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de Kam PJ, Zielen S, Bernstein JA, Berger U, Berger M, Cuevas M, Cypcar D, Fuhr-Horst A, Greisner WA, Jandl M, Laßmann S, Worm M, Matz J, Sher E, Smith C, Steven GC, Mösges R, Shamji MH, DuBuske L, Borghese F, Oluwayi K, Zwingers T, Seybold M, Armfield O, Heath MD, Hewings SJ, Kramer MF, Skinner MA. Response to Correspondence to "Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy". Allergy 2024. [PMID: 38525846 DOI: 10.1111/all.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
| | - S Zielen
- Children and Adolescents Deptartment, Allergology, Pulmonology & Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - J A Bernstein
- Bernstein Clinical Research Center LLC, Cincinnati, Ohio, USA
| | - U Berger
- Department of Botany, University of Innsbruck, Innsbruck, Austria
| | - M Berger
- Department of Otorhinolaryngology, Wiener Gesundheitsverbund, Hospital Hietzing, Vienna, Austria
| | - M Cuevas
- Clinic and Polyclinic of Otorhinolaryngology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - D Cypcar
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | - A Fuhr-Horst
- ENT Research-Institut für klinische Studien, Essen, Germany
| | - W A Greisner
- Bluegrass Allergy Research, Lexington, Kentucky, USA
| | - M Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - S Laßmann
- Studienzentrum Dr. Sabine Laßmann, Saalfeld, Germany
| | - M Worm
- Department of Dermatology and Allergy-Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - J Matz
- Chesapeake Clinical Research, Inc., White Marsh, Maryland, USA
| | - E Sher
- Allergy Partners of New Jersey, Ocean, New Jersey, USA
| | - C Smith
- Certified Research Associates, Cortland, New York, USA
| | - G C Steven
- Allergy Asthma & Sinus Center S.C., Greenfield, Wisconsin, USA
| | - R Mösges
- IMSB (Institute of Computational Biology and Medical Statistics), University at Cologne, Cologne, Germany
- ClinCompetence, Cologne, Germany
| | - M H Shamji
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - L DuBuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - K Oluwayi
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M Seybold
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M D Heath
- Allergy Therapeutics PLC, Worthing, UK
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Sousa-Pinto B, Palamarchuk Y, Leemann L, Jankin S, Basagaña X, Ballester J, Bedbrook A, Czarlewski W, Almeida R, Haahtela T, Haveri H, Prass M, Henriques T, Vieira RJ, Klimek L, Ollert M, Shamji MH, Jutel M, Del Giacco S, Torres MJ, Zuberbier T, Fonseca JA, Sofiev M, Anto JM, Bousquet J. From MASK-air and SILAM to CATALYSE (Climate Action To Advance HeaLthY Societies in Europe). J Investig Allergol Clin Immunol 2024; 34:12-19. [PMID: 37498647 DOI: 10.18176/jiaci.0923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Plant species vary under different climatic conditions and the distribution of pollen in the air. Trends in pollen distribution can be used to assess the impact of climate change on public health. In 2015, the Mobile Airways Sentinel networK for rhinitis and asthma (MASK-air®) was launched as a project of the European Innovation Partnership on Active and Healthy Ageing (EIP-on-AHA, DG Santé and DG CONNECT). This project aimed to develop a warning system to inform patients about the onset of the pollen season, namely, the System for Integrated modeLling of Atmospheric coMposition (SILAM). A global-to-meso-scale dispersion model was developed by the Finnish Meteorological Institute (FMI). It provides quantitative information on atmospheric pollution of anthropogenic and natural origins, particularly on allergenic pollens. Impact of Air Pollution on Asthma and Rhinitis (POLLAR, EIT Health) has combined MASK-air clinical data with SILAM forecasts. A new Horizon Europe grant (Climate Action to Advance HeaLthY Societies in Europe [CATALYSE]; grant agreement number 101057131), which came into force in September 2022, aims to improve our understanding of climate change and help us find ways to counteractit. One objective of this project is to develop early warning systems and predictive models to improve the effectiveness of strategies for adapting to climate change. One of the warning systems is focused on allergic rhinitis (CATALYSE Task 3.2), with a collaboration between the FMI (Finland), Porto University (Portugal), MASK-air SAS (France), ISGlobal (Spain), Hertie School (Germany), and the University of Zurich (Switzerland). It is to be implemented with the support of the European Academy of Allergy and Clinical Immunology. This paper reports the planning of CATALYSE Task 3.2.
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Affiliation(s)
- B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Center for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Y Palamarchuk
- Finnish Meteorological Institute (FMI), Helsinki, Finland
| | - L Leemann
- Department of Political Science, University of Zürich, Zurich, Switzerland
| | - S Jankin
- Data Science Lab, Hertie School, Berlin, Germany
| | - X Basagaña
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - J Ballester
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | | | - W Czarlewski
- MASK-air SAS, Montpellier, France
- Medical Consulting Czarlewski, Levallois, France
| | - R Almeida
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Center for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
- Medical Consulting Czarlewski, Levallois, France
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - H Haveri
- Health and Hospital Care Services, Wellbeing services county of Päijät-Häme, Lahti, Finland
| | - M Prass
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland
- Coordination Unit, Lahti University Campus, Lahti, Finland
| | - T Henriques
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Center for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R J Vieira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Center for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - L Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - M Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
- Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - M H Shamji
- National Heart and Lung Institute, Imperial College, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | - S Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - M J Torres
- Allergy Unit, Regional University Hospital of Malaga, Malaga University, ARADyAL, Malaga, Spain
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Center for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Sofiev
- Finnish Meteorological Institute (FMI), Helsinki, Finland
| | - J M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - J Bousquet
- MASK-air SAS, Montpellier, France
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- University Hospital Montpellier, Montpellier, France
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Pascal M, Edelman SM, Nopp A, Möbs C, Geilenkeuser WJ, Knol EF, Ebo DG, Mertens C, Shamji MH, Santos AF, Patil S, Eberlein B, Mayorga C, Hoffmann HJ. EAACI task force report: A consensus protocol for the basophil activation test for collaboration and external quality assurance. Allergy 2024; 79:290-293. [PMID: 37795777 PMCID: PMC10843141 DOI: 10.1111/all.15907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Affiliation(s)
- M Pascal
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- RETICS Asma reacciones adversas y alérgicas (ARADYAL) and RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
| | - S M Edelman
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - A Nopp
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, and Sachs´ Children and Youth Hospital, Stockholm, Sweden
| | - C Möbs
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | | | - E F Knol
- Center of Translational Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D G Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology-Allergology- Rheumatology, University of Antwerp, Antwerp, Belgium
| | - C Mertens
- Faculty of Medicine and Health Sciences, Department of Immunology-Allergology- Rheumatology, University of Antwerp, Antwerp, Belgium
| | - M H Shamji
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - A F Santos
- Department of Women and Children's Health (Pediatric Allergy) & Peter Gorer Department of Immunobiology, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom
| | - S Patil
- Division of Allergy and Immunology, Departments of Medicine and Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - B Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - C Mayorga
- RETICS Asma reacciones adversas y alérgicas (ARADYAL) and RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga and Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA-BIONAND, Málaga, Spain
| | - H J Hoffmann
- Department of Clinical Medicine, Aarhus University, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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de Kam PJ, Zielen S, Bernstein JA, Berger U, Berger M, Cuevas M, Cypcar D, Fuhr-Horst A, Greisner WA, Jandl M, Laßmann S, Worm M, Matz J, Sher E, Smith C, Steven GC, Mösges R, Shamji MH, DuBuske L, Borghese F, Oluwayi K, Zwingers T, Seybold M, Armfield O, Heath MD, Hewings SJ, Kramer MF, Skinner MA. Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy. Allergy 2023; 78:2756-2766. [PMID: 37366581 DOI: 10.1111/all.15788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND A modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine and monophosphoryl lipid-A as an adjuvant system (Grass MATA MPL [PQ Grass]) is being developed as short-course treatment of grass-pollen allergic rhinitis (SAR) and/or rhinoconjunctivitis. We sought to evaluate the combined symptom and medication score (CSMS) of the optimized cumulative dose of 27,600 standardized units (SU) PQ Grass in a field setting prior to embarking on a pivotal Phase III trial. METHODS In this exploratory, randomized, double-blind, placebo-controlled trial subjects were enrolled across 14 sites (Germany and the United States of America). Six pre-seasonal subcutaneous injections of PQ Grass (using conventional or extended regimens) or placebo were administered to 119 subjects (aged 18-65 years) with moderate-to-severe SAR with or without asthma that was well-controlled. The primary efficacy endpoint was CSMS during peak grass pollen season (GPS). Secondary endpoints included Rhinoconjunctivitis Quality of Life Questionnaire standardized (RQLQ-S) and allergen-specific IgG4 response. RESULTS The mean CSMS compared to placebo was 33.1% (p = .0325) and 39.5% (p = .0112) for the conventional and extended regimens, respectively. An increase in IgG4 was shown for both regimens (p < .01) as well as an improvement in total RQLQ-S for the extended regimen (mean change -0.72, p = .02). Both regimens were well-tolerated. CONCLUSIONS This trial demonstrated a clinically relevant and statistically significant efficacy response to PQ Grass. Unprecedented effect sizes were reached for grass allergy of up to ≈40% compared to placebo for CSMS after only six PQ Grass injections. Both PQ Grass regimens were considered equally safe and well-tolerated. Based on enhanced efficacy profile extended regime will be progressed to the pivotal Phase III trial.
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Affiliation(s)
| | - S Zielen
- Children and Adolescents Department, Allergology, Pulmonology & Cystic Fibrosis, Goethe University, Frankfurt, Germany
| | - J A Bernstein
- Bernstein Clinical Research Center, LLC, Cincinnati, Ohio, USA
| | - U Berger
- Aerobiology and Pollen Research Unit, Department of Oto-Rhino-Laryngology, Medical University Vienna, Vienna, Austria
| | - M Berger
- Department of Otorhinolaryngology, Wiener Gesundheitsverbund, Hospital Hietzing, Vienna, Austria
| | - M Cuevas
- Clinic and Polyclinic of Otorhinolaryngology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - D Cypcar
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | - A Fuhr-Horst
- ENT Research- Institut für klinische Studien, Essen, Germany
| | - W A Greisner
- Bluegrass Allergy Research, Lexington, Kentucky, USA
| | - M Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - S Laßmann
- Studienzentrum Dr. Sabine Laßmann, Saalfeld, Germany
| | - M Worm
- Department of Dermatology and Allergy-Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - J Matz
- Chesapeake Clinical Research, Inc, White Marsh, Maryland, USA
| | - E Sher
- Allergy Partners of New Jersey, Ocean Township, New Jersey, USA
| | - C Smith
- Certified Research Associates, Cortland, New York, USA
| | - G C Steven
- Allergy Asthma & Sinus Center, S.C., Greenfield, Wisconsin, USA
| | - R Mösges
- IMSB (Institute of Computational Biology and Medical Statistics), University at Cologne, Cologne, Germany
- ClinCompetence, Cologne, Germany
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - L DuBuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University Hospital, Washington, DC, USA
| | | | - K Oluwayi
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M Seybold
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M D Heath
- Allergy Therapeutics PLC, Worthing, UK
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5
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Sousa-Pinto B, Louis R, Anto JM, Amaral R, Sá-Sousa A, Czarlewski W, Brussino L, Canonica GW, Chaves Loureiro C, Cruz AA, Gemicioglu B, Haahtela T, Kupczyk M, Kvedariene V, Larenas-Linnemann DE, Okamoto Y, Ollert M, Pfaar O, Pham-Thi N, Puggioni F, Regateiro FS, Romantowski J, Sastre J, Scichilone N, Taborda-Barata L, Ventura MT, Agache I, Bedbrook A, Becker S, Bergmann KC, Bosnic-Anticevich S, Bonini M, Boulet LP, Brusselle G, Buhl R, Cecchi L, Charpin D, de Blay F, Del Giacco S, Ivancevich JC, Jutel M, Klimek L, Kraxner H, Kuna P, Laune D, Makela M, Morais-Almeida M, Nadif R, Niedoszytko M, Papadopoulos NG, Papi A, Patella V, Pétré B, Rivero Yeverino D, Robalo Cordeiro C, Roche N, Rouadi PW, Samolinski B, Savouré M, Shamji MH, Sheikh A, Suppli Ulrik C, Usmani OS, Valiulis A, Yorgancioglu A, Zuberbier T, Fonseca JA, Costa EM, Bousquet J. Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: A MASK-air study. Pulmonology 2023:S2531-0437(23)00130-7. [PMID: 37543524 DOI: 10.1016/j.pulmoe.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting β2-agonists (ICS+LABA) in users of the MASK-air® app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA. MATERIALS AND METHODS We analysed complete weeks of MASK-air® data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day. RESULTS In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication ≥80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001). CONCLUSIONS In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control.
