and timothy and skin prick test reactivity remained mainly unchanged. Conjunctival challenge tests with timothy extract showed a higher threshold for allergen. In all three groups, regulatory T cell frequencies were increased 3 years after treatment. Conclusions Intralymphatic immunotherapy with one or two allergens in patients with grass and birch pollen allergy was safe, effective and may be associated with bystander immune modulatory responses. Clinical Trial Registration: EudraCT (2013‐004726‐28).
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Affiliation(s)
- Lars Ahlbeck
- Allergy Center, University Hospital, Linköping, Sweden.,Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Emelie Ahlberg
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Caroline Aldén
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Georgia Papapavlou
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Palmberg
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ulla Nyström
- Allergy Center, University Hospital, Linköping, Sweden
| | - Pavlos Retsas
- Allergy Center, University Hospital, Linköping, Sweden
| | | | - Totte Togö
- Allergy Center, University Hospital, Linköping, Sweden
| | - Pål Johansen
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Bo Rolander
- Futurum, Academy of Health and Care, Jönköping, Sweden
| | - Karel Duchén
- Allergy Center, University Hospital, Linköping, Sweden.,Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maria C Jenmalm
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Hellkvist L, Hjalmarsson E, Weinfeld D, Dahl Å, Karlsson A, Westman M, Lundkvist K, Winqvist O, Georén SK, Westin U, Cardell LO. High-dose pollen intralymphatic immunotherapy: Two RDBPC trials question the benefit of dose increase. Allergy 2022; 77:883-896. [PMID: 34379802 DOI: 10.1111/all.15042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The same dosing schedule, 1000 SQ-U times three, with one-month intervals, have been evaluated in most trials of intralymphatic immunotherapy (ILIT) for the treatment of allergic rhinitis (AR). The present studies evaluated if a dose escalation in ILIT can enhance the clinical and immunological effects, without compromising safety. METHODS Two randomized double-blind placebo-controlled trials of ILIT for grass pollen-induced AR were performed. The first included 29 patients that had recently ended 3 years of SCIT and the second contained 39 not previously vaccinated patients. An up-dosage of 1000-3000-10,000 (5000 + 5000 with 30 minutes apart) SQ-U with 1 month in between was evaluated. RESULTS Doses up to 10,000 SQ-U were safe after recent SCIT. The combined symptom-medication scores (CSMS) were reduced by 31% and the grass-specific IgG4 levels in blood were doubled. In ILIT de novo, the two first patients that received active treatment developed serious adverse reactions at 5000 SQ-U. A modified up-dosing schedule; 1000-3000-3000 SQ-U appeared to be safe but failed to improve the CSMS. Flow cytometry analyses showed increased activation of lymph node-derived dendritic but not T cells. Quality of life and nasal provocation response did not improve in any study. CONCLUSION Intralymphatic immunotherapy in high doses after SCIT appears to further reduce grass pollen-induced seasonal symptoms and may be considered as an add-on treatment for patients that do not reach full symptom control after SCIT. Up-dosing schedules de novo with three monthly injections that exceeds 3000 SQ-U should be avoided.
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Affiliation(s)
- Laila Hellkvist
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Eric Hjalmarsson
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Dan Weinfeld
- Asthma and Allergy Clinic Outpatient Unit (adults) Department of Internal Medicine South Alvsborgs Central Hospital Boras Sweden
| | - Åslög Dahl
- Departments of Biological and Environmental Sciences Gothenburg University Gothenburg Sweden
| | - Agneta Karlsson
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Marit Westman
- Immunology and Allergy Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Karin Lundkvist
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | | | - Susanna Kumlien Georén
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Ulla Westin
- Laboratory of Clinical and Experimental Allergy Research Department of Otorhinolaryngology Malmö Lund University Skåne University Hospital Malmö Sweden
| | - Lars Olaf Cardell
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
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Sun MJ, Teng Z, Fan PS, Chen XG, Liu Y. Bridging micro/nano-platform and airway allergy intervention. J Control Release 2021; 341:364-382. [PMID: 34856226 DOI: 10.1016/j.jconrel.2021.11.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/22/2022]
Abstract
Allergic airway diseases, with incidence augmenting visibly as industrial development and environmental degradation, are characterized by sneezing, itching, wheezing, chest tightness, airway obstruction, and hyperresponsiveness. Current medical modalities attempt to combat these symptoms mostly by small molecule chemotherapeutants, such as corticosteroids, antihistamines, etc., via intranasal approach which is one of the most noninvasive, rapid-absorbed, and patient-friendly routes. Nevertheless, inherent defects for irritation to respiratory mucosa, drug inactivation and degradation, and rapid drug dispersal to off-target sites are inevitable. Lately, intratracheal micro/nano therapeutic systems are emerging as innovative alternatives for airway allergy interventions. This overview introduces several potential application directions of mic/nano-platform in the treatment of airway allergic diseases, including carriers, therapeutic agents, and immunomodulators. The improvement of the existing drug therapy of respiratory allergy management by micro/nano-platform is described in detail. The challenges of the micro/nano-platform nasal approach in the treatment of airway allergy are summarized and the development of micro/nano-platform is also prospected. Although still a burgeoning area, micro/nano therapeutic systems are gradually turning to be realistic orientations as crucial future alternative therapeutic options in allergic airway inflammation interventions.
