1
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Mack DP, Dribin TE, Turner PJ, Wasserman RL, Hanna MA, Shaker M, Tang MLK, Rodríguez Del Río P, Sobolewski B, Abrams EM, Anagnostou A, Arasi S, Bajowala S, Bégin P, Cameron SB, Chan ES, Chinthrajah S, Clark AT, Detjen P, du Toit G, Ebisawa M, Elizur A, Factor JM, Greiwe J, O'B Hourihane J, Hughes SW, Jones DH, Muraro A, Nowak-Wegrzyn A, Patel NB, Scurlock AM, Shah AN, Sindher SB, Tilles S, Vickery BP, Wang J, Windom HH, Greenhawt M. Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent. J Allergy Clin Immunol 2024:S0091-6749(24)00238-0. [PMID: 38597862 DOI: 10.1016/j.jaci.2024.02.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process. OBJECTIVE We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form. METHODS We convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed. RESULTS The expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form. CONCLUSION We developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center; and Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute; the Department of Paediatrics, University of Melbourne, Australia; and the Department of Allergy and Immunology, the Royal Children's Hospital Melbourne, Melbourne, Australia
| | | | - Brad Sobolewski
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | | | - Stefania Arasi
- Pediatric Allergology Unit of the Allergy Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Philippe Bégin
- Department of Pediatrics, Section of Allergy, CHU Sainte-Justine; and the Department of Medicine, Section of Allergy, CHUM, Montreal, Canada
| | - Scott B Cameron
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Edmond S Chan
- Department of Pediatrics, Division of Allergy, University of British Columbia, BC Children's Hospital, Vancouver, Canada
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif
| | - Andrew T Clark
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | | | - George du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London; and the Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Yokosuka, Japan
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center; and the Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Factor
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Conn
| | - Justin Greiwe
- Bernstein Allergy Group; the Department of Internal Medicine, Division of Immunology/Allergy Section, the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland; and Children's Health Ireland, Dublin, Ireland
| | | | | | - Antonella Muraro
- Food Allergy Referral Centre Padua, University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York; and the Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Nandinee B Patel
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital and Research Institute, Little Rock, Ark
| | - Atul N Shah
- Center for Asthma & Allergy, New York Food Allergy & Wellness, New York, NY
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Tilles
- Aimmune Therapeutics, Brisbane; and the University of Washington, Seattle, Wash
| | - Brian P Vickery
- Emory University School of Medicine; and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Julie Wang
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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2
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Trevisonno J, Venter C, Pickett-Nairne K, Bégin P, Cameron SB, Chan ES, Cook VE, Factor JM, Groetch M, Hanna MA, Jones DH, Wasserman RL, Mack DP. Age-Related Food Aversion and Anxiety Represent Primary Patient Barriers to Food Oral Immunotherapy. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00276-9. [PMID: 38492666 DOI: 10.1016/j.jaip.2024.03.014] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Although oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure's implementation have not been extensively evaluated from a patient perspective. OBJECTIVE We evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and the role of health care professionals, especially dietitians. METHODS A survey in Canada and the United States involved families currently enrolled in food OIT programs. RESULTS Of responses from 379 participants, fear of reaction was the most common barrier to OIT initiation, with 45.6% reporting it being a "very significant" barrier with other fears reported. However, taste aversion represented the prominent obstacle to continuation. Taste aversion was associated with a slower buildup (P = .02) and a reduction in dose (P = .002). Taste aversion was a strongly age-dependent barrier for initiation (P < .001) and continuation (P < .002), with older children over 6 years of age reporting it as a very significant barrier (P < .001). Boredom was reported as a concern for specific allergens such as peanut, egg, sesame, and hazelnuts (P < .05), emphasizing the need for diverse food options. Notably, 59.9% of respondents mixed OIT foods with sweet items. Despite these dietary concerns, dietitians were underutilized, with only 9.5% of respondents having seen a dietitian and the majority finding dietitian support helpful with greater certainty about the exact dose (P < .001). CONCLUSIONS Taste aversion and anxiety represent primary patient-related barriers to OIT. Taste aversion was highly age dependent, with older patients being more affected. Dietitians and psychology support were underutilized, representing a critical target to improve adherence and OIT success.