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Affiliation(s)
- B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - J M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - R Amaral
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Sá-Sousa
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - W Czarlewski
- Medical Consulting Czarlewski, Levallois, France; MASK-air, Montpellier, France
| | - L Brussino
- Department of Medical Sciences, University of Torino, Torino, Italy; Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
| | - G W Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Center, Rozzano, Milan, Italy
| | - C Chaves Loureiro
- Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal
| | - A A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - M Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V Kvedariene
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - D E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Y Okamoto
- Chiba Rosai Hospital, Chiba, Japan; Chiba University Hospital, Chiba, Japan
| | - M Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg; Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - O Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - N Pham-Thi
- Ecole Polytechnique de Palaiseau, Palaiseau, France; IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France; Université Paris Cité, Paris, France
| | - F Puggioni
- IRCCS Humanitas Research Center, Personalized Medicine Asthma & Allergy, Rozzano, Milan, Italy
| | - F S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Romantowski
- Medical University of Gdańsk, Department of Allergology, Gdansk, Poland
| | - J Sastre
- Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain
| | - N Scichilone
- PROMISE Department, University of Palermo, Palermo, Italy
| | - L Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal; UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - M T Ventura
- Allergy and Clinical Immunology, University of Bari Medical School, Bari, Italy; Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy
| | - I Agache
- Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - A Bedbrook
- MASK-air, Montpellier, France; ARIA, Montpellier, France
| | - S Becker
- Department of Otorhinolaryngology, University of Tübingen, Tübingen, Germany
| | - K C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - S Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Macquarie Medical School, Macquarie University, Macquarie Park, NSW, Australia
| | - M Bonini
- Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy; Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy; National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - L-P Boulet
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - R Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - D Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - F de Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France; Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - S Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; ALL-MED Medical Research Institute, Wroclaw, Poland
| | - L Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - H Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - D Laune
- KYomed INNOV, Montpellier, France
| | - M Makela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - R Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - M Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - A Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy; Agency of Health ASL, Salerno, Italy; Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - B Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - D Rivero Yeverino
- Servicio de Alergia e Inmunología clínica, Hospital Universitario de Puebla, Puebla, México
| | - C Robalo Cordeiro
- Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal
| | - N Roche
- Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France; UMR 1016, Institut Cochin, Paris, France
| | - P W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - B Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - M Savouré
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - M H Shamji
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - A Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - C Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - O S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK; Royal Brompton Hospital, Airways Disease Section, London, UK
| | - A Valiulis
- Interdisciplinary Research Group of Human Ecology, Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania; European Academy of Paediatrics (EAP/UEMS-SP), Brussel, Belgium
| | - A Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - E M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - J Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France; University Hospital Montpellier, Montpellier, France.
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6
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Bousquet J, Melén E, Haahtela T, Koppelman GH, Togias A, Valenta R, Akdis CA, Czarlewski W, Rothenberg M, Valiulis A, Wickmann M, Aguilar D, Akdis M, Ansotegui IJ, Barbara C, Bedbrook A, Bindslev Jensen C, Bosnic-Anticevich S, Boulet LP, Brightling CE, Brussino L, Burte E, Bustamante M, Canonica GW, Cecchi L, Celedon JC, Chaves-Loureiro C, Costa E, Cruz AA, Erhola M, Gemicioglu B, Fokkens WJ, Garcia Aymerich J, Guerra S, Heinrich J, Ivancevich JC, Keil T, Klimek L, Kuna P, Kupczyk M, Kvedariene V, Larenas-Linnemann DE, Lemonnier N, Lodrup Carlsen KC, Louis R, Makris M, Maurer M, Momas I, Morais-Almeida M, Mullol J, Naclerio RN, Nadeau K, Nadif R, Niedoszytko M, Okamoto Y, Ollert M, Papadopoulos NG, Passalacqua G, Patella V, Pawankar R, Pham-Thi N, Pfaar O, Regateiro FS, Ring J, Rouadi PW, Samolinski B, Sastre J, Savouré M, Scichilone N, Shamji MH, Sheikh A, Siroux V, Sousa-Pinto B, Standl M, Sunyer J, Taborda-Barata L, Toppila-Salmi S, Torres MJ, Tsiligianni I, Valovirta E, Vandenplas O, Ventura MT, Weiss S, Yorgancioglu A, Zhang L, Abdul Latiff AH, Aberer W, Agache I, Al-Ahmad M, Alobid I, Arshad HS, Asayag E, Baharudin A, Battur L, Bennoor KS, Berghea EC, Bergmann KC, Bernstein D, Bewick M, Blain H, Bonini M, Braido F, Buhl R, Bumbacea R, Bush A, Calderon M, Calvo G, Camargos P, Caraballo L, Cardona V, Carr W, Carreiro-Martins P, Casale T, Cepeda Sarabia AM, Chandrasekharan R, Charpin D, Chen YZ, Cherrez-Ojeda I, Chivato T, Chkhartishvili E, Christoff G, Chu DK, Cingi C, Correia da Sousa J, Corrigan C, Custovic A, D'Amato G, Del Giacco S, De Blay F, Devillier P, Didier A, do Ceu Teixeira M, Dokic D, Douagui H, Doulaptsi M, Durham S, Dykewicz M, Eiwegger T, El-Sayed ZA, Emuzyte R, Emuzyte R, Fiocchi A, Fyhrquist N, Gomez RM, Gotua M, Guzman MA, Hagemann J, Hamamah S, Halken S, Halpin DMG, Hofmann M, Hossny E, Hrubiško M, Irani C, Ispayeva Z, Jares E, Jartti T, Jassem E, Julge K, Just J, Jutel M, Kaidashev I, Kalayci O, Kalyoncu O, Kardas P, Kirenga B, Kraxner H, Kull I, Kulus M, La Gruta S, Lau S, Le Tuyet Thi L, Levin M, Lipworth B, Lourenço O, Mahboub B, Mäkelä MJ, Martinez-Infante E, Matricardi P, Miculinic N, Migueres N, Mihaltan F, Mohamad Y, Moniusko M, Montefort S, Neffen H, Nekam K, Nunes E, Nyembue Tshipukane D, O'Hehir RE, Ogulur I, Ohta K, Okubo K, Ouedraogo S, Olze H, Pali-Schöll I, Palomares O, Palosuo K, Panaitescu C, Panzner P, Park HS, Pitsios C, Plavec D, Popov TA, Puggioni F, Quirce S, Recto M, Repka-Ramirez R, Roballo-Cordeiro C, Roche N, Rodriguez-Gonzales M, Romantowski J, Rosario Filho N, Rottem M, Sagara H, Sarquis-Serpa F, Sayah Z, Scheire S, Schmid-Grendelmeier P, Sisul JC, Sole D, Soto-Martinez M, Sova M, Sperl A, Spranger O, Stelmach R, Suppli Ulrik C, Thomas M, To T, Todo-Bom A, Tomazic PV, Urrutia-Pereira M, Valentin-Rostan M, van Ganse E, Van Hage M, Vasankari T, Vichyanond P, Viegi G, Wallace D, Wang DY, Williams S, Worm M, Yiallouros P, Yiallouros P, Yusuf O, Zaitoun F, Zernotti M, Zidarn M, Zuberbier J, Fonseca JA, Zuberbier T, Anto JM. Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis. Allergy 2023; 78:1169-1203. [PMID: 36799120 DOI: 10.1111/all.15679] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
Asthma, rhinitis and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease", coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitisation and multimorbidity, (iii) advances in mHealth for novel phenotype definition, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis". This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitisation patterns (mono- or pauci-sensitisation versus polysensitisation), (iii) severity of symptoms and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and auto-immune diseases.