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Affiliation(s)
- Meng-Jie Sun
- College of Marine Life Science, Ocean University of China, Qingdao 266003, PR China
| | - Zhuang Teng
- College of Marine Life Science, Ocean University of China, Qingdao 266003, PR China
| | - Peng-Sheng Fan
- College of Marine Life Science, Ocean University of China, Qingdao 266003, PR China
| | - Xi-Guang Chen
- College of Marine Life Science, Ocean University of China, Qingdao 266003, PR China; Qingdao National Laboratory for Marine Science and Technology, Qingdao 266000, PR China
| | - Ya Liu
- College of Marine Life Science, Ocean University of China, Qingdao 266003, PR China.
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Li Y, Guo XQ. Mild moxibustion plus loratadine tablets for children with allergic rhinitis: a randomized controlled trial. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2021. [DOI: 10.1007/s11726-021-1274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Choi YJ, Kim KA, Jung JH, Choi YS, Baek SK, Kim ST, Park JH. Epicutaneous Allergen Administration with Microneedles as a Novel Method of Immunotherapy for House Dust Mite (HDM) Allergic Rhinitis. Pharm Res 2021; 38:1199-1207. [PMID: 34145532 DOI: 10.1007/s11095-021-03070-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/31/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Epicutaneous immunotherapy (EPIT) is being studied as a method for treating allergic rhinitis because of skin immunology, user convenience and enhanced patient compliance. However, the use of EPIT is limited because of the very low skin permeability of the allergen. In this study, the limitations of EPIT were overcome by using sophisticated delivery with microneedles. The immunological efficacy of this method was studied in a murine model of house dust mite (HDM) allergic rhinitis. METHODS The length of the microneedles was 400 μm, and the coating formulation containing HDM was locally distributed near the end of the microneedle tips. The change of distribution of FITC-dextran in porcine skin in vitro was observed over time using a confocal microscope. The effect of immunotherapy in the allergic rhinitis model, sensitized by HDM-coated microneedles (HDM MNs), was observed according to the amount of HDM applied. RESULTS The microneedles delivered the coating formulation with precision into the porcine skin layer, and the coated formulation on the microneedles was all dissolved in the porcine skin in vitro within 20 min of administration and then gradually diffused into the skin layer. When HDM MNs were administered to mice, a 0.1-μg dose of HDM provided the most effective immunization, and improved efficacy was shown between 0.1- and 0.5- μg doses of HDM. CONCLUSIONS Effective immunotherapy can be achieved by precision delivery of the allergen into the skin layer, and microneedles can provide effective immunological therapy by delivering the appropriate amount of allergen.
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Affiliation(s)
- Yu-Ji Choi
- Department of BioNano Technology, Gachon BioNano Research Institute, Gachon University, Seongnam, Republic of Korea
| | - Kyeong-Ah Kim
- Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Joo-Hyun Jung
- Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yun-Sook Choi
- Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seung-Ki Baek
- QuadMedicine R&D Centre, QuadMedicine Co., Ltd, Seongnam, Republic of Korea
| | - Seon-Tae Kim
- Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Jung-Hwan Park
- Department of BioNano Technology, Gachon BioNano Research Institute, Gachon University, Seongnam, Republic of Korea.