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Affiliation(s)
| | - Carina Venter
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo
| | - Kaci Pickett-Nairne
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Philippe Bégin
- Section of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada; Section of Allergy, Department of Medicine, CHUM, Montréal, QC, Canada
| | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Victoria E Cook
- Division of Allergy, Department of Pediatrics, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada
| | | | - Marion Groetch
- Division of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mariam A Hanna
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | | | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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3
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Wasserman RL, Windom HH, Jones DH. Oral immunotherapy in US allergy practice. J Allergy Clin Immunol Pract 2023; 11:3814-3815. [PMID: 38065643 DOI: 10.1016/j.jaip.2023.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/20/2023] [Indexed: 12/18/2023]
Affiliation(s)
| | - Hugh H Windom
- Food Allergy Center of Florida, Windom Allergy, Sarasota, Fla
| | - Douglas H Jones
- Department of Allergy, Asthma and Immunology, Tanner Clinic, Layton, Utah
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Tzivelekis S, Orange J, Poulos C, Meckley LM, Peay H, Sutphin J, Hernandez-Trujillo VP, Wasserman RL. Development of a novel shared decision making aid for primary immunodeficiency diseases. Immunotherapy 2023; 15:647-656. [PMID: 37158075 DOI: 10.2217/imt-2022-0193] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Aim: To describe development of a shared decision making (SDM) aid in treating primary immunodeficiency diseases (PID) with immunoglobulin replacement therapy (IGRT). Materials & methods: Expert engagement and qualitative formative research informed development. IGRT administration features were prioritized using object-case best-worst scaling (BWS) methodology. The aid was assessed by US adults self-reporting PID and revised following interviews/mock treatment-choice discussions with immunologists. Results: Patients participating in interviews (n = 19) and mock treatment-choice discussions (n = 5) deemed the aid useful/accessible and supported the utility of BWS, with content and BWS exercises refined following participant feedback. Conclusion: Formative research led to an improved SDM aid/BWS exercise, and illustrated how the aid may improve treatment decision making. The aid may help less-experienced patients and facilitate efficient SDM.
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Affiliation(s)
| | - Jordan Orange
- Columbia University Irving Medical Center, 632 W168th Street, New York, NY 10032, USA
| | - Christine Poulos
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | - Lisa M Meckley
- Takeda, 650 East Kendall Street, Cambridge, MA 02142, USA
| | - Holly Peay
- RTI International, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | - Jessie Sutphin
- Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham NC 27705-3976, USA
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | | | - Richard L Wasserman
- Allergy Partners of North Texas, Suite B-332, 7777 Forest Lane, Dallas, TX 75230, USA
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5
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Wasserman RL. Traveling with primary immunodeficiency. Ann Allergy Asthma Immunol 2023; 130:422-424.e4. [PMID: 36441081 DOI: 10.1016/j.anai.2022.10.019] [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: 08/31/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
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Gupta RS, Sehgal S, Wlodarski M, Bilaver LA, Wehbe FH, Spergel JM, Wang J, Ciaccio CE, Nimmagadda SR, Assa'ad A, Mahdavinia M, Wasserman RL, Brown E, Sicherer SH, Bird JA, Roberts B, Sharma HP, Mendez K, Holding EG, Mitchell L, Corbett M, Makhija M, Starren JB. Accelerating Food Allergy Research: Need for a Data Commons. J Allergy Clin Immunol Pract 2023; 11:1063-1067. [PMID: 36796512 DOI: 10.1016/j.jaip.2023.02.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
Food allergy is a significant health problem affecting approximately 8% of children and 11% of adults in the United States. It exhibits all the characteristics of a "complex" genetic trait; therefore, it is necessary to look at very large numbers of patients, far more than exist at any single organization, to eliminate gaps in the current understanding of this complex chronic disorder. Advances may be achieved by bringing together food allergy data from large numbers of patients into a Data Commons, a secure and efficient platform for researchers, comprising standardized data, available in a common interface for download and/or analysis, in accordance with the FAIR (Findable, Accessible, Interoperable, and Reusable) principles. Prior data commons initiatives indicate that research community consensus and support, formal food allergy ontology, data standards, an accepted platform and data management tools, an agreed upon infrastructure, and trusted governance are the foundation of any successful data commons. In this article, we will present the justification for the creation of a food allergy data commons and describe the core principles that can make it successful and sustainable.