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Affiliation(s)
- J Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.,University Hospital Montpellier, Montpellier, France.,Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - E Melén
- Sach´s Children and Youth Hospital, Södersjukhuset, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - G H Koppelman
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, Groningen, the Netherlands
| | - A Togias
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, USA
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - W Czarlewski
- Medical Consulting Czarlewski, Levallois, France.,MASK-air, Montpellier, France
| | - M Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - A Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Vilnius, Lithuania.,Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - M Wickmann
- Institute of Environmental medicine, Karolinska Institutet, Stockholm, Sweden
| | - D Aguilar
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
| | - M Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - C Barbara
- Portuguese Nacional Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal
| | | | - C Bindslev Jensen
- Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Finland
| | - S Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - L P Boulet
- Quebec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - C E Brightling
- Institute of Lung Health, NIHR Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, UK
| | - L Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino, Torino, Italy.,Mauriziano Hospital, Torino, Italy
| | - E Burte
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - M Bustamante
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - G W Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - J C Celedon
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - C Chaves-Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - A A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - M Erhola
- Pirkanmaa Welfare district, Tampere, Finland
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - J Garcia Aymerich
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - S Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - J Heinrich
- Ludwig Maximilians University Munich, University Hospital Munich - Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.,State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - L Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - M Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - V Kvedariene
- Institute of Clinical medicine, Clinic of Chest diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - D E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - N Lemonnier
- Institute for Advanced Biosciences, UGA - INSERM U1209 - CNRS UMR5309, Site Santé, Allée des Alpes, La Tronche, France
| | | | - R Louis
- Department of Pulmonary Medicine, CHU, Liege, Liège, Belgium.,GIGA I3 research group, University of Liege, Belgium
| | - M Makris
- Allergy Unit "D Kalogeromitros", 2nd Dpt of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - M Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - I Momas
- Department of Public health and health products, Paris Descartes University-Sorbonne Paris Cité, EA 4064 and Paris Municipal Department of social action, childhood, and health, Paris, France
| | | | - J Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Spain
| | - R N Naclerio
- Department of Otolaryngology - Head and Neck Surgery - Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - K Nadeau
- Stanford University School of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford, USA
| | - R Nadif
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - M Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Y Okamoto
- Chiba University Hospital, Chiba, Japan.,Chiba Rosai Hospital, Chiba, Japan
| | - M Ollert
- Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Finland.,Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.,Agency of Health ASL, Salerno, Italy
| | - R Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - N Pham-Thi
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
| | - O Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - F S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Ring
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.,Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - P W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.,Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - B Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
| | - J Sastre
- Fundacion Jimenez Diaz, CIBERES, Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - M Savouré
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - N Scichilone
- PROMISE Department, University of Palermo, Palermo, Italy
| | - M H Shamji
- National Heart and Lung Institute, Imperial College, and NIHR Imperial Biomedical Research Centre, London, UK
| | - A Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - V Siroux
- INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France
| | - B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research; University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - M Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - J Sunyer
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.,UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - S Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M J Torres
- Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain
| | - I Tsiligianni
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland.,Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - E Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland.,Terveystalo Allergy Clinic, Turku, Finland
| | - O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, and Université Catholique de Louvain, Yvoir, Belgium
| | - M T Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - S Weiss
- Harvard Medical School and Channing Division of Network Medicine, Boston, USA
| | - A Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - L Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
| | - A H Abdul Latiff
- Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - I Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - M Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - I Alobid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | - H S Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - E Asayag
- Argentine Society of Allergy and Immunopathology, Buenos Ayres, Argentian
| | - A Baharudin
- Department of Otorhinolaryngology, Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - L Battur
- Mongolian Association of Hospital Managers, Ulaanbaatar, Mongolia
| | - K S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - E C Berghea
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - K C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - D Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - M Bewick
- University of Central Lancashire Medical School, Preston, UK
| | - H Blain
- Department of Geriatrics, Montpellier University hospital, MUSE, Montpellier, France
| | - M Bonini
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy and National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, UK
| | - F Braido
- University of Genoa, Department of Internal Medicine (DiMI), and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - R Buhl
- Dept of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - R Bumbacea
- Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
| | - A Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | - M Calderon
- Imperial College and National Heart and Lung Institute, London, UK
| | - G Calvo
- Pediatrics Department, Universidad Austral de Chile, Valvidia, Chile
| | - P Camargos
- Federal University of Minas Gerais, Medical School, Department of Pediatrics, Belo Horizonte, Brazil
| | - L Caraballo
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
| | - V Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL research network, Barcelona, Spain
| | - W Carr
- Allergy & Asthma Associates of Southern California, A Medical Group , Southern California Research, Mission Viejo, CA, USA
| | - P Carreiro-Martins
- NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal.,Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - T Casale
- Division of Allergy/immunology, University of South Florida, Tampa, FLA, USA
| | - A M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia and SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Branquilla, Columbia
| | - R Chandrasekharan
- Department of ENT, Badr al Samaa Hospital, Salalah, Sultanate of Oman
| | - D Charpin
- Clinique des bronches, allergie et sommeil, Hôpital Nord, Marseille, France
| | - Y Z Chen
- The capital institute of pediatrics, Beijing, China
| | - I Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - T Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - E Chkhartishvili
- David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia
| | - G Christoff
- Medical University - Sofia, Faculty of Public Health, Sofia, Bulgaria
| | - D K Chu
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C Cingi
- skisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - J Correia da Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - C Corrigan
- Division of Asthma, Allergy & Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - A Custovic
- National Heart and Lung Institute, Imperial College London, UK
| | - G D'Amato
- Division of Respiratory and Allergic Diseases,Hospital 'A Cardarelli', University of Naples Federico II, Naples, Italy
| | - S Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, and Federation of translational medicine, University of Strasbourg, Strasbourg, France
| | - P Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - A Didier
- Department of Respiratory Diseases, Larrey Hospital, Toulouse University Hospital, Toulouse, France
| | - M do Ceu Teixeira
- Hospital Dr Agostinho Neto,Praia, Faculdade de Medicina de Cabo Verde
| | - D Dokic
- University Clinic of Pulmology and Allergy, Medical Faculty Skopje, Republic of Macedonia
| | - H Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria
| | - M Doulaptsi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Crete, Heraklion, Crete
| | - S Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK
| | - M Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - T Eiwegger
- The Hospital for Sick Children, Department of Paediatrics, Division of Clinical Immunology and Allergy, Food allergy and Anaphylaxis Program, The University of Toronto, Toronto, Ontario, Canada
| | - Z A El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - R Emuzyte
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Emuzyte
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Fiocchi
- Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - N Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - R M Gomez
- School of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - M Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - M A Guzman
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - J Hagemann
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
| | - S Hamamah
- Biology of reproduction department, INSERM 1203, University hospital, Montpellier, France
| | - S Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - D M G Halpin
- University of Exeter, Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - M Hofmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - E Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - M Hrubiško
- Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia
| | - C Irani
- Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Z Ispayeva
- President of Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and clinical immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | - E Jares
- Servicio de Alergia, Consultorios Médicos Privados, Buenos Aires, Argentina
| | - T Jartti
- EDEGO Research Unit, University of Oulu, Oulu, Finland
| | - E Jassem
- Medical University of Gdańsk, Department of Pneumology, Gdansk, Poland
| | - K Julge
- Tartu University Institute of Clinical Medicine, Children's Clinic, Tartu, Estonia
| | - J Just
- Sorbonne université, Hôpital américain de Paris, Neuilly, France
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.,ALL-MED Medical Research Institute, Wroclaw, Poland
| | | | - O Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - O Kalyoncu
- Hacettepe University, School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Ankara, Turkey
| | - P Kardas
- Department of Family Medicine, Medical University of Lodz, Poland
| | - B Kirenga
- Makerere University Lung Institute, Kampala, Uganda
| | - H Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - I Kull
- Sach´s Children and Youth Hospital, Södersjukhuset, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - M Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Poland
| | - S La Gruta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - S Lau
- Department of Paediatric Respiratory Medicine, Immunology and Crital Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - L Le Tuyet Thi
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - M Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - B Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, UK
| | - O Lourenço
- Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - B Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - M J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - P Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - N Migueres
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, and Federation of translational medicine, University of Strasbourg, Strasbourg, France
| | - F Mihaltan
- National Institute of Pneumology M Nasta, Bucharest, Romania
| | - Y Mohamad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia and Syrian Private University-, Damascus, Syria
| | - M Moniusko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystock, Poland
| | - S Montefort
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, MSD, Malta
| | - H Neffen
- Director of Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - K Nekam
- Hungarian Allergy Association, Budapest, Hungary
| | - E Nunes
- Eduardo Mondlane University · Faculty of Medicine, Maputo, Mozambique
| | | | - R E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - I Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - K Ohta
- National Hospital Organization Tokyo National Hospital, and JATA Fukujuji Hospital, Tokyo, Japan
| | - K Okubo
- Dept of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - S Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - H Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - I Pali-Schöll
- Dept of Comparative Medicine; Messerli Research Institute of the University of Veterinary Medicine, Medical University, and University of Vienna, Vienna, Austria
| | - O Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - K Palosuo
- Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland
| | - C Panaitescu
- OncoGen Center, County Clinical Emergency Hospital "Pius Branzeu," and University of Medicine and Pharmacy V Babes, Timisoara, Romania
| | - P Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - H S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - C Pitsios
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - D Plavec
- Srebrnjak Children's Hospital, Zagreb; Medical Faculty, University JJ Strossmayer of Osijek, Croatia
| | - T A Popov
- Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria
| | - F Puggioni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - S Quirce
- QDepartment of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - M Recto
- Asian Hospital And Medical Center, Manilla, Philippines
| | - R Repka-Ramirez
- Division of Allergy, Asthma and Immunology, Clinics Hospital, San Lorenzo, Paraguay
| | | | - N Roche
- Pneumologie, AP-HP, Centre Université de Paris Cité, Hôpital Cochin, Paris, France.,UMR 1016, Institut Cochin, Paris, France
| | - M Rodriguez-Gonzales
- Pediatric Allergy and Clinical Immunology, Hospital Espanol de Mexico, Mexico City, Mexico
| | - J Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - N Rosario Filho
- Department of Pediatrics, Federal University of Parana, Curitiba, Brazil
| | - M Rottem
- Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - H Sagara
- Showa University School of Medicine, Tokyo, Japan
| | - F Sarquis-Serpa
- Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil
| | - Z Sayah
- SMAIC Société Marocaine d' Allergologie et Immunologie Clinique, Rabat, Morocco
| | - S Scheire
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
| | - J C Sisul
- Allergy & Asthma, Medical Director, CLINICA SISUL, FACAAI, SPAAI, Asuncion, Paraguay
| | - D Sole
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - M Soto-Martinez
- Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica
| | - M Sova
- Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic
| | - A Sperl
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - M Thomas
- University of Southampton, Southampton, UK
| | - T To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - A Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Portugal
| | - P V Tomazic
- Dept of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Austria
| | | | | | - E van Ganse
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon1, Lyon, France
| | - M Van Hage
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - T Vasankari
- Fihla, Finnish Lung Association, Helsinki, Finland.,University of Turku, Turku, Finland
| | - P Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa
| | - D Wallace
- Nova Southeastern University, Florida, USA
| | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S Williams
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | - M Worm
- Division of Allergy and Immunology Department of Dermatology, Allergy and Venerology Charité Universitätsmedizin Berlin Berlin, Germany
| | - P Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - P Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - F Zaitoun
- Lebanese-American University, Clemenceau Medical Center DHCC, Dubai, UAE
| | - M Zernotti
- Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Argentina
| | - M Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - J Zuberbier
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research; University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J M Anto
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Mösges R, Bachert C, Panzner P, Calderon MA, Haazen L, Pirotton S, Wathelet N, Durham SR, Bonny MA, Legon T, von Frenckell R, Pfaar O, Shamji MH. Short course of grass allergen peptides immunotherapy over 3 weeks reduces seasonal symptoms in allergic rhinoconjunctivitis with/without asthma: A randomized, multicenter, double-blind, placebo-controlled trial. Allergy 2018. [PMID: 29512827 PMCID: PMC6175232 DOI: 10.1111/all.13433] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Immunotherapy with peptide hydrolysates from Lolium perenne (LPP) is an alternative treatment for seasonal allergic rhinitis with or without asthma. The aim of this study was to assess the clinical efficacy and safety of a cumulative dose of 170 μg LPP administered subcutaneously over 3 weeks. Methods In a randomized, double‐blind, placebo‐controlled trial, 554 adults with grass pollen rhinoconjunctivitis were randomized (1:2 ratio) to receive 8 subcutaneous injections of placebo or 170 μg LPP administered in increasing doses in 4 visits over 3 weeks. The primary outcome was the combined symptom and medication score (CSMS) measured over the peak pollen season. Reactivity to conjunctival provocation test (CPT) and quality of life (QOL) was assessed as secondary endpoints. Results The mean reduction in CSMS in the LPP vs placebo group was −15.5% (P = .041) during the peak period and −17.9% (P = .029) over the entire pollen season. LPP‐treated group had a reduced reactivity to CPT (P < .001) and, during the pollen season, a lower rhinoconjunctivitis QOL global score (P = .005) compared with placebo group. Mostly mild and WAO grade 1 early systemic reaction (ESR) were observed ≤30 minutes in 10.5% of LPP‐treated patients, whereas 3 patients with a medical history of asthma (<1%) experienced a serious ESR that resolved with rescue medication. Conclusion Lolium perenne pollen peptides administered over 3 weeks before the grass pollen season significantly reduced seasonal symptoms and was generally safe and well‐tolerated.