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Caimmi D, Demoly P. Recommandations pour la prescription de l’immunothérapie allergénique et le suivi du patient — Questions développées et revue de la littérature. REVUE FRANÇAISE D'ALLERGOLOGIE 2021. [DOI: 10.1016/j.reval.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Shen L, Wang J, Kang X, Han M, Li M, Huang Z, Luo L, Tu J, Ye J. Clinical Efficacy and Possible Mechanism of Endoscopic Vidian Neurectomy for House Dust Mite-Sensitive Allergic Rhinitis. ORL J Otorhinolaryngol Relat Spec 2021; 83:75-84. [PMID: 33395682 DOI: 10.1159/000511711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Endoscopic vidian neurectomy (EVN) for allergic rhinitis (AR) has good clinical effects. However, the pathophysiological basis of the effect of EVN on AR is still poorly understood. This study aimed to investigate the efficacy of EVN on house dust mite (HDM)-sensitive AR and the dynamic changes of serum immunoglobulin E and some immune regulatory factors. METHODS Twenty HDM-sensitive AR patients were treated with bilateral EVN (EVN group), 15 HDM-sensitive AR patients were treated with subcutaneous immunotherapy (SCIT group), and 15 healthy subjects served as healthy controls. Quality of daily life was assessed by the scores of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQs). The visual analog scale was used to assess clinical efficacy. Serum molecules were measured by ELISA and the UNICAP system. RESULTS Compared with the SCIT group, the RQLQs in the EVN group were lower 12 months after treatment (both p < 0.05). There was no significant difference in improving nasal itching and sneezing (both p > 0.05), but the clinical efficacy of bilateral EVN was greater than SCIT in improving nasal obstruction, rhinorrhea, eye itching, and lachrymation 12 months after treatment (all p < 0.05). Compared with before treatment, the serum levels of total immunoglobulin E (tIgE), Dermatophagoides pteronyssinus- and Dermatophagoides farinae-specific immunoglobulin E (sIgE), and tumor necrosis factor (TNF)-α in the EVN group and the serum levels of TNF-α and interleukin-4 in the SCIT group were lower 12 months after treatment (all p < 0.05). CONCLUSION The short-term efficacy of bilateral EVN is more effective than SCIT in treating HDM-sensitive AR. This may be because the surgery reduced the tIgE and sIgE levels. TNF-α may be involved in the therapeutic mechanism.
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Affiliation(s)
- Li Shen
- Department of Allergology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jun Wang
- Department of Allergology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xue Kang
- Department of Otorhinolaryngology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Mei Han
- Department of Allergology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mengyue Li
- Department of Allergology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhiqun Huang
- Department of Allergology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liping Luo
- Department of Otorhinolaryngology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Junhao Tu
- Department of Allergology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Ye
- Department of Allergology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
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Ma TT, Cao MD, Yu RL, Shi HY, Yan WJ, Liu JG, Pan C, Sun J, Wei QY, Wang DY, Wei JF, Wang XY, Yin JS. Leukotriene A 4 Hydrolase Is a Candidate Predictive Biomarker for Successful Allergen Immunotherapy. Front Immunol 2020; 11:559746. [PMID: 33329520 PMCID: PMC7732448 DOI: 10.3389/fimmu.2020.559746] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background Allergic rhinitis is a common disorder that affects 10% to 40% of the population worldwide. Allergen immunotherapy (AIT) represents the only therapy that has the potential to resolve clinical symptoms of allergic rhinitis. However, up to 30% of patients do not respond to AIT. Biomarkers predicting the clinical efficacy of AIT as early as possible would significantly improve the patient selection and reduce unnecessary societal costs. Methods Artemisia pollen allergic patients who received at least 1-year AIT were enrolled. Clinical responses before and after 1-year AIT were evaluated to determine AIT responders. Artemisia specific IgE and IgG4 levels were measured by using ImmunoCAP and enzyme-linked immunosorbent assay (ELISA) separately. Stepwise regression analysis was performed to identify which rhinitis-relevant parameters explained the most variability in AIT results. Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based proteomics was applied to identify the potential candidate biomarkers in the sera of responders and non-responders collected before and after 1-year therapy. The diagnostic performance of the potential biomarkers was then assessed using enzyme-linked immunosorbent assay (ELISA) in 30 responders and 15 non-responders. Results Artemisia specific IgE and IgG4 levels were elevated only in the responders. Regression analysis of allergic rhinitis-relevant parameters provided a robust model that included two most significant variables (sneeze and nasal congestion). Thirteen candidate biomarkers were identified for predicting AIT outcomes. Based on their association with allergy and protein fold change (more than 1.1 or less than 0.9), four proteins were identified to be potential biomarkers for predicting effective AIT. However, further ELISA revealed that only leukotriene A4 hydrolase (LTA4H) was consistent with the proteomics data. The LTA4H level in responders increased significantly (P < 0.001) after 1-year therapy, while that of non-responders remained unchanged. Assessment of LTA4H generated area under curve (AUC) value of 0.844 (95% confidence interval: 0.727 to 0.962; P < 0.05) in distinguishing responders from the non-responders, suggesting that serum LTA4H might be a potential biomarker for predicting the efficiency of AIT. Conclusion Serum LTA4H may be a potential biomarker for early prediction of an effective AIT.