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Affiliation(s)
- Ruchi S Gupta
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; The Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
| | - Shruti Sehgal
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Mark Wlodarski
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lucy A Bilaver
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Firas H Wehbe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christina E Ciaccio
- Departments of Pediatrics and Medicine, the University of Chicago, Chicago, Ill
| | - Sai R Nimmagadda
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Amal Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mahboobeh Mahdavinia
- Allergy and Immunology Division, Department of Internal Medicine, and Department of Pediatrics, Rush University Medical Center, Chicago, Ill
| | | | | | - Scott H Sicherer
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Andrew Bird
- Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Hemant P Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | | | | | | | - Mark Corbett
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Ky
| | - Melanie Makhija
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Justin B Starren
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
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7
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Alpan O, Wasserman RL, Kim T, Darter A, Shah A, Jones D, McNeil D, Li H, Ispas L, Rathkopf M, Perez E, Siri D, O’Connor M, Plassmeyer M, Romito K, Pettibone C, O’Reilly S, Sønder SU, Marti G. Towards an FDA-cleared basophil activation test. Front Allergy 2023; 3:1009437. [PMID: 36698379 PMCID: PMC9869275 DOI: 10.3389/falgy.2022.1009437] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
Food allergy is a global health problem affecting up to 10% of the world population. Accurate diagnosis of food allergies, however, is still a major challenge in medical offices and for patients seeking alternative avenues of diagnosis. A flawless test to confirm or rule out a food allergy does not exist. The lack of optimum testing methods to establish precise clinical correlations remains a major obstacle to effective treatment. Certain IgE measurement methods, including component testing, have received FDA clearance, but they have been used primarily as an analytical tool and not to establish clinical correlations. Most allergy tests are still carried out within the laboratory, and skin tests outside a laboratory setting that are used for food allergy diagnosis rely on non-standardized allergens, according to the FDA definition. Epitope mapping and basophil activation test (BAT) have recently been proposed as a means of establishing better clinical correlations. Yet neither have received FDA clearance for widespread distribution. Of the two methods, the BAT has the advantage of being a functional assay. Over the past few years, several large private practice groups in the United States, have developed BAT as a clinical assay and have started using it in patient care. Given this clinical experience, the vast number of papers published on BAT (more than 1,400 as of 2022) and the trend toward increasing FDA regulation, it is essential to understand the roadmap for regulatory clearance of this assay.
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Affiliation(s)
- Oral Alpan
- Amerimmune, Fairfax, VA, United States,Correspondence: Oral Alpan
| | | | - Theodore Kim
- Allergy Partners of Northern Virginia, Chantilly, VA, United States
| | - Amy Darter
- Oklahoma Institute of Allergy, Asthma and Immunology, Oklahoma City, OK, United States
| | - Atul Shah
- New York Food Allergy and Wellness Center, Centereach, NY, United States
| | | | | | - Henry Li
- Institute for Asthma and Allergy, Wheaton, MD, United States
| | - Laura Ispas
- Allergy, Asthma and Immunology Institute, Leesburg, VA, United States
| | - Melinda Rathkopf
- Allergy Asthma and Immunology Center of Alaska, Anchorage, AK, United States
| | - Elena Perez
- Allergy Associates of the Palm Beaches, Palm Beach, FL, United States
| | - Dareen Siri
- Midwest Allergy Sinus Asthma, Normal, IL, United States
| | - Maeve O’Connor
- Allergy, Asthma and Immunology Relief of Charlotte, Charlotte, NC, United States
| | | | | | | | - Sean O’Reilly
- New Columbia Capital, LLC, Arlington, VA, United States
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8
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Mack DP, Greenhawt M, Turner PJ, Wasserman RL, Hanna MA, Shaker M, Hughes SW, Del Río PR. Information needs of patients considering oral immunotherapy for food allergy. Clin Exp Allergy 2022; 52:1391-1402. [PMID: 36083693 DOI: 10.1111/cea.14225] [Citation(s) in RCA: 10] [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: 07/18/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 01/26/2023]
Abstract
While the historic management of food allergy includes avoidance strategies and allergic reaction treatment, oral immunotherapy (OIT) approaches have become more commonly integrated into therapeutic approaches. International guidelines, phase 3 trials and real-world experience have supported the implementation of this procedure. However, OIT is an elective, rarely curative procedure with inherent risks that necessitates an increased degree of health literacy for the patients and families. Families assume the responsibility of amateur healthcare providers to ensure the daily safe administration of the allergenic food. As such, it is incumbent upon physicians to ensure that families are prepared for this role. A thorough educational and shared decision-making approach is necessary during the counselling and consent process to adequately inform the families. Educated discussion about the efficacy and patient-centred effectiveness, therapeutic alternatives and family goals is required to align physician and patient expectations. A frank discussion about the struggles, practical challenges, risks and contraindications can help to develop an understanding of the risk mitigation strategies employed to maintain safety. Physicians should develop a proactive approach to educate families about this, at times, burdensome procedure. This educational approach should encourage ongoing support starting prior to consent through the maintenance visits. By preparing families for their unique management role, physicians can help ensure the safe and successful integration of OIT into the therapeutic offering for the management of food allergies.