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Affiliation(s)
- R. Mösges
- Institute of Medical Statistics, Informatics and Epidemiology; Cologne Germany
| | - C. Bachert
- Upper Airways Research Laboratory; Ghent University Hospital; Ghent Belgium
| | - P. Panzner
- Department of Immunology and Allergology; Faculty of Medicine and Faculty Hospital in Pilsen; Charles University in Prague; Pilsen Czech Republic
| | - M. A. Calderon
- Immune Tolerance Group; Allergy and Clinical Immunology, Inflammation; Repair and Development, NHLI; Imperial College; London MRC Asthma UK Centre, UK
| | | | | | | | - S. R. Durham
- Immune Tolerance Group; Allergy and Clinical Immunology, Inflammation; Repair and Development, NHLI; Imperial College; London MRC Asthma UK Centre, UK
| | | | | | | | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - M. H. Shamji
- Immune Tolerance Group; Allergy and Clinical Immunology, Inflammation; Repair and Development, NHLI; Imperial College; London MRC Asthma UK Centre, UK
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Campo P, Eguiluz-Gracia I, Bogas G, Salas M, Plaza Serón C, Pérez N, Mayorga C, Torres MJ, Shamji MH, Rondon C. Local allergic rhinitis: Implications for management. Clin Exp Allergy 2018; 49:6-16. [PMID: 29900607 DOI: 10.1111/cea.13192] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022]
Abstract
A significant proportion of rhinitis patients without systemic IgE-sensitisation tested by skin prick test and serum allergen-specific IgE (sIgE) display nasal reactivity upon nasal allergen provocation test (NAPT). This disease phenotype has been termed local allergic rhinitis (LAR). LAR is an underdiagnosed entity affecting children and adults from different parts of the world, with moderate-to-severe symptoms, impairment of quality of life and rapid progression to symptom worsening. LAR is a stable phenotype and not merely an initial state of AR. Allergic rhinitis and LAR share many clinical features including a positive NAPT response, markers of type 2 nasal inflammation including sIgE in nasal secretions and a significant rate of asthma development. LAR should be considered as a differential diagnosis in those subjects of any age with symptoms suggestive of AR but no evidence of systemic atopy. Although LAR pathophysiology is partially unknown, in some patients sIgE can be demonstrated directly in the nasal secretions and/or indirectly via positive responses in basophil activation test (BAT). LAR can coexist with other rhinitis phenotypes, especially AR. The diagnosis currently relies on the positivity of NAPT to a single or multiple allergens. NAPT has high sensitivity, specificity and reproducibility, and it is considered the gold standard. BAT and the measurement of nasal sIgE can also contribute to LAR diagnosis. LAR patients benefit from the same therapeutic strategies than AR individuals, including the avoidance of allergen exposure and the pharmacotherapy. Moreover, several recent studies support the effectiveness and safety of allergen immunotherapy for LAR, which opens a window of treatment opportunity in these patients.
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Affiliation(s)
- P Campo
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - I Eguiluz-Gracia
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - G Bogas
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - M Salas
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - C Plaza Serón
- Research Laboratory-Allergy Unit, Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - N Pérez
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - C Mayorga
- Research Laboratory-Allergy Unit, Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - M J Torres
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, MRC Asthma UK Centre Imperial College London, London, UK
| | - C Rondon
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
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9
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Mösges R, Koch AF, Raskopf E, Singh J, Shah‐Hosseini K, Astvatsatourov A, Hauswald B, Yarin Y, Corazza F, Haazen L, Pirotton S, Allekotte S, Zadoyan G, Legon T, Durham SR, Shamji MH. Lolium perenne peptide immunotherapy is well tolerated and elicits a protective B-cell response in seasonal allergic rhinitis patients. Allergy 2018; 73:1254-1262. [PMID: 29322510 PMCID: PMC6032848 DOI: 10.1111/all.13392] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Systemic allergic reactions are a risk for allergen immunotherapy that utilizes intact allergen preparations. We evaluated the safety, efficacy and immune mechanisms of short-course treatment with adjuvant-free Lolium perenne peptides (LPP) following a 6-week dose-escalation protocol. METHODS In a prospective, dose-escalation study, 61 grass pollen-allergic patients received 2 subcutaneous injections of LPP once weekly for 6 weeks. Safety was assessed evaluating local reactions, systemic reactions and adverse events. The clinical effect of LPP was determined by reactivity to the conjunctival provocation test (CPT). Specific IgE, IgG4 and blocking antibodies were measured at baseline (V1), during (V6) and after treatment (V8). RESULTS No fatality, serious adverse event or epinephrine use was reported. Mean wheal diameters after injections were <0.6 cm and mean redness diameters <2.5 cm, independent of dose. Transient and mostly mild adverse events were reported in 33 patients. Two patients experienced a grade I and 4 patients a grade II reaction (AWMF classification). At V8, 69.8% of patients became nonreactive to CPT. sIgG4 levels were higher at V6 (8.1-fold, P < .001) and V8 (12.2-fold, P < .001) than at V1. The sIgE:sIgG4 ratio decreased at V6 (-54.6%, P < .001) and V8 (-71.6%, P < .001) compared to V1. The absolute decrease in IgE-facilitated allergen binding was 18% (P < .001) at V6 and 25% (P < .001) at V8. CONCLUSION Increasing doses of subcutaneous LPP appeared safe, substantially diminished reactivity to CPT and induced blocking antibodies as early as 4 weeks after treatment initiation. The benefit/risk balance of LPP immunotherapy remains to be further evaluated in large studies.
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Affiliation(s)
- R. Mösges
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
- CRI—Clinical Research International LimitedHamburgGermany
| | - A. F. Koch
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - E. Raskopf
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - J. Singh
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - K. Shah‐Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - A. Astvatsatourov
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - B. Hauswald
- Department of Oto‐Rhino‐LaryngologyUniversity Clinic Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Y. Yarin
- Department of Oto‐Rhino‐LaryngologyUniversity Clinic Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - F. Corazza
- Laboratory of Brussels University HospitalsLaboratory of Translational ResearchBrugmann University Hospital, ULBBrusselsBelgium
| | | | | | - S. Allekotte
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - G. Zadoyan
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - T. Legon
- ASIT biotech s.a.BrusselsBelgium
| | - S. R. Durham
- Immunomodulation and Tolerance GroupAllergy and Clinical Immunology, Respiratory Science DivisionNational Heart and Lung InstituteImperial CollegeLondonUK
| | - M. H. Shamji
- Immunomodulation and Tolerance GroupAllergy and Clinical Immunology, Respiratory Science DivisionNational Heart and Lung InstituteImperial CollegeLondonUK
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Kortekaas Krohn I, Shikhagaie MM, Golebski K, Bernink JH, Breynaert C, Creyns B, Diamant Z, Fokkens WJ, Gevaert P, Hellings P, Hendriks RW, Klimek L, Mjösberg J, Morita H, Ogg GS, O'Mahony L, Schwarze J, Seys SF, Shamji MH, Bal SM. Emerging roles of innate lymphoid cells in inflammatory diseases: Clinical implications. Allergy 2018; 73:837-850. [PMID: 29069535 DOI: 10.1111/all.13340] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 12/23/2022]
Abstract
Innate lymphoid cells (ILC) represent a group of lymphocytes that lack specific antigen receptors and are relatively rare as compared to adaptive lymphocytes. ILCs play important roles in allergic and nonallergic inflammatory diseases due to their location at barrier surfaces within the airways, gut, and skin, and they respond to cytokines produced by activated cells in their local environment. Innate lymphoid cells contribute to the immune response by the release of cytokines and other mediators, forming a link between innate and adaptive immunity. In recent years, these cells have been extensively characterized and their role in animal models of disease has been investigated. Data to translate the relevance of ILCs in human pathology, and the potential role of ILCs in diagnosis, as biomarkers and/or as future treatment targets are also emerging. This review, produced by a task force of the Immunology Section of the European Academy of Allergy and Clinical Immunology (EAACI), encompassing clinicians and researchers, highlights the role of ILCs in human allergic and nonallergic diseases in the airways, gastrointestinal tract, and skin, with a focus on new insights into clinical implications, therapeutic options, and future research opportunities.
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Affiliation(s)
- I. Kortekaas Krohn
- Laboratory of Clinical Immunology; Department Microbiology & Immunology; KU Leuven; Leuven Belgium
| | - M. M. Shikhagaie
- Department of Experimental Immunology; Academic Medical Center; Amsterdam the Netherlands
| | - K. Golebski
- Department of Experimental Immunology; Academic Medical Center; Amsterdam the Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
| | - J. H. Bernink
- Department of Experimental Immunology; Academic Medical Center; Amsterdam the Netherlands
| | - C. Breynaert
- Laboratory of Clinical Immunology; Department Microbiology & Immunology; KU Leuven; Leuven Belgium
- Department of General Internal Medicine; Allergy and Clinical Immunology; University Hospitals of Leuven; Leuven Belgium
| | - B. Creyns
- Laboratory of Clinical Immunology; Department Microbiology & Immunology; KU Leuven; Leuven Belgium
| | - Z. Diamant
- Department of Respiratory Medicine and Allergology; Institute for Clinical Science; Skåne University Hospital; Lund Sweden
- Department of General Practice and Department of Clinical Pharmacy & Pharmacology; University Medical Centre Groningen; and QPS-Netherlands; University of Groningen; Groningen the Netherlands
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
| | - P. Gevaert
- Upper Airways Research Laboratory; Ghent University; Ghent Belgium
| | - P. Hellings
- Laboratory of Clinical Immunology; Department Microbiology & Immunology; KU Leuven; Leuven Belgium
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
- Clinical Division of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
| | - R. W. Hendriks
- Department of Pulmonary Medicine; Erasmus MC; Rotterdam the Netherlands
| | - L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - J. Mjösberg
- Center for Infectious Medicine; Department of Medicine Huddinge; Karolinska Institutet; Stockholm Sweden
| | - H. Morita
- Department of Allergy and Clinical Immunology; National Research Institute for Child Health and Development; Tokyo Japan
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
| | - G. S. Ogg
- MRC Human Immunology Unit and Oxford University Hospitals NHS Trust; Weatherall Institute of Molecular Medicine; Oxford UK
| | - L. O'Mahony
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
| | - J. Schwarze
- MRC Centre for Inflammation Research; The University of Edinburgh; Edinburgh UK
- Child Life & Health; The University of Edinburgh; Edinburgh UK
| | - S. F. Seys
- Laboratory of Clinical Immunology; Department Microbiology & Immunology; KU Leuven; Leuven Belgium
| | - M. H. Shamji
- Immunomodulation and Tolerance group, Allergy and Clinical Immunology; Inflammation, Repair and Development; Imperial College London; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
| | - S. M. Bal
- Department of Experimental Immunology; Academic Medical Center; Amsterdam the Netherlands
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Mösges R, Kasche EM, Raskopf E, Singh J, Sohlich L, Astvatsatourov A, Shah-Hosseini K, Pirotton S, Haazen L, Durham SR, Legon T, Zadoyan G, Shamji MH. A randomized, double-blind, placebo-controlled, dose-finding trial with Lolium perenne peptide immunotherapy. Allergy 2018; 73:896-904. [PMID: 29150857 PMCID: PMC5947135 DOI: 10.1111/all.13358] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/30/2022]
Abstract
Background A novel subcutaneous allergen immunotherapy formulation (gpASIT+™) containing Lolium perenne peptides (LPP) and having a short up‐dosing phase has been developed to treat grass pollen–induced seasonal allergic rhinoconjunctivitis. We investigated peptide immunotherapy containing the hydrolysate from perennial ryegrass allergens for the optimum dose in terms of clinical efficacy, immunogenicity and safety. Methods This prospective, double‐blind, placebo‐controlled, phase IIb, parallel, four‐arm, dose‐finding study randomized 198 grass pollen–allergic adults to receive placebo or cumulative doses of 70, 170 or 370 μg LPP. All patients received weekly subcutaneous injections, with the active treatment groups reaching assigned doses within 2, 3 and 4 weeks, respectively. Efficacy was assessed by comparing conjunctival provocation test (CPT) reactions at baseline, after 4 weeks and after completion. Grass pollen–specific immunoglobulins were analysed before and after treatment. Results Conjunctival provocation test (CPT) response thresholds improved from baseline to V7 by at least one concentration step in 51.2% (170 μg; P = .023), 46.3% (370 μg), and 38.6% (70 μg) of patients receiving LPP vs 25.6% of patients receiving placebo (modified per‐protocol set). Also, 39% of patients in the 170‐μg group became nonreactive to CPT vs 18% in the placebo group. Facilitated allergen‐binding assays revealed a highly significant (P < .001) dose‐dependent reduction in IgE allergen binding across all treatment groups (70 μg: 17.1%; 170 μg: 18.8%; 370 μg: 26.4%). Specific IgG4 levels increased to 1.6‐fold (70 μg), 3.1‐fold (170 μg) and 3.9‐fold (370 μg) (mPP). Conclusion Three‐week immunotherapy with 170 μg LPP reduced CPT reactivity significantly and increased protective specific antibodies.