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Affiliation(s)
- Ting-Ting Ma
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Meng-Da Cao
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rui-Li Yu
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hai-Yun Shi
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wei-Jun Yan
- Department of Allergy, Duolun People's Hospital, Duolun, China
| | - Jian-Guo Liu
- Department of Allergy, Duolun People's Hospital, Duolun, China
| | - Chen Pan
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jinlyu Sun
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases, Beijing, China
| | - Qing-Yu Wei
- Department of Allergy, General Hospital of Northern Theater Command, Shenyang, China
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ji-Fu Wei
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue-Yan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jin-Shu Yin
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Jensen‐Jarolim E, Bachmann MF, Bonini S, Jacobsen L, Jutel M, Klimek L, Mahler V, Mösges R, Moingeon P, O´Hehir RE, Palomares O, Pfaar O, Renz H, Rhyner C, Roth‐Walter F, Rudenko M, Savolainen J, Schmidt‐Weber CB, Traidl‐Hoffmann C, Kündig T. State-of-the-art in marketed adjuvants and formulations in Allergen Immunotherapy: A position paper of the European Academy of Allergy and Clinical Immunology (EAACI). Allergy 2020; 75:746-760. [PMID: 31774179 DOI: 10.1111/all.14134] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 02/06/2023]
Abstract
Since the introduction of allergen immunotherapy (AIT) over 100 years ago, focus has been on standardization of allergen extracts, with reliable molecular composition of allergens receiving the highest attention. While adjuvants play a major role in European AIT, they have been less well studied. In this Position Paper, we summarize current unmet needs of adjuvants in AIT citing current evidence. Four adjuvants are used in products marketed in Europe: aluminium hydroxide (Al(OH)3 ) is the most frequently used adjuvant, with microcrystalline tyrosine (MCT), monophosphoryl lipid A (MPLA) and calcium phosphate (CaP) used less frequently. Recent studies on humans, and using mouse models, have characterized in part the mechanisms of action of adjuvants on pre-existing immune responses. AIT differs from prophylactic vaccines that provoke immunity to infectious agents, as in allergy the patient is presensitized to the antigen. The intended mode of action of adjuvants is to simultaneously enhance the immunogenicity of the allergen, while precipitating the allergen at the injection site to reduce the risk of anaphylaxis. Contrasting immune effects are seen with different adjuvants. Aluminium hydroxide initially boosts Th2 responses, while the other adjuvants utilized in AIT redirect the Th2 immune response towards Th1 immunity. After varying lengths of time, each of the adjuvants supports tolerance. Further studies of the mechanisms of action of adjuvants may advise shorter treatment periods than the current three-to-five-year regimens, enhancing patient adherence. Improved lead compounds from the adjuvant pipeline are under development and are explored for their capacity to fill this unmet need.