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Affiliation(s)
- Douglas Paul Mack
- Halton Pediatric Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Mariam A Hanna
- Halton Pediatric Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Marcus Shaker
- Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Sarah W Hughes
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth, New Hampshire, USA
| | - Pablo Rodríguez Del Río
- Adjunto Especialista en Alergología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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9
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Wasserman RL, Cunningham-Rundles C, Anderson J, Lugar P, Palumbo M, Patel NC, Hofmann J, Glassman F, Rogers E, Praus M, Rojavin MA. Systemic IgG exposure and safety in patients with primary immunodeficiency: a randomized crossover study comparing a novel investigational wearable infusor versus the Crono pump. Immunotherapy 2022; 14:1315-1328. [PMID: 36128795 DOI: 10.2217/imt-2022-0097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: A novel, Investigational Wearable Infusor (IWI) was evaluated in a randomized, controlled, crossover, open-label study to determine if its delivery of subcutaneous immunoglobulin (IgPro20) achieved a comparable area under the concentration-time curve (AUC) for immunoglobulin G (IgG) versus the Crono S-PID-50 infusion pump (CP). EudraCT: 2016-003798-16. Materials & methods: Patients with primary immunodeficiency (PID) were randomized to receive IgPro20 in Sequence 1 (CP/IWI) or 2 (IWI/CP). The primary end point was AUC for IgG during the final week of each 4-week period. Results: 23 patients were enrolled. Evaluation of area under the concentration-time curve from time 0 (pre-infusion) to 7 days after infusion (AUC0-7 days) (IWI: 1806 h*g/l; CP: 1829 h*g/l) and geometric mean ratio indicated comparable AUCs for IgG for both devices. Conclusion: Similar IgG exposure, indicated by AUC values, can be achieved with IgPro20 using the IWI or CP in PID.
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Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas Research, 7777 Forest Lane, Suite B-332, Dallas, TX 75230, USA
| | - Charlotte Cunningham-Rundles
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA
| | - John Anderson
- Clinical Research Center of Alabama (a division of AllerVie Health), 504 Brookwood Blvd Suite 250, Birmingham, AL 35209, USA
| | - Patricia Lugar
- Departments of Medicine & Pediatrics, Division of Pulmonary, Allergy & Critical Medicine; Duke University Medical Center, Durham, NC 27705, USA
| | - Michael Palumbo
- Allergy & Clinical Immunology Associates, 180 Fort Couch Road, Pittsburgh PA 15241, USA
| | - Niraj C Patel
- Children's Healthcare of Atlanta, Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis, & Sleep, Emory University School of Medicine, 1400 Tullie RD NE, Atlanta, GA 30329, USA
| | - Jutta Hofmann
- CSL Behring AG, Wankdorfstrasse 10, 3014, Bern, Switzerland
| | - Fiona Glassman
- CSL Behring LLC, 1020 First Avenue, King of Prussia, PA 19406, USA
| | - Eileen Rogers
- Enable Injections, Inc., 2863 E. Sharon Rd Cincinnati, OH 45241, USA
| | - Michaela Praus
- CSL Behring Innovation GmbH, Emil-von-Behring-Straße 76, 35041, Marburg, Germany
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10
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Wasserman RL, Gupta S, Stein M, Rabbat CJ, Engl W, Leibl H, Yel L. Infection rates and tolerability of three different immunoglobulin administration modalities in patients with primary immunodeficiency diseases. Immunotherapy 2021; 14:215-224. [PMID: 34931880 DOI: 10.2217/imt-2021-0256] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This post hoc analysis evaluated the efficacy and overall tolerability of immunoglobulin (Ig) treatment modalities (intravenous Ig [iv.Ig], subcutaneous Ig [sc.Ig] and facilitated sc.Ig [fsc.Ig]). Materials & methods: A total of 30 participants with primary immunodeficiency diseases aged ≥2 years sequentially received iv.Ig, sc.Ig and fsc.Ig during consecutive clinical studies. Results: For iv.Ig, sc.Ig and fsc.Ig, rates of validated acute serious bacterial infections/participant-year (0, 0.09 and 0.04, respectively) and all infections/participant year (4.17, 3.68 and 2.42, respectively) were similarly low; rates of systemic and local causally related adverse events/participant-year were 5.60, 1.93 and 0.88, respectively and 0.13, 0.92 and 1.57, respectively. Conclusion: fsc.Ig provided similar efficacy to iv.Ig and sc.Ig. Clinical Trial registration: NCT00546871, NCT00814320, NCT01175213 (ClinicalTrials.gov).