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Affiliation(s)
- R. Mösges
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE); Faculty of Medicine; University of Cologne; Cologne Germany
- CRI - Clinical Research International Limited; Hamburg Germany
| | - E. M. Kasche
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE); Faculty of Medicine; University of Cologne; Cologne Germany
- University Hospital Schleswig-Holstein; Lübeck Germany
| | - E. Raskopf
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE); Faculty of Medicine; University of Cologne; Cologne Germany
| | - J. Singh
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE); Faculty of Medicine; University of Cologne; Cologne Germany
| | - L. Sohlich
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE); Faculty of Medicine; University of Cologne; Cologne Germany
| | - A. Astvatsatourov
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE); Faculty of Medicine; University of Cologne; Cologne Germany
| | - K. Shah-Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE); Faculty of Medicine; University of Cologne; Cologne Germany
| | | | | | - S. R. Durham
- Immunomodulation and Tolerance Group, Allergy & Clinical Immunology; Inflammation, Repair and Development National Heart & Lung Institute; Imperial College London; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London United Kingdom
| | - T. Legon
- ASIT Biotech s.a.; Brussels Belgium
| | - G. Zadoyan
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE); Faculty of Medicine; University of Cologne; Cologne Germany
| | - M. H. Shamji
- Immunomodulation and Tolerance Group, Allergy & Clinical Immunology; Inflammation, Repair and Development National Heart & Lung Institute; Imperial College London; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London United Kingdom
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12
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Pfaar O, Bonini S, Cardona V, Demoly P, Jakob T, Jutel M, Kleine-Tebbe J, Klimek L, Klysner S, Kopp MV, Kuna P, Larché M, Muraro A, Schmidt-Weber CB, Shamji MH, Simonsen K, Somoza C, Valovirta E, Zieglmayer P, Zuberbier T, Wahn U. Perspectives in allergen immunotherapy: 2017 and beyond. Allergy 2018; 73 Suppl 104:5-23. [PMID: 29171712 DOI: 10.1111/all.13355] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 01/01/2023]
Abstract
The Future of the Allergists and Specific Immunotherapy (FASIT) workshop provides a regular platform for global experts from academia, allergy clinics, regulatory authorities and industry to review developments in the field of allergen immunotherapy (AIT). The most recent meeting, held in February 2017, had two main themes: advances in AIT and hot topics in AIT from the regulatory point of view. The first theme covered opportunities for personalized AIT, advances in adjuvants and delivery systems, and the development of new molecules and future vaccines for AIT. Key topics in the second part of the meeting were the effects of the enactment of European Directive 2001/83 on the availability of allergens for therapy and diagnosis across the EU, the challenges of conducting Phase 3 studies in the field, the future role of allergen exposure chambers in AIT studies and specific considerations in performing AIT studies in the paediatric population. Finally, the group highlighted the forthcoming EAACI guidelines and their particular importance for the standardization of practice in the treatment of allergies. This review presents a comprehensive insight into those panel discussions and highlights unmet needs and also possible solutions to them for the future.
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Affiliation(s)
- O. Pfaar
- Department of Otorhinolaryngology; Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - S. Bonini
- Italian National Research Council; Institute of Translational Pharmacology; Rome, and University of Campania ‘Luigi Vanvitelli’; Naples Italy
- Expert-on Secondment at the European Medicines Agency; London UK
| | - V. Cardona
- Hospital Vall D'Hebron, S. Allergologia, S. Medicina Interna; Barcelona Spain
| | - P. Demoly
- Departement de Pneumologie et Addictologie; Hopital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
| | - T. Jakob
- Department of Dermatology and Allergology; University Medical Center Giessen (UKGM); Justus-Liebig-University Giessen; Giessen Germany
- Allergy Research Group; Department of Dermatology; Medical Center - University Freiburg; Freiburg Germany
| | - M. Jutel
- Department of Clinical Immunology; Wroclaw Medical University; Wroclaw Poland
- All-Med Medical Research Institute; Wroclaw Poland
| | - J. Kleine-Tebbe
- Allergy & Asthma Center Westend; Outpatient Clinic and Clinical Research Center; Berlin Germany
| | - L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - S. Klysner
- Expres ion Biotechnologies Aps; Hørsholm Denmark
| | - M. V. Kopp
- Department of Pediatric Allergy and Pulmonology; University of Luebeck; Luebeck Germany
- Airway Research Center North (ARCN); Member of the Deutsches Zentrum für Lungenforschung (DZL); Luebeck Germany
| | - P. Kuna
- Department of Internal Medicine, Asthma and Allergy; Barlicki University Hospital; Medical University of Lodz; Lodz Poland
| | - M. Larché
- Divisions of Clinical Immunology & Allergy, and Respirology; Department of Medicine and Firestone Institute for Respiratory Health; McMaster University; Hamilton ON Canada
| | - A. Muraro
- Food Allergy Referral Centre; Padua University Hospital; Padua Italy
| | - C. B. Schmidt-Weber
- Center of Allergy and Environment (ZAUM); Member of the German Center for Lung Research (DZL); Technical University of Munich and Helmholtz Center Munich; Munich Germany
| | - M. H. Shamji
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology; Inflammation Repair and Development; National Heart and Lung Institute; Imperial College; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
| | | | - C. Somoza
- Biological Products and Biotechnology Division; Medicines for Human Use Department; Agencia Española de Medicamentos y Productos Sanitarios (AEMPS); Madrid Spain
| | - E. Valovirta
- Department of Lung Disease and Clinical Allergology; University of Turku and Terveystalo Allergy Clinic; Turku Finland
| | - P. Zieglmayer
- Allergy Center Vienna West; Vienna Challenge Chamber; Vienna Austria
| | - T. Zuberbier
- Comprehensive Allergy-Centre-Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
- Member of Global Allergy and Asthma European Network (GA LEN); GA LEN coordinating Office; Charité - Universitätsmedizin Berlin; Germany
| | - U. Wahn
- Department for Pediatric Pneumology and Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
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13
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Shamji MH, Kappen JH, Akdis M, Jensen-Jarolim E, Knol EF, Kleine-Tebbe J, Bohle B, Chaker AM, Till SJ, Valenta R, Poulsen LK, Calderon MA, Demoly P, Pfaar O, Jacobsen L, Durham SR, Schmidt-Weber CB. Biomarkers for monitoring clinical efficacy of allergen immunotherapy for allergic rhinoconjunctivitis and allergic asthma: an EAACI Position Paper. Allergy 2017; 72:1156-1173. [PMID: 28152201 DOI: 10.1111/all.13138] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is an effective treatment for allergic rhinoconjunctivitis (AR) with or without asthma. It is important to note that due to the complex interaction between patient, allergy triggers, symptomatology and vaccines used for AIT, some patients do not respond optimally to the treatment. Furthermore, there are no validated or generally accepted candidate biomarkers that are predictive of the clinical response to AIT. Clinical management of patients receiving AIT and efficacy in randomised controlled trials for drug development could be enhanced by predictive biomarkers. METHOD The EAACI taskforce reviewed all candidate biomarkers used in clinical trials of AR patients with/without asthma in a literature review. Biomarkers were grouped into seven domains: (i) IgE (total IgE, specific IgE and sIgE/Total IgE ratio), (ii) IgG-subclasses (sIgG1, sIgG4 including SIgE/IgG4 ratio), (iii) Serum inhibitory activity for IgE (IgE-FAB and IgE-BF), (iv) Basophil activation, (v) Cytokines and Chemokines, (vi) Cellular markers (T regulatory cells, B regulatory cells and dendritic cells) and (vii) In vivo biomarkers (including provocation tests?). RESULTS All biomarkers were reviewed in the light of their potential advantages as well as their respective drawbacks. Unmet needs and specific recommendations on all seven domains were addressed. CONCLUSIONS It is recommended to explore the use of allergen-specific IgG4 as a biomarker for compliance. sIgE/tIgE and IgE-FAB are considered as potential surrogate candidate biomarkers. Cytokine/chemokines and cellular reponses provided insight into the mechanisms of AIT. More studies for confirmation and interpretation of the possible association with the clinical response to AIT are needed.