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Affiliation(s)
- Erika Jensen‐Jarolim
- Institute of Pathophysiology & Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
- The Interuniversity Messerli Research Institute University of Veterinary Medicine Vienna Medical University of Vienna University of Vienna Vienna Austria
| | - Martin F. Bachmann
- Institute of Immunology Inselspital University of Berne Bern Switzerland
| | - Sergio Bonini
- Institute of Translational Pharmacology Italian National Research Council Rome Italy
| | - Lars Jacobsen
- ALC, Allergy Learning & Consulting Copenhagen Denmark
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wrocław Poland
- ALL‐MED Medical Research Institute Wroclaw Poland
| | - Ludger Klimek
- Center of Rhinology and Allergology Wiesbaden Germany
| | - Vera Mahler
- Division of Allergology Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Ralph Mösges
- CRI‐Clinical Research International Ltd Hamburg Germany
- Institute of Medical Statistics and Bioinformatics University of Cologne Cologne Germany
| | - Philippe Moingeon
- Center for Therapeutic Innovation – Immuno‐Inflammatory Disease Servier Suresnes France
| | - Robyn E. O´Hehir
- Department of Respiratory Medicine, Allergy and Clinical Immunology (Research) Central Clinical School Monash University and Alfred Hospital Melbourne Vic. Australia
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital MarburgPhilipps‐Universität Marburg Marburg Germany
| | - Harald Renz
- Institute of Laboratory Medicine Universities of Giessen and Marburg Lung Center (UGMLC) German Center for Lung Research (DZL) Philipps Universität Marburg Marburg Germany
| | - Claudio Rhyner
- SIAF – Swiss Institute of Allergy and Asthma Research Davos Switzerland
| | - Franziska Roth‐Walter
- The Interuniversity Messerli Research Institute University of Veterinary Medicine Vienna Medical University of Vienna University of Vienna Vienna Austria
| | | | - Johannes Savolainen
- Department of Pulmonary Diseases and Clinical Allergology University of Turku and Turku University Hospital Turku Finland
| | - Carsten B. Schmidt‐Weber
- Center of Allergy and Environment (ZAUM) German Center of Lung Research (DZL) and Helmholtz I&I Initiative Technical University, and Helmholtz Center Munich Munich Germany
| | - Claudia Traidl‐Hoffmann
- Institute of Environmental Medicine (IEM) Technical University Munich and Helmholtz Center Munich Munich Germany
| | - Thomas Kündig
- Department of Dermatology University Hospital Zurich Zurich Switzerland
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Abstract
Allergen immunotherapy (AIT) is an effective treatment for patients with allergic diseases; it has been shown to modify the underlying cause of the disease. The house dust mite (HDM) is a major perennial allergen source and a significant cause of allergic-related diseases such as allergic rhinitis, asthma, and atopic dermatitis. HDM allergen is an important factor in the pathogenesis of allergic diseases. Sensitization to HDM allergen often occurs early in life and appears to play an important role in the progression from allergic rhinitis to asthma in children. The role of HDM AIT results in immunologic tolerance, provides an alternative option for treating HDM allergy through targeting the mechanisms of allergic reaction, and creates a long-term benefit. There are two forms of testing for aeroallergen, either detect by skin testing or by in vitro IgE assays. Both subcutaneous immunotherapy and sublingual immunotherapy are effective in the treatment of allergic diseases. In the future, new forms of allergen extracts can help improve safety and efficacy of AIT. Novel approaches to immunotherapy currently being explored include the use of adjuvants, allergen-derived peptides, modified recombinant allergen vaccines, and gene-specific immunotherapy.
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Affiliation(s)
- Ren-Bin Tang
- Department of Pediatrics, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
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14
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Zielen S, Kuna P, Aberer W, Lassmann S, Pfaar O, Klimek L, Wade A, Kluehr K, Raab J, Wessiepe D, Lee D, Kramer M, Gunawardena K, Higenbottam T, Heath M, Skinner M, de Kam P. Strong dose response after immunotherapy with PQ grass using conjunctival provocation testing. World Allergy Organ J 2019; 12:100075. [PMID: 31709029 PMCID: PMC6831906 DOI: 10.1016/j.waojou.2019.100075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background Pollinex Quattro Grass (PQ Grass) is an effective, well-tolerated, short pre-seasonal subcutaneous immunotherapy to treat seasonal allergic rhinoconjunctivitis (SAR) due to grass pollen. In this Phase II study, 4 cumulative doses of PQ Grass and placebo were evaluated to determine its optimal cumulative dose. Methods Patients with grass pollen-induced SAR were randomised to either a cumulative dose of PQ Grass (5100, 14400, 27600 and 35600 SU) or placebo, administered as 6 weekly subcutaneous injections over 31-41 days (EudraCT number 2017-000333-31). Standardized conjunctival provocation tests (CPT) using grass pollen allergen extract were performed at screening, baseline and post-treatment to determine the total symptom score (TSS) assessed approximately 4 weeks after dosing. Three models were pre-defined (Emax, logistic, and linear in log-dose model) to evaluate a dose response relationship. Results In total, 95.5% of the 447 randomized patients received all 6 injections. A highly statistically significant (p < 0.0001), monotonic dose response was observed for all three pre-specified models. All treatment groups showed a statistically significant decrease from baseline in TSS compared to placebo, with the largest decrease observed after 27600 SU (p < 0.0001). The full course of 6 injections was completed by 95.5% of patients. Treatment-emergent adverse events were similar across PQ Grass groups, and mostly mild and transient in nature. Conclusions PQ Grass demonstrated a strong curvilinear dose response in TSS following CPT without compromising its safety profile.