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Affiliation(s)
- Richard L Wasserman
- Research Department, Allergy Partners of North Texas Research, Dallas, TX 75230, USA
| | - Sudhir Gupta
- School of Medicine, University of California, Irvine, CA 92697, USA
| | - Mark Stein
- Department of Medicine, Allergy Section, Good Samaritan Medical Center, West Palm Beach, FL 33401, USA; Allergy Associates of the Palm Beaches, North Palm Beach, FL 33401, USA
| | - Christopher J Rabbat
- Global Medical Affairs, Takeda Development Center Americas, Inc., Bannockburn, IL 60015, USA
| | - Werner Engl
- Baxalta Innovations GmbH, a Takeda company, Vienna, Austria
| | - Heinz Leibl
- Baxalta Innovations GmbH, a Takeda company, Vienna, Austria
| | - Leman Yel
- Clinical Medicine, Takeda Development Center Americas, Inc., Cambridge, MA 02139, USA
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Abstract
Background: Immunoglobulin replacement therapy (IGRT) is the foundation of treatment for the majority of patients with primary immunodeficiency. Clinical history and laboratory evaluation define the patients for whom IGRT is necessary and appropriate. During the 70 years since the first patient was treated, new products have led to the development of several modes of administration that facilitate the individualization of treatment that enables the optimization of care. Objective: The objective was to explain the assessment of candidates for IGRT and approaches to reevaluating recipients of IGRT to decide on the need to continue treatment and to review the approaches to optimize IGRT. Methods: The relevant literature was reviewed in the context of the author's experience supervising > 20,000 IGRT treatments over a 40-year period. Results: Providing the most appropriate form of IGRT for individual patients ameliorates disease and lessens the burden of care for patients with primary immunodeficiency. Conclusion: IGRT is safe and effective when used to treat patients with primary immunodeficiency who meet established and appropriate clinical and laboratory criteria.
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Warren CM, Roach A, Das R, Casale TB, Vickery BP, Wasserman RL, Gupta RS. Oral Immunotherapy (OIT)-related awareness, attitudes, and experiences among a Nationally-Representative Sample of Food Allergy Patients/Caregivers. J Allergy Clin Immunol Pract 2021; 9:4087-4094.e3. [PMID: 34333192 DOI: 10.1016/j.jaip.2021.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/17/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advances in oral immunotherapy (OIT) have led to recently expanded treatment options for food allergy (FA) patients. However, to inform future outreach efforts and ensure equitable access to emerging treatments, a greater understanding of current OIT-related awareness, attitudes and experiences is needed. OBJECTIVE To characterize current OIT awareness, attitudes and experiences among a nationally-representative sample of US adults with FA and parents/caregivers of pediatric patients. METHODS A probability-based sample of US adults and parents/caregivers of children with FA was surveyed about OIT-related knowledge, attitudes, and experiences. RESULTS Surveys were completed by respondents (N=781) from all 50 states. Overall, 72% did not know what OIT was prior to the survey. Respondents from households earning over $100,000/year or with a college degree each had significantly greater odds of reporting any OIT awareness compared to lower-income (OR=2.0; 95%CI:1.2-3.4) and non-college-educated (OR=1.9; 95%CI:1.2-3.0) respondents. Among respondents familiar/unfamiliar with OIT, 54%/34% reported their expected treatment outcome was to obtain protection against accidental exposure. Among respondents familiar/unfamiliar with OIT, 38%/35% reported their expected treatment outcome to be curing the allergy. Furthermore, 55% of OIT unfamiliar respondents said they would not be comfortable initiating a conversation with their healthcare provider about their suitability for OIT. CONCLUSION This study shows that among a nationally-representative sample of FA patients and pediatric caregivers, awareness of OIT is low, and over 95% of patients lack personal experience with OIT. Furthermore, the data suggest current OIT awareness is disproportionately elevated among wealthier, more highly-educated respondents.