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Affiliation(s)
- M. H. Shamji
- Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College London; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
- Allergy and Clinical Immunology; Immunomodulation and Tolerance Group; Imperial College London; London UK
| | - J. H. Kappen
- Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College London; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
- Allergy and Clinical Immunology; Immunomodulation and Tolerance Group; Imperial College London; London UK
- Department of Pulmonology; STZ Centre of Excellence for Asthma & COPD; Sint Franciscus Vlietland Group; Rotterdam The Netherlands
| | - M. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zürich; Davos Switzerland
| | - E. Jensen-Jarolim
- Department of Pathophysiology and Allergy Research; Center of Pathophysiology, Infectiology and Immunology; Medical University Vienna; Vienna Austria
- The interuniversity Messerli Research Institute; University of Veterinary Medicine Vienna; Medical University Vienna; Vienna Austria
| | - E. F. Knol
- Departments Immunology and Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - J. Kleine-Tebbe
- Allergy & Asthma Center Westend; Outpatient Clinic and Research Center Hanf, Ackermann & Kleine-Tebbe; Berlin Germany
| | - B. Bohle
- Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
| | - A. M. Chaker
- Center of Allergy and Environment (ZAUM); Technische Universität and Helmholtz Center Munich; Munich Germany
- Department of Otolaryngology; Allergy Section; Klinikum rechts der Isar; Technische Universität; Munich Germany
| | - S. J. Till
- Division of Asthma, Allergy and Lung Biology; King's College London; London UK
- Department of Allergy; Guy's and St. Thomas’ NHS Foundation Trust; London UK
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte; Copenhagen Denmark
| | - M. A. Calderon
- Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College London; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
- Allergy and Clinical Immunology; Immunomodulation and Tolerance Group; Imperial College London; London UK
| | - P. Demoly
- Division of Allergy; Department of Pulmonology; Arnaud de Villeneuve Hospital; University Hospital of Montpellier and Sorbonne University; Paris France
| | - O. Pfaar
- Department of Otorhinolaryngology; Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - L. Jacobsen
- Allergy Learning and Consulting; Copenhagen Denmark
| | - S. R. Durham
- Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College London; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
- Allergy and Clinical Immunology; Immunomodulation and Tolerance Group; Imperial College London; London UK
| | - C. B. Schmidt-Weber
- Center of Allergy and Environment (ZAUM); Technische Universität and Helmholtz Center Munich; Munich Germany
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14
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Calderon MA, Demoly P, Casale T, Akdis CA, Bachert C, Bewick M, Bilò BM, Bohle B, Bonini S, Bush A, Caimmi DP, Canonica GW, Cardona V, Chiriac AM, Cox L, Custovic A, De Blay F, Devillier P, Didier A, Di Lorenzo G, Du Toit G, Durham SR, Eng P, Fiocchi A, Fox AT, van Wijk RG, Gomez RM, Haathela T, Halken S, Hellings PW, Jacobsen L, Just J, Tanno LK, Kleine-Tebbe J, Klimek L, Knol EF, Kuna P, Larenas-Linnemann DE, Linneberg A, Matricardi M, Malling HJ, Moesges R, Mullol J, Muraro A, Papadopoulos N, Passalacqua G, Pastorello E, Pfaar O, Price D, Del Rio PR, Ruëff R, Samolinski B, Scadding GK, Senti G, Shamji MH, Sheikh A, Sisul JC, Sole D, Sturm GJ, Tabar A, Van Ree R, Ventura MT, Vidal C, Varga EM, Worm M, Zuberbier T, Bousquet J. Allergy immunotherapy across the life cycle to promote active and healthy ageing: from research to policies: An AIRWAYS Integrated Care Pathways (ICPs) programme item (Action Plan B3 of the European Innovation Partnership on active and healthy ageing) and the Global Alliance against Chronic Respiratory Diseases (GARD), a World Health Organization GARD research demonstration project. Clin Transl Allergy 2016; 6:41. [PMID: 27895895 PMCID: PMC5120439 DOI: 10.1186/s13601-016-0131-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/02/2016] [Indexed: 12/17/2022] Open
Abstract
Allergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Santé). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.
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Affiliation(s)
- M A Calderon
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - P Demoly
- Unité d'allergologie, Département de Pneumologie et AddictologieHôpital Arnaud de Villeneuve, CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - T Casale
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - C A Akdis
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Swiss Institute of Allergy and Asthma Research (SIAF)University of Zurich, Davos, Switzerland
| | - C Bachert
- Upper Airways Research Laboratory (URL), ENT Department, University Hospital Ghent, Ghent, Belgium
| | - M Bewick
- iQ4U consultants Ltd, London, UK
| | - B M Bilò
- Allergy Unit, Department of Internal Medicine, University Hosp Ospedali Riuniti, Ancona, Italy
| | - B Bohle
- Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - S Bonini
- Second University of Naples and IFT-CNR, Rome, Italy
| | - A Bush
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - D P Caimmi
- Unité d'allergologie, Département de Pneumologie et AddictologieHôpital Arnaud de Villeneuve, CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - G W Canonica
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - V Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A M Chiriac
- Division of Allergy, Hôpital Arnaud de Villeneuve, Department of Pulmonology, University Hospital of Montpellier, Montpellier - UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France
| | - L Cox
- Nova Southeastern University, Ft. Lauderdale, FL USA
| | - A Custovic
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
| | - P Devillier
- University Versailles Saint-Quentin and Clinical Pharmacology Unit, UPRES EA 220, Department of Airway Diseases, Foch Hospital, Suresnes, France
| | - A Didier
- Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
| | - G Di Lorenzo
- Dipartimento BioMedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), University of Palermo, Palermo, Italy
| | - G Du Toit
- Guy's and St. Thomas' NHS Trust, Kings College, London, UK
| | - S R Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - P Eng
- Department of Pediatric Pulmonology and Allergy, Children's Hospital, Aarau, Switzerland
| | - A Fiocchi
- Division of Allergy, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Vatican City, Rome, Italy
| | - A T Fox
- King's College London Allergy Academy, London, UK
| | - R Gerth van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Building Rochussenstraat, Rotterdam, The Netherlands
| | - R M Gomez
- Unidad Alergia and Asma, Hospital San Bernardo, Salta, Argentina
| | - T Haathela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - S Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - P W Hellings
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - L Jacobsen
- Allergy Learning and Consulting, Secretary Immunotherapy Interest Group EAACI, Copenhagen, Denmark
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau, INSERM, UMR_S 1136, Sorbonne Universités, UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - L K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil ; University Hospital of Montpellier, Montpellier, France ; UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Universités, Paris, France
| | - J Kleine-Tebbe
- Allergy and Asthma Center Westend, Outpatient Clinic and Clinical Research Center, Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - L Klimek
- Center for Rhinology and Allergology, German Society for Otorhinolaryngology HNS, Wiesbaden, Germany
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - P Kuna
- Medical University of Lodz, Lodz, Poland
| | | | - A Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark ; Department of Clinical Experimental Research, Rigshospitalet, Copenhagen, Denmark ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Matricardi
- Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - H J Malling
- Danish Allergy Centre, Allergy Clinic, Gentofte University Hospital, Hellerup, Denmark
| | - R Moesges
- IMSIE, Klinikum der Universität zu Köln A. ö. R., Cologne, Germany
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, ENT Department, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, Barcelona, Catalonia Spain
| | - A Muraro
- Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy
| | - N Papadopoulos
- Allergy Unit, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, Univesity of Genoa, Genoa, Italy
| | - E Pastorello
- ASST Grande Ospedale Metropolitano Niguarda, P.zza Ospedale Maggiore, Milan, Italy
| | - O Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Mannheim, Germany ; Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany ; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - D Price
- Division of Applied Health Sciences, Primary Care Respiratory Medicine, Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, UK ; Research in Real Life (RiRL), Oakington, Cambridge, UK ; Optimum Patient Care Ltd, Singapore, Singapore
| | | | - R Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximillian University, Munich, Germany
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - G K Scadding
- Royal National Throat, Nose and Ear Hospital, London, UK ; University College London, London, UK
| | - G Senti
- Clinical Trials Center, University Hospital of Zurich, Zurich, Switzerland
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - A Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | | | - D Sole
- Programa de Pòs-Graduação em Pediatria e Ciências Aplicadas à Pediatria, Departamento de Pediatria EPM, UNIFESP, São Paulo, Brazil
| | - G J Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria ; Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
| | - A Tabar
- Servicio de Alergologia, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - R Van Ree
- Departments of Experimental Immunology and Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M T Ventura
- Unit of Geriatric Immunoallergology, Interdisciplinary Department of Medicine, University of Bari Medical School, Bari, Italy
| | - C Vidal
- Allergy Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E M Varga
- Respiratory and Allergic Disease Division, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - M Worm
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Zuberbier
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Bousquet
- University Hospital of Montpellier, Montpellier, France ; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Paris, France ; INSERM, VIMA, U1168, Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, Paris, France ; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles Cedex, France ; CHRU, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
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Varricchi G, Harker J, Borriello F, Marone G, Durham SR, Shamji MH. T follicular helper (Tfh ) cells in normal immune responses and in allergic disorders. Allergy 2016; 71:1086-94. [PMID: 26970097 DOI: 10.1111/all.12878] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 12/21/2022]
Abstract
Follicular helper T cells (Tfh ) are located within germinal centers of lymph nodes. Cognate interaction between Tfh , B cells, and IL-21 drives B cells to proliferate and differentiate into plasma cells thereby leading to antibody production. Tfh cells and IL-21 are involved in infectious and autoimmune diseases, immunodeficiencies, vaccination, and cancer. Human peripheral blood CXCR5(+) CD4(+) T cells comprise different subsets of Tfh -like cells. Despite the importance of the IgE response in the pathogenesis of allergic disorders, little is known about the role of follicular and blood Tfh cells and IL-21 in human and experimental allergic disease. Here, we review recent advances regarding the phenotypic and functional characteristics of both follicular and blood Tfh cells and of the IL-21/IL-21R system in the context of allergic disorders.
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Affiliation(s)
- G. Varricchi
- Immunomodulation and Tolerance Group; Imperial College London; London UK
- Allergy and Clinical Immunology; Imperial College London; London UK
| | - J. Harker
- Inflammation, Repair & Development Section; Faculty of Medicine; National Heart and Lung Institute; Imperial College London; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
| | - F. Borriello
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI); School of Medicine; University of Naples Federico II; Naples Italy
| | - G. Marone
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI); School of Medicine; University of Naples Federico II; Naples Italy
- CNR Institute of Experimental Endocrinology and Oncology ‘G. Salvatore’; Naples Italy
| | - S. R. Durham
- Immunomodulation and Tolerance Group; Imperial College London; London UK
- Allergy and Clinical Immunology; Imperial College London; London UK
| | - M. H. Shamji
- Immunomodulation and Tolerance Group; Imperial College London; London UK
- Allergy and Clinical Immunology; Imperial College London; London UK
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Gadermaier E, James LK, Shamji MH, Blatt K, Fauland K, Zieglmayer P, Garmatiuk T, Focke‐Tejkl M, Villalba M, Beavil R, Keller W, Valent P, Durham SR, Gould HJ, Flicker S, Valenta R. Epitope specificity determines cross-protection of a SIT-induced IgG4 antibody. Allergy 2016. [PMID: 26221749 PMCID: PMC4716291 DOI: 10.1111/all.12710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The calcium‐binding 2EF‐hand protein Phl p 7 from timothy grass pollen is a highly cross‐reactive pollen pan‐allergen that can induce severe clinical symptoms in allergic patients. Recently, a human monoclonal Phl p 7‐specific IgG4 antibody (mAb102.1F10) was isolated from a patient who had received grass pollen‐specific immunotherapy (SIT). Methods We studied epitope specificity, cross‐reactivity, affinity and cross‐protection of mAb102.1F10 towards homologous calcium‐binding pollen allergens. Sequence comparisons and molecular modelling studies were performed with ClustalW and SPADE, respectively. Surface plasmon resonance measurements were made with purified recombinant allergens. Binding and cross‐reactivity of patients' IgE and mAb102.1F10 to calcium‐binding allergens and peptides thereof were studied with quantitative RAST‐based methods, in ELISA, basophil activation and IgE‐facilitated allergen presentation experiments. Results Allergens from timothy grass (Phl p 7), alder (Aln g 4), birch (Bet v 4), turnip rape (Bra r 1), lamb's quarter (Che a 3) and olive (Ole e 3, Ole e 8) showed high sequence similarity and cross‐reacted with allergic patients' IgE. mAb102.1F10 bound the C‐terminal portion of Phl p 7 in a calcium‐dependent manner. It cross‐reacted with high affinity with Ole e 3, whereas binding and affinity to the other allergens were low. mAb102.1F10 showed limited cross‐inhibition of patients' IgE binding and basophil activation. Sequence comparison and surface exposure calculations identified three amino acids likely to be responsible for limited cross‐reactivity. Conclusions Our results demonstrate that a small number of amino acid differences among cross‐reactive allergens can reduce the affinity of binding by a SIT‐induced IgG and thus limit cross‐protection.