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Key Words
- ADRs, adverse drug reactions
- AE, adverse events
- AIT, allergen immunotherapy
- ANCOVA, analysis of covariance
- ARC, adverse reaction complexes
- Allergen immunotherapy
- Allergoid
- CIA-CPT, Culture – Independent Assessment of the Conjunctival Provocation Test
- CPT, conjunctival provocation test
- Cumulative dose
- Curvilinear dose response
- EAACI, European Academy of Allergy and Clinical Immunology
- EMA, European Medicine Agency
- FAS, Full Analysis Set
- FEV, forced expiratory volume
- FVC, forced vital capacity
- Grass pollen
- HEP, Histamine Equivalent Potency
- LPS, lipopolysaccharide
- MCP-Mod, Multiple Comparison Procedure and Modelling
- MCT, microcrystalline tyrosine
- MPL, Monophosphoryl Lipid A
- MedDRA, Medical Dictionary for Regulatory Activities
- PPS, Per Protocol Set
- SAEs, serious adverse events
- SAF, safety set
- SAR, seasonal allergic rhinoconjunctivitis
- SD, standard deviation
- SU, standardized units
- TEAEs, treatment-emergent adverse events
- TLR, Toll-like receptor
- TSS, Total Symptom Score
- mFAS, Modified Full Analysis Set
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Affiliation(s)
- S. Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - P. Kuna
- Poradnia Alergologii i Chorób Płuc Lodz, Poland
| | - W. Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S. Lassmann
- Specialist in Otolaryngology, Saalfeld, Germany
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Germany
| | - L. Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - A. Wade
- Allergy Therapeutics Ltd., Worthing, UK
| | - K. Kluehr
- Allergy Therapeutics Ltd., Worthing, UK
| | - J. Raab
- Allergy Therapeutics Ltd., Worthing, UK
| | - D. Wessiepe
- Metronomia Clinical Research GmbH, Munich, Germany
| | - D. Lee
- Allergy Therapeutics Ltd., Worthing, UK
| | | | | | | | | | | | - P.J. de Kam
- Allergy Therapeutics Ltd., Worthing, UK
- Corresponding author. Allergy Therapeutics (UK) Ltd, Dominion Way Worthing, West Sussex BN14 8SA, UK
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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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16
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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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17
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Ring J, Jakob T. Management von Allergien — was macht es so besonders? ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1808-y] [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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Pfaar O, Lou H, Zhang Y, Klimek L, Zhang L. Recent developments and highlights in allergen immunotherapy. Allergy 2018; 73:2274-2289. [PMID: 30372537 DOI: 10.1111/all.13652] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
Abstract
Allergen immunotherapy (AIT) is the only disease-modifying treatment option for patients with IgE-mediated inhalant allergies. Though used in clinical practice for more than 100 years, most innovations in AIT efficacy and safety have been developed in the last two decades. This expert review aimed to highlight the recent progress in AIT for both application routes, the sublingual (SLIT) and subcutaneous (SCIT) forms. As such, it covers recent aspects regarding efficacy and safety in clinical trials and real-life data and outlines new concepts in consensus and position papers as well as in guidelines for AIT. Potential clinical and nonclinical biomarkers are discussed. This review also focuses on potential future perspectives in AIT, such as alternative application routes, immune-modulating adjuvants, and recombinant vaccines. In conclusion, this state of the art review provides a comprehensive overview of AIT and highlights unmet needs for the future.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Section of Rhinology and Allergy; University Hospital Marburg; Philipps-Universität Marburg; Marburg Germany
| | - Hongfei Lou
- Department of Otolaryngology; Head and Neck Surgery; Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
- Department of Allergy; Beijing TongRen Hospital; Capital Medical University; Beijing China
| | - Yuan Zhang
- Department of Otolaryngology; Head and Neck Surgery; Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
- Department of Allergy; Beijing TongRen Hospital; Capital Medical University; Beijing China
| | - Ludger Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - Luo Zhang
- Department of Otolaryngology; Head and Neck Surgery; Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
- Department of Allergy; Beijing TongRen Hospital; Capital Medical University; Beijing China
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Esposito S, Isidori C, Pacitto A, Salvatori C, Sensi L, Frati F, Di Cara G, Marcucci F. Epicutaneous immunotherapy in rhino-conjunctivitis and food allergies: a review of the literature. J Transl Med 2018; 16:329. [PMID: 30482237 PMCID: PMC6260732 DOI: 10.1186/s12967-018-1701-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/20/2018] [Indexed: 12/22/2022] Open
Abstract