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Affiliation(s)
- Christopher M Warren
- Northwestern University Feinberg School of Medicine Department of Preventive Medicine, Center for Food Allergy & Asthma Research, Chicago, IL
| | - Anita Roach
- FARE - Food Allergy Research & Education, McLean, VA
| | - Rajeshree Das
- Northwestern University Feinberg School of Medicine Department of Preventive Medicine, Center for Food Allergy & Asthma Research, Chicago, IL
| | - Thomas B Casale
- FARE - Food Allergy Research & Education, McLean, VA; Department of Medicine, Division of Allergy and Immunology, University of South Florida, Tampa, FL
| | | | - Richard L Wasserman
- Allergy Partners of North Texas, Dallas, Texas; Department of Pediatrics, Medical City Children's Hospital, Dallas, TX
| | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine Department of Preventive Medicine, Center for Food Allergy & Asthma Research, Chicago, IL; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
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13
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Perez EE, Hébert J, Ellis AK, Alpan O, Lumry WR, Shapiro R, Suez D, Mandujano JF, Wasserman RL. Efficacy, Safety and Tolerability of a New 10% Intravenous Immunoglobulin for the Treatment of Primary Immunodeficiencies. Front Immunol 2021; 12:707463. [PMID: 34305948 PMCID: PMC8297997 DOI: 10.3389/fimmu.2021.707463] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
We report here the results of a phase 3 study to assess the efficacy, safety, and tolerability of GC5107, a new 10% liquid intravenous immunoglobulin (IVIG) in preventing serious bacterial infections in patients with primary immunodeficiency (ClinicalTrials.gov: NCT02783482). Over a 12-month study period, 49 patients aged 3 to 70 years with a confirmed diagnosis of primary immunodeficiency received GC5107 at doses ranging from 319 to 881 mg/kg body weight every 21 or 28 days, according to their previous IVIG maintenance therapy. A total of 667 infusions of GC5107 were administered comprising a total of 45.86 patient-years of treatment. A single acute serious bacterial infection occurred during the study, resulting in an incidence of 0.02 events per patient-year (upper 99% one-sided confidence interval limit: 0.21), meeting the prespecified primary efficacy endpoint. The mean incidence of infections other than acute serious bacterial infections was 2.9 infections per patient-year. Efficacy was also demonstrated by the low mean annualized rate of hospitalizations due to infection (0.1 day) and the mean annualized duration of hospitalizations (0.1 day). The mean rate of intravenous and oral antibiotic use was 0.1 day and 13.2 days, respectively. There was a mean of 7.1 days of missed work, school, or daycare days. The proportion of infusions with temporally associated adverse events (TAAEs) occurring during or within 72 hours after GC5107 infusion was 0.24 (upper 95% one-sided confidence interval limit: 0.31), meeting the pre-specified primary safety endpoint. Overall, 149 of 667 infusions (22%) were associated with TAAEs. The most common TAAE was headache, reported by 49% of patients. More than 98% (731/743) of all adverse events that occurred throughout the 12-month study period were mild or moderate. More than 98% of infusions were completed without discontinuation, interruption or rate reduction. There were no treatment-emergent serious adverse events related to GC5107 or study discontinuations due to an adverse event. Overall, pharmacokinetic parameters for GC5107 were within the range of those reported in studies of other marketed IVIG products. Results of the present study demonstrate that GC5107 is an effective, safe and well-tolerated treatment for patients with primary immunodeficiency.
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Affiliation(s)
- Elena E Perez
- Allergy Associates of the Palm Beaches, North Palm Beach, FL, United States
| | - Jacques Hébert
- Department of Medicine, Laval University, Québec City, QC, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Oral Alpan
- Section on Immunopathogenesis, O&O Alpan, Fairfax, VA, United States
| | - William R Lumry
- Allergy and Asthma Research Associates Research Center, Dallas, TX, United States
| | - Ralph Shapiro
- Immunology Department, Midwest Immunology Clinic, Plymouth, MN, United States
| | - Daniel Suez
- Allergy, Asthma & Immunology Clinic, PA, Irving, TX, United States
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14
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Wasserman RL, Factor J, Windom HH, Abrams EM, Begin P, Chan ES, Greenhawt M, Hare N, Mack DP, Mansfield L, Ben-Shoshan M, Stukus DR, Leek TV, Shaker M. An Approach to the Office-Based Practice of Food Oral Immunotherapy. J Allergy Clin Immunol Pract 2021; 9:1826-1838.e8. [PMID: 33684637 DOI: 10.1016/j.jaip.2021.02.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/30/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
Oral immunotherapy (OIT) provides an active treatment option for patients with food allergies. OIT may improve quality of life and raise the threshold at which a patient with food allergy may react to an allergen, but it is a rigorous therapy that requires a high degree of commitment by the clinician, patients, and families. Recent guidelines from the Canadian Society for Allergy and Clinical Immunology have provided a framework for the ethical, evidence-based, and patient-oriented clinical practice of OIT, and the European Academy of Allergy, Asthma, and Immunology guidelines have also recommended that OIT can be used as a potential treatment. The recent Food and Drug Administration approval of an OIT pharmaceutical has accelerated the adoption of OIT. This review provides a summary of the recent Canadian Society for Allergy and Clinical Immunology guidelines and a consensus of practical experience of clinicians across the United States and Canada related to patient selection, office and staff preparation, the general OIT process, OIT-related reaction management, and treatment outcomes.