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Affiliation(s)
- E. Gadermaier
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
| | - L. K. James
- Randall Division of Cell and Molecular Biophysics King's College London London UK
| | - M. H. Shamji
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - K. Blatt
- Division of Hematology and Hemostaseology Department of Internal Medicine I Vienna General Hospital Medical University of Vienna Vienna Austria
| | - K. Fauland
- Institute of Molecular Biosciences University of Graz Graz Austria
| | - P. Zieglmayer
- Vienna Challenge Chamber Allergy Centre Vienna West Vienna Austria
| | - T. Garmatiuk
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
| | - M. Focke‐Tejkl
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
| | - M. Villalba
- Departamento de Bioquımica y Biologıa Molecular I Universidad Complutense de Madrid Madrid Spain
| | - R. Beavil
- Randall Division of Cell and Molecular Biophysics King's College London London UK
| | - W. Keller
- Institute of Molecular Biosciences University of Graz Graz Austria
| | - P. Valent
- Division of Hematology and Hemostaseology Department of Internal Medicine I Vienna General Hospital Medical University of Vienna Vienna Austria
| | - S. R. Durham
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - H. J. Gould
- Randall Division of Cell and Molecular Biophysics King's College London London UK
| | - S. Flicker
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
| | - R. Valenta
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
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17
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Scadding GW, Eifan A, Penagos M, Dumitru A, Switzer A, McMahon O, Phippard D, Togias A, Durham SR, Shamji MH. Local and systemic effects of cat allergen nasal provocation. Clin Exp Allergy 2015; 45:613-23. [PMID: 25303516 PMCID: PMC4778413 DOI: 10.1111/cea.12434] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/29/2014] [Accepted: 09/01/2014] [Indexed: 01/05/2023]
Abstract
Background Cat allergen is widely distributed in homes and schools; allergic sensitization is common. Objective To develop a model of cat allergen nasal challenge to establish dose–response and time–course characteristics and investigate local and systemic biomarkers of allergic inflammation. Methods Nineteen cat‐allergic individuals underwent titrated nasal challenge, range 0.243 to 14.6 μg/mL Fel d1, and matched diluent‐only provocation. Clinical response to 8 h was assessed by symptom scores and peak nasal inspiratory flow (PNIF). Nasal fluid was collected using polyurethane sponges and analysed by ImmunoCAP and multiplex assays. Whole blood flow cytometry for basophil surface CD63, CD107a, and CD203c was carried out at baseline and 6 h post‐challenge. Results A dose–response to allergen was seen in symptom scores and PNIF, maximal at 10 000 BU/mL (4.87 μg/mL Fel d1), P < 0.0001 vs. diluent. Nasal fluid tryptase was elevated at 5 min after challenge (P < 0.05 vs. diluent); eotaxin, IL‐4, ‐5, ‐9, and ‐13 were increased at 8 h (P < 0.05 to P < 0.0001 vs. diluent); TSLP was undetectable; IL‐10, IL‐17A, and IL‐33 were unchanged compared to diluent challenge. Nasal fluid IL‐5 and IL‐13 correlated inversely with PNIF after challenge (IL‐5, r = −0.79, P < 0.0001; IL‐13, r = −0.60, P = 0.006). Surface expression of CD63 and CD107a was greater at 6 h than at baseline, both in the presence (both P < 0.05) and absence (CD63, P < 0.01; CD107a, P < 0.05) of in vitro allergen stimulation; no changes were seen on diluent challenge day. Conclusions Cat allergen nasal challenge produces local and systemic Th2‐driven inflammatory responses and has potential as a surrogate outcome measure in clinical trials.
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Affiliation(s)
- G W Scadding
- Allergy and Clinical Immunology, Imperial College London, London, UK
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18
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Dodev TS, Bowen H, Shamji MH, Bax HJ, Beavil AJ, McDonnell JM, Durham SR, Sutton BJ, Gould HJ, James LK. Inhibition of allergen-dependent IgE activity by antibodies of the same specificity but different class. Allergy 2015; 70:720-4. [PMID: 25758595 PMCID: PMC4949685 DOI: 10.1111/all.12607] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 01/01/2023]
Abstract
IgG4 purified from patients undergoing specific allergen immunotherapy inhibits the activities of the serum IgE in in vitro assays and is thought to reduce the symptoms of the disease. However, it is not known whether this is related to an intrinsic property of this subclass or only the allergen specificity. We tested the hypothesis that allergen specificity is the critical determinant for this activity using a panel of antibodies with identical specificity but different subclasses. The different antibodies were all able to inhibit the activity of IgE to the same extent. We demonstrate that specificity is the dominant factor determining the ability of an antibody to block allergen-dependent IgE activity.
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Affiliation(s)
- T. S. Dodev
- Randall Division of Cell and Molecular Biophysics King's College LondonLondon UK
| | - H. Bowen
- Randall Division of Cell and Molecular Biophysics King's College LondonLondon UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
| | - M. H. Shamji
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - H. J. Bax
- Randall Division of Cell and Molecular Biophysics King's College LondonLondon UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
| | - A. J. Beavil
- Randall Division of Cell and Molecular Biophysics King's College LondonLondon UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
| | - J. M. McDonnell
- Randall Division of Cell and Molecular Biophysics King's College LondonLondon UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
| | - S. R. Durham
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - B. J. Sutton
- Randall Division of Cell and Molecular Biophysics King's College LondonLondon UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
| | - H. J. Gould
- Randall Division of Cell and Molecular Biophysics King's College LondonLondon UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
| | - L. K. James
- Randall Division of Cell and Molecular Biophysics King's College LondonLondon UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma King's College LondonLondon UK
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Scadding GW, Eifan AO, Lao‐Araya M, Penagos M, Poon SY, Steveling E, Yan R, Switzer A, Phippard D, Togias A, Shamji MH, Durham SR. Effect of grass pollen immunotherapy on clinical and local immune response to nasal allergen challenge. Allergy 2015; 70:689-96. [PMID: 25773990 PMCID: PMC4826905 DOI: 10.1111/all.12608] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 02/03/2023]
Abstract
Rationale Nasal allergen provocations may be useful in investigating the pathophysiology of allergic rhinitis and effects of treatments. Objective To use grass pollen nasal allergen challenge (NAC) to investigate the effects of allergen immunotherapy in a cross‐sectional study. Methods We studied nasal and cutaneous responses in untreated subjects with seasonal grass‐pollen allergic rhinitis (n = 14) compared with immunotherapy‐treated allergics (n = 14), plus a nonatopic control group (n = 14). Volunteers underwent a standardized NAC with 2000 biological units of timothy grass allergen (equivalent to 1.3 μg major allergen, Phl p5). Nasal fluid was collected and analysed by ImmunoCAP and multiplex assays. Clinical response was assessed by symptom scores and peak nasal inspiratory flow (PNIF). Cutaneous response was measured by intradermal allergen injection. Retrospective seasonal symptom questionnaires were also completed. Results Immunotherapy‐treated patients had lower symptom scores (P = 0.04) and higher PNIF (P = 0.02) after challenge than untreated allergics. They had reduced early (P = 0.0007) and late (P < 0.0001) skin responses, and lower retrospective seasonal symptom scores (P < 0.0001). Compared to untreated allergics, immunotherapy‐treated patients had reduced nasal fluid concentrations of IL‐4, IL‐9 and eotaxin (all P < 0.05, 8 h level and/or area under the curve comparison), and trends for reduced IL‐13 (P = 0.07, area under the curve) and early‐phase tryptase levels (P = 0.06). Conclusions Nasal allergen challenge is sensitive in the detection of clinical and biological effects of allergen immunotherapy and may be a useful surrogate marker of treatment efficacy in future studies.
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Affiliation(s)
- G. W. Scadding
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - A. O. Eifan
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - M. Lao‐Araya
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - M. Penagos
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - S. Y. Poon
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - E. Steveling
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - R. Yan
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - A. Switzer
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | | | - A. Togias
- The National Institute of Allergy and Infectious Diseases Bethesda MDUSA
| | - M. H. Shamji
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - S. R. Durham
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
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20
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Shamji MH, Bellido V, Scadding GW, Layhadi JA, Cheung DKM, Calderon MA, Asare A, Gao Z, Turka LA, Tchao N, Togias A, Phippard D, Durham SR. Effector cell signature in peripheral blood following nasal allergen challenge in grass pollen allergic individuals. Allergy 2015; 70:171-9. [PMID: 25377909 DOI: 10.1111/all.12543] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have demonstrated the time course of inflammatory mediators in nasal fluids following nasal allergen challenge (NAC), whereas the effects of NAC on cells in the periphery are unknown. We examined the time course of effector cell markers (for basophils, dendritic cells and T cells) in peripheral blood after nasal grass pollen allergen challenge. METHODS Twelve participants with seasonal allergic rhinitis underwent a control (diluent) challenge followed by NAC after an interval of 14 days. Nasal symptoms and peak nasal inspiratory flow (PNIF) were recorded along with peripheral basophil, T-cell and dendritic cell responses (flow cytometry), T-cell proliferative responses (thymidine incorporation), and cytokine expression (FluoroSpot assay). RESULTS Robust increases in nasal symptoms and decreases in PNIF were observed during the early (0-1 h) response and modest significant changes during the late (1-24 h) response. Sequential peaks in peripheral blood basophil activation markers were observed (CD107a at 3 h, CD63 at 6 h, and CD203c(bright) at 24 h). T effector/memory cells (CD4(+) CD25(lo) ) were increased at 6 h and accompanied by increases in CD80(+) and CD86(+) plasmacytoid dendritic cells (pDCs). Ex vivo grass antigen-driven T-cell proliferative responses and the frequency of IL-4(+) CD4(+) T cells were significantly increased at 6 h after NAC when compared to the control day. CONCLUSION Basophil, T-cell, and dendritic cell activation increased the frequency of allergen-driven IL-4(+) CD4(+) T cells, and T-cell proliferative responses are detectable in the periphery after NAC. These data confirm systemic cellular activation following a local nasal provocation.