Background Epicutaneous immunotherapy (EPIT) is a new way of allergen administration that has a high rate of adherence and safety. The aim of this manuscript is to review clinical trials on EPIT for respiratory and food allergies published in the last 10 years, taking into account how different variables (i.e., dose, patch application duration, skin preparation, and efficacy and safety evaluation) have influenced study results. Main body From a review of the literature, we identified eight placebo-controlled, double-blind trials conducted on children and adults, including four studies on grass pollen rhino-conjunctivitis, one on cow’s milk allergy and three on peanut allergy. Different methods for skin pre-treatment, such as skin abrasion and tape stripping or stratum corneous hydration by an occlusive system, different endpoints and cumulative allergen doses, and different durations of patch application and tape stripping, were used in the rhino-conjunctivitis studies. A visual analogue system was used for the efficacy evaluation. Several local skin reactions (eczema) and some systemic adverse reactions were reported at higher rates in the active group compared to placebo in one study, but this was not shown by other authors. Local eczema reactions were correlated to the times for applying the tape stripping, while systemic side effects were correlated to the deepness of scraping. In the food allergy trials, differences in the food challenge thresholds, endpoints and allergen sites of the cutaneous patch application influenced the study results. A slight dose-dependent efficacy was found in the peanut allergy studies, which was confirmed by a more significant increase in the following progressive open study. Few adverse events and high adherence in all of the food allergen trials were reported. Conclusions Overall, the EPIT study results, even if they were affected by great heterogeneity among the methodologies applied, have shown not only the high safety and adherence with this kind of immunotherapy but also suggested the possibility for obtaining definitive evidence of the efficacy of EPIT, especially for food allergies.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy.
| | - Chiara Isidori
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Alessandra Pacitto
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Cristina Salvatori
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Laura Sensi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Franco Frati
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Giuseppe Di Cara
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Francesco Marcucci
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
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Anzaghe M, Schülke S, Scheurer S. Virus-Like Particles as Carrier Systems to Enhance Immunomodulation in Allergen Immunotherapy. Curr Allergy Asthma Rep 2018; 18:71. [PMID: 30362017 DOI: 10.1007/s11882-018-0827-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Utilization of virus-like particles (VLPs) is considered to improve allergen-specific immunotherapy (AIT). AIT aims at the efficient uptake of the target allergen by antigen-presenting cells (APCs) subsequently inducing adaptive allergen-specific immune responses to induce tolerance. The purpose of this review is to describe the immune-modulating properties of VLPs per se and to summarize the application of VLPs as antigen carriers, preferably for Th2 cytokines or allergens, with and without simultaneous administration of adjuvants in order to modulate allergic immune responses. RECENT FINDINGS Currently, a broad variety of approaches considering the origin of the VLPs, the choice of the adjuvant and antigen, and the coupling of the antigen are under preclinical investigation. The data provide evidence that VLPs used as carrier for antigens/allergens strongly increase antigen immunogenicity, and might be suitable to prevent allergies. However, systematic studies in mice showing the immunological mechanism and data from clinical studies are scarce.
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Affiliation(s)
- Martina Anzaghe
- Product Testing of Immunological Biomedicines, Paul-Ehrlich-Institut, Langen, Germany
| | - Stefan Schülke
- Section Molecular Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich Str. 51-59, D-63225, Langen, Germany
| | - Stephan Scheurer
- Section Molecular Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich Str. 51-59, D-63225, Langen, Germany.
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Klimek L, Senti G, Hoffmann HJ, Kündig T. What Do We Really Know About Intralymphatic Immunotherapy? CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0180-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Ahlbeck L, Ahlberg E, Nyström U, Björkander J, Jenmalm MC. Intralymphatic allergen immunotherapy against pollen allergy: A 3-year open follow-up study of 10 patients. Ann Allergy Asthma Immunol 2018; 121:626-627. [PMID: 30021119 DOI: 10.1016/j.anai.2018.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/18/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Lars Ahlbeck
- Allergy Center, University Hospital, Linköping, Sweden.