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Affiliation(s)
| | - Jeffrey Factor
- New England Food Allergy Treatment Center, West Hartford, Conn
| | - Hugh H Windom
- Windom Allergy, Asthma and Sinus Specialists, Sarasota, Fla
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Philippe Begin
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Edmond S Chan
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Matthew Greenhawt
- Section of Allergy/Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | | | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Moshe Ben-Shoshan
- Division of Allergy Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Marcus Shaker
- Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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15
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Kim T, Yu J, Li H, Scarupa M, Wasserman RL, Economides A, White M, Ward C, Shah A, Jones D, Rathkopf M, Frye K, Aybar A, Shayegan S, Enav B, Ispas L, Loizou D, Fitzhugh D, Tracy J, Friedlander J, Jacobs Z, Matz J, Golden D, McNeil D, McCann W, Copenhaver C, Factor J, Gupta R, Alpan O, Plassmeyer M, Sønder SU. Validation of inducible basophil biomarkers: Time, temperature and transportation. Cytometry B Clin Cytom 2021; 100:632-644. [PMID: 33539657 PMCID: PMC9291082 DOI: 10.1002/cyto.b.21991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/26/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022]
Abstract
Background The short stability window of several hours from blood collection to measuring basophil activation has limited the use of flow cytometry‐based basophil activation assays in clinical settings. We examine if it is possible to extend this window to 1 day allowing for shipment of samples between laboratories. Several options exist for reporting the results including reporting all the measured values directly, calculating ratios and reporting a single value covering all measured results. Each of these options have different stability and value to the physician. Methods Whole blood samples from peanut allergic patients were stimulated with four different peanut concentrations at Day 0, Day 1, and Day 2. Samples were stored under temperature‐controlled conditions. Flow cytometry was used to analyze the samples. The basophil activation and degranulation were measured as percentage of positive CD63 basophils and CD203c MFI fold change. Shipped samples were transported under ambient conditions. Results The results show that CD63 is a stable marker at Day 1. The CD203c ratio decreases significantly at Day 1. Calculating the CD63/IgE ratio proves to be more stable than CD63 alone. The most stable readouts are the semi‐quantitative results and the trajectory of the dose response curve. Finally, we confirmed that the stability can be extended to samples shipped overnight to the laboratory. Conclusions It is possible to extend the stability of the basophil activation assay to 1 day for samples stored at 18–25°C as well as samples shipped under ambient conditions as long as the temperature is within the 2–37°C range.
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Affiliation(s)
- Theodore Kim
- Allergy Partners of Northern Virginia, Chantilly, Virginia, USA
| | - Jing Yu
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | - Henry Li
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | - Mark Scarupa
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | | | | | - Martha White
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | - Carla Ward
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | - Atul Shah
- New York Food Allergy and Wellness Center, Centereach, New York, USA
| | | | - Melinda Rathkopf
- Allergy Asthma and Immunology Center of Alaska, Anchorage, Alaska, USA
| | | | - Ahmet Aybar
- Annapolis Pediatric Gastroenterology and Nutrition, Annapolis, Maryland, USA
| | | | - Benjamin Enav
- Pediatric Gastroenterology of Northern Virginia, Fairfax, Virginia, USA
| | - Laura Ispas
- Allergy, Asthma and Immunology Institute, Leesburg, Virginia, USA
| | | | - David Fitzhugh
- Allergy Partners of Chapel Hill, Chapel Hill, North Carolina, USA
| | - James Tracy
- Allergy, Asthma and Immunology Associates, Omaha, Nebraska, USA
| | | | - Zachary Jacobs
- The Center for Allergy and Immunology, Kansas City, Missouri, USA
| | - Jonathan Matz
- Allergy and Asthma Specialists of Maryland, Baltimore, Maryland, USA
| | - David Golden
- Allergy and Asthma Specialists of Maryland, Baltimore, Maryland, USA
| | | | - William McCann
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | | | - Jeffrey Factor
- New England Food Allergy Treatment Center, Farmington, Connecticut, USA
| | - Raavi Gupta
- Amerimmune, Fairfax, Virginia, USA.,Department of Pathology, SUNY, New York, New York, USA
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16
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Mattison CP, Aryana KJ, Clermont K, Prestenburg E, Lloyd SW, Grimm CC, Wasserman RL. Microbiological, Physicochemical, and Immunological Analysis of a Commercial Cashew Nut-Based Yogurt. Int J Mol Sci 2020; 21:ijms21218267. [PMID: 33158240 PMCID: PMC7663355 DOI: 10.3390/ijms21218267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
Nut-based milks and yogurts are gaining popularity, but may not offer the same benefits as dairy yogurts to consumers. Cashew nuts often cause severe allergic reactions, and cashew nut allergens are stable to several types of processing. To compare its characteristics to dairy yogurt and characterize the effects of fermentation on the Ana o 1-3 cashew nut allergens, a commercial yogurt made from cashew nuts (Cashewgurt) was evaluated for microbiological, physiochemical, and immunological properties. Average counts for lactobacilli and Streptococcus thermophilus were greater than 10 million colony forming units per milliliter, indicating the capacity to provide a health benefit. Cashewgurt pH and viscosity values were comparable to cow milk yogurts, and it was off white in color. SDS-PAGE analysis indicated a clear reduction in Ana o 1 and 2, and immuno-assay with polyclonal anti-cashew IgG antibody and cashew-allergic IgE indicated an overall reduction in allergen content. In contrast, SDS-PAGE, mass spectrometry, immunoblot, and ELISA all revealed that Ana o 3 was relatively unaffected by the fermentation process. In conclusion, Ana o 1 and Ana o 2 are sensitive to degradation, while Ana o 3 survives lactic acid bacterial fermentation during yogurt production. The analysis presented here indicates that cashew nut yogurt is not suitable for those with cashew nut allergy.