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Affiliation(s)
- M. H. Shamji
- Immunomodulation and Tolerance Group; National Heart and Lung Institute; Imperial College London; London UK
| | - V. Bellido
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - G. W. Scadding
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - J. A. Layhadi
- Immunomodulation and Tolerance Group; National Heart and Lung Institute; Imperial College London; London UK
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - D. K. M. Cheung
- Immunomodulation and Tolerance Group; National Heart and Lung Institute; Imperial College London; London UK
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - M. A. Calderon
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - A. Asare
- Immune Tolerance Network; Bethesda MD USA
| | - Z. Gao
- Immune Tolerance Network; Bethesda MD USA
| | - L. A. Turka
- Immune Tolerance Network; Bethesda MD USA
- Massachusetts General Hospital; Boston MA USA
| | - N. Tchao
- Immune Tolerance Network; Bethesda MD USA
| | - A. Togias
- National Institute of Allergy and Infectious Diseases; Bethesda MD USA
| | | | - S. R. Durham
- Immunomodulation and Tolerance Group; National Heart and Lung Institute; Imperial College London; London UK
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
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Jones M, Jeal H, Schofield S, Harris JM, Shamji MH, Francis JN, Durham SR, Cullinan P. Rat-specific IgG and IgG₄ antibodies associated with inhibition of IgE-allergen complex binding in laboratory animal workers. Occup Environ Med 2014; 71:619-23. [PMID: 24944289 DOI: 10.1136/oemed-2014-102119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The relationship between exposure to rodent allergens and laboratory animal allergy is complex; at highest allergen exposures there is an attenuation of sensitisation and symptoms which are associated with increased levels of rat-specific immunoglobulin (Ig)G and IgG4 antibodies. We set out to examine whether the increased levels of rat-specific IgG and IgG4 antibodies that we have previously observed at high allergen exposure in our cohort of laboratory animal workers play a functional role through blockage of the binding of IgE-allergen complex binding to CD23 receptors on B cells. METHODS Cross-sectional survey of laboratory animal workers (n=776) in six UK pharmaceutical companies were surveyed. IgE-allergen complex binding to B cells was measured in 703 (97.9%) eligible employees; their exposure was categorised by either job group or number of rats handled daily. RESULTS We observed a significant decrease in IgE-allergen complex binding to B cells with increasing quartiles of both rat-specific IgG and IgG4 antibodies (p<0.001). IgE-allergen complex binding to B cells was lower in workers with high allergen exposure, and significantly so (p=0.033) in the subgroup with highest exposures but no work-related chest symptoms. CONCLUSIONS These findings demonstrate a functional role for rat-specific IgG/G4 antibodies in laboratory animal workers, similar to that observed in patients treated with high dose immunotherapy who become clinically tolerant, suggesting a potential explanation for the attenuation of risk at highest allergen exposures.
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Affiliation(s)
- M Jones
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - H Jeal
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - S Schofield
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - J M Harris
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - M H Shamji
- Department of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, part of the Medical Research Council and Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - J N Francis
- Department of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, part of the Medical Research Council and Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - S R Durham
- Department of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, part of the Medical Research Council and Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
| | - P Cullinan
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
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Shamji MH, Ljørring C, Francis JN, Calderon MA, Larché M, Kimber I, Frew AJ, Ipsen H, Lund K, Würtzen PA, Durham SR. Functional rather than immunoreactive levels of IgG4 correlate closely with clinical response to grass pollen immunotherapy. Allergy 2012; 67:217-26. [PMID: 22077562 DOI: 10.1111/j.1398-9995.2011.02745.x] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Induction of allergen-specific IgG(4) antibodies is the most consistent immunological finding in immunotherapy trials. However, quantitative assessments of IgG(4) antibodies have not proven beneficial in evaluating clinical changes during or after immunotherapy. In the current study, we investigated the relationship between clinical outcome and allergen-specific IgG(4) titres or functional antibody responses following immunotherapy. We hypothesized that functional assays of serum IgG-associated inhibitory activity such as inhibition of IgE-allergen interactions (IgE-blocking factor) and inhibition of CD23-dependent IgE-facilitated allergen binding (IgE-FAB) correlate more closely with clinical outcome and may be biomarkers of clinical response. METHODS In an 8-month dose-response randomized double-blind placebo-controlled study, 221 polysensitized subjects with severe seasonal rhinitis received Alutard SQ, Phleum pratense 100,000 SQ-U, 10,000 SQ-U or placebo injections. Serum specimens were collected before treatment, after up-dosing, during the peak season and at the end of the study. Allergen-specific IgG(4) titres and IgG-associated inhibitory activity were evaluated. RESULTS A time- and dose-dependent increase in serum inhibitory activity for both the IgE-blocking factor and IgE-FAB was observed, which paralleled increases in grass pollen-specific IgG(4) antibodies. A modest but significant inverse relationship was demonstrated between postimmunotherapy serum inhibitory activity and combined symptom-rescue medication scores (IgE-FAB: r = -0.25, P = 0.0002; IgE-blocking factor: r = -0.28, P < 0.0001), whereas this was not observed for immunoreactive IgG(4) levels (r = -0.11, P = 0.12). CONCLUSIONS Functional assays of inhibitory IgG(4) and IgE-blocking factor may be more useful surrogates of clinical response than IgG(4). Whether these antibody effects may serve as predictive biomarkers of clinical efficacy in individual patients requires further investigation.
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Affiliation(s)
- M H Shamji
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, UK
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Abstract
Allergen immunotherapy is allergen-specific, allergen dose- and time-dependent and is associated with long-term clinical and immunological tolerance that persists for years after discontinuation. Successful immunotherapy is accompanied by the suppression of numbers of T-helper 2 (Th2) effector cells, eosinophils, basophils, c-kit+mast cells and neutrophils infiltration in target organs, induction of IL-10 and/or TGF-β+Treg cells and increases in 'protective' non-inflammatory blocking antibodies, particularly IgG4 and IgA2 subclasses with inhibitory activity. These events are accompanied by a reduction and/or a redirection of underlying antigen-specific Th2-type T cell-driven hypersensitivity to the allergen(s) used for therapy. This suppression occurs within weeks or months as a consequence of the appearance of a population of regulatory T cells that exert their effects by mechanisms involving cell-cell contact, but also by the release of cytokines such as IL-10 (increases IgG4) and TGF-β (increases specific IgA). The more delayed-in-time appearance of antigen-specific T-helper 1 responses and alternative mechanisms such as Th2 cell anergy and/or apoptosis may also be involved. The mechanisms of sublingual immunotherapy are similar to those following a subcutaneous administration of allergen, whereas it is likely that additional events following antigen presentation in the sublingual mucosa and regional lymph nodes are involved. These insights have resulted in novel approaches and portend future biomarkers that may be surrogate or predictive of the clinical response to treatment.
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Affiliation(s)
- M H Shamji
- Allergy and Clinical Immunology Section, Medical Research Council and Asthma UK Centre for Allergic Mechanisms of Asthma, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
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Pree I, Shamji MH, Kimber I, Valenta R, Durham SR, Niederberger V. Inhibition of CD23-dependent facilitated allergen binding to B cells following vaccination with genetically modified hypoallergenic Bet v 1 molecules. Clin Exp Allergy 2010; 40:1346-52. [DOI: 10.1111/j.1365-2222.2010.03548.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scadding GW, Shamji MH, Jacobson MR, Lee DI, Wilson D, Lima MT, Pitkin L, Pilette C, Nouri-Aria K, Durham SR. Sublingual grass pollen immunotherapy is associated with increases in sublingual Foxp3-expressing cells and elevated allergen-specific immunoglobulin G4, immunoglobulin A and serum inhibitory activity for immunoglobulin E-facilitated allergen binding to B cells. Clin Exp Allergy 2010; 40:598-606. [PMID: 20184605 DOI: 10.1111/j.1365-2222.2010.03462.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The mechanisms of sublingual immunotherapy (SLIT) are less well understood than those of subcutaneous immunotherapy (SCIT). OBJECTIVES To determine the effects of grass-pollen SLIT on oral mucosal immune cells, local regulatory cytokines, serum allergen-specific antibody subclasses and B cell IgE-facilitated allergen binding (IgE-FAB). METHODS Biopsies from the sublingual mucosa of up to 14 SLIT-treated atopics, nine placebo-treated atopics and eight normal controls were examined for myeloid dendritic cells (mDCs) (CD1c), plasmacytoid dendritic cells (CD303), mast cells (AA1), T cells (CD3) and Foxp3 using immunofluorescence microscopy. IL-10 and TGF-beta mRNA expression were identified by in situ hybridization. Allergen-specific IgG and IgA subclasses and serum inhibitory activity for binding of allergen-IgE complexes to B cells (IgE-FAB) were measured before, during and on the completion of SLIT. RESULTS Foxp3(+) cells were increased in the oral epithelium of SLIT- vs. placebo-treated atopics (P=0.04). Greater numbers of subepithelial mDCs were present in placebo-treated, but not in SLIT-treated, atopics compared with normal controls (P=0.05). There were fewer subepithelial mast cells and greater epithelial T cells in SLIT- compared with placebo-treated atopics (P=0.1 for both). IgG(1) and IgG(4) were increased following SLIT (P<0.001). Peak seasonal IgA(1) and IgA(2) were increased during SLIT (P<0.05). There was a time-dependent increase in serum inhibitory activity for IgE-FAB in SLIT-treated atopics. CONCLUSIONS SLIT with grass pollen extract is associated with increased Foxp3(+) cells in the sublingual epithelium and systemic humoral changes as observed previously for SCIT.
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Affiliation(s)
- G W Scadding
- National Heart and Lung Institute, Imperial College London, UK
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Steel A, John L, Shamji MH, Henderson DC, Gotch FM, Gazzard BG, Kelleher P. CD38 expression on CD8 T cells has a weak association with CD4 T-cell recovery and is a poor marker of viral replication in HIV-1-infected patients on antiretroviral therapy. HIV Med 2008; 9:118-25. [PMID: 18257774 DOI: 10.1111/j.1468-1293.2007.00528.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether the expression of CD38 on CD8 T cells can identify patients with virological failure on antiretroviral therapy (ART). DESIGN This was a cross-sectional study of patients attending a single HIV clinic in London. METHODS The expression of CD38 on CD8 T cells was assessed using a biologically calibrated flow cytometry protocol. Patients were characterized by lymphocyte subset and viral load measurements. Characteristics including historical CD4 T cell counts, therapeutic history, co-infections and demographics were obtained from medical records. RESULTS Elevated levels of CD8 CD38(high) T cells were found in HIV-1-infected patients who failed to suppress viral replication with ART; however, this parameter lacked sufficient sensitivity and specificity to replace viral load testing in assessing the efficacy of ART. Increased levels of CD8 CD38(high) cells were associated with reduced CD4 T cell counts in HIV-1-infected patients on ART after correcting for known determinants of CD4 T-cell recovery. CONCLUSIONS The expression of CD38 on CD8 T cells lacks sufficient sensitivity and specificity to be used as a surrogate marker for viral load to monitor HIV-1 infection. T-cell activation is associated with reduced CD4 T-cell reconstitution in patients receiving ART.
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Affiliation(s)
- A Steel
- Department of Immunology, Imperial College, Chelsea & Westminster Hospital, London, UK
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