| | - Emelie Ahlberg
- Unit of Autoimmunity and Immune Regulation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ulla Nyström
- Allergy Center, University Hospital, Linköping, Sweden
| | | | - Maria C Jenmalm
- Unit of Autoimmunity and Immune Regulation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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23
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Gunawardana NC, Durham SR. New approaches to allergen immunotherapy. Ann Allergy Asthma Immunol 2018; 121:293-305. [PMID: 30025907 DOI: 10.1016/j.anai.2018.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE New insights into mechanisms should enable strategic improvement of allergen immunotherapy, aiming to make it safer, faster, more effective, and able to induce long-term tolerance. We review novel approaches with potential to translate into clinical use. DATA SOURCES Database searches were conducted in PubMed, Scopus, and Google Scholar. STUDY SELECTIONS Search terms were based on current and novel approaches in immunotherapy. Literature was selected primarily from recent randomized double-blinded placebo-controlled trials and meta-analyses. RESULTS Alum, microcrystalline tyrosine, and calcium phosphate are adjuvants in current use. Toll-like receptor-4 agonists combined with allergen have potential to shorten duration of treatment. Other novel adjuvants, nanoparticles, and virus-like particles in combination with allergen have shown early promise. Omalizumab lessens systemic side effects but does not improve efficacy. Intralymphatic immunotherapy for aeroallergens, epicutaneous immunotherapy for food allergens, and use of modified allergens (allergoids), recombinant allergens (and hypoallergenic variants), and T- and B-cell peptide approaches have shown evidence of efficacy and permitted shortened courses but have only rarely been compared with conventional extracts. CONCLUSION Novel routes of immunotherapy, use of modified allergens, and combination of allergens with immunostimulatory adjuvants or immune modifiers have been developed to augment downregulation of T-helper cell type 2 immunity and/or induce "protective" blocking antibodies. Although these strategies have permitted shortened courses, confirmatory phase 3 trials are required to confirm efficacy and safety and head-to-head trials are required for comparative efficacy. Currently, subcutaneous and sublingual immunotherapies using in-house standardized crude extracts remain the only approaches proved to induce long-term tolerance.
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Affiliation(s)
- Natasha C Gunawardana
- Imperial College London, London, United Kingdom; Royal Brompton and Harefield Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Stephen R Durham
- Imperial College London, London, United Kingdom; Royal Brompton and Harefield Hospitals, NHS Foundation Trust, London, United Kingdom.
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Han M, Chen Y, Wang M. Sublingual immunotherapy for treating adult patients with allergic rhinitis induced by house dust mite among Chinese Han population: A retrospective study. Medicine (Baltimore) 2018; 97:e11705. [PMID: 30045332 PMCID: PMC6078716 DOI: 10.1097/md.0000000000011705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The objective of this retrospective study was to evaluate the efficacy and safety of sublingual immunotherapy (SLIT) for treating adult patients with allergic rhinitis (AR) induced by house dust mite (HDM) among Chinese Han population.A total of 201 adult patients with AR induced by HDM were included. All of them received SLIT treatment. The outcomes consisted of AR symptoms, and quality of life. In addition, any adverse events were also recorded in this study.Compared with the AR symptoms and quality of life before the treatment, significant differences were found after 1-year treatment (P < .01), and 2-year treatment (P < .01). Additionally, only mild and acceptable adverse events were observed in this study.This study demonstrated that SLIT may be efficacious and safety for adult patients with HDM induced by AR among Chinese Han population.
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Advances and highlights in allergen immunotherapy: On the way to sustained clinical and immunologic tolerance. J Allergy Clin Immunol 2017; 140:1250-1267. [PMID: 28941667 DOI: 10.1016/j.jaci.2017.08.025] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022]
Abstract
Allergen immunotherapy (AIT) is an effective treatment strategy for allergic diseases and has been used for more than 100 years. In recent years, however, the expectations on concepts, conduct, statistical evaluation, and reporting have developed significantly. Products have undergone dose-response and confirmative studies in adults and children to provide evidence for the optimal dosage, safety, and efficacy of AIT vaccines using subcutaneous and sublingual delivery pathways in large patient cohorts, ensuring solid conclusions to be drawn from them for the advantage of patients and societies alike. Those standards should be followed today, and products answering to them should be preferred over others lacking optimization and proof of efficacy and safety. Molecular and cellular mechanisms of AIT include early mast cell and basophil desensitization effects, regulation of T- and B-cell responses, regulation of IgE and IgG4 production, and inhibition of responses from eosinophils, mast cells, and basophils in the affected tissues. There were many developments to improve vaccination strategies, demonstration of new molecules involved in molecular mechanisms, and demonstration of new biomarkers for AIT during the last few years. The combination of probiotics, vitamins, and biological agents with AIT is highlighting current advances. Development of allergoids and recombinant and hypoallergenic vaccines to skew the immune response from IgE to IgG4 and regulation of dendritic cell, mast cell, basophil, innate lymphoid cell, T-cell, and B-cell responses to allergens are also discussed in detail.
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