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Affiliation(s)
- Christopher P. Mattison
- Southern Regional Research Center, United States Department of Agriculture, Agricultural Research Service, New Orleans, LA 70124, USA; (K.C.); (E.P.); (S.W.L.); (C.C.G.)
- Correspondence: ; Tel.: +1-(504)-286-4392; Fax: +1-(504)-286-4419
| | - Kayanush J. Aryana
- School of Nutrition and Food Science, Louisiana State University Agricultural Center, 115 Dairy Science Building, Baton Rouge, LA 70803, USA;
| | - Kristen Clermont
- Southern Regional Research Center, United States Department of Agriculture, Agricultural Research Service, New Orleans, LA 70124, USA; (K.C.); (E.P.); (S.W.L.); (C.C.G.)
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Oak Ridge, TN 37831-0117, USA
| | - Eric Prestenburg
- Southern Regional Research Center, United States Department of Agriculture, Agricultural Research Service, New Orleans, LA 70124, USA; (K.C.); (E.P.); (S.W.L.); (C.C.G.)
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Oak Ridge, TN 37831-0117, USA
| | - Steven W. Lloyd
- Southern Regional Research Center, United States Department of Agriculture, Agricultural Research Service, New Orleans, LA 70124, USA; (K.C.); (E.P.); (S.W.L.); (C.C.G.)
| | - Casey C. Grimm
- Southern Regional Research Center, United States Department of Agriculture, Agricultural Research Service, New Orleans, LA 70124, USA; (K.C.); (E.P.); (S.W.L.); (C.C.G.)
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17
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Wasserman RL. Common variable immunodeficiency and respiratory complications: take-home messages for the clinician. Ann Allergy Asthma Immunol 2020; 124:414-415. [PMID: 32336461 DOI: 10.1016/j.anai.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas, Dallas, Texas; Department of Pediatrics, Medical City Children's Hospital, Dallas, Texas.
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18
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Wasserman RL. Clinical Practice Experience with HyQvia in Adults Using Alternative Dosing Regimens and Pediatric Patients: A Retrospective Study. Adv Ther 2020; 37:1536-1549. [PMID: 32124273 PMCID: PMC7140738 DOI: 10.1007/s12325-020-01264-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Indexed: 11/03/2022]
Abstract
Introduction HyQvia (Immune Globulin Infusion 10% [Human] with Recombinant Human Hyaluronidase) was developed to combine the advantages of intravenous and subcutaneous immune globulin (SCIG), allowing administration of larger volumes at a single subcutaneous site with less frequent dosing when compared to other SCIG products. Current US prescribing guidelines for HyQvia are limited to adults and do not encompass the flexibility required to achieve success in all patients with primary immunodeficiency (PID). Methods This retrospective study was designed to evaluate the clinical experience of treating patients with PID with HyQvia regimens outside of package insert recommendations as well as in pediatric patients. Data were abstracted from 38 patient records (317 HyQvia infusions), including five patients less than 16 years of age, from seven US immunology clinics. Results Among 37 patients receiving HyQvia regimens differing from prescribing guidelines, the most notable variations included shorter ramp-up periods, use of two rather than one infusion site, and slower than maximal infusion rates to mitigate local adverse events (AEs). The medication volume infused for single site doses ranged from 75 to 200 mL and doses split between two sites ranged from 100 to 750 mL. The most common type of regimen variation was a condensed ramp-up phase (shorter schedule, higher doses), and 96% (24/25) of patients managed in this way completed ramp-up. The most common ramp-up schedule was three infusions (one at 25–45%, another at 50–75%, and the final at 100% of target dose) spread over 2–4 weeks. Conclusions A shorter ramp-up schedule did not appear to increase the number of AEs compared to standard ramp-up schedules. For patients with AEs, slower infusion rates and the use of two sites may improve medication tolerability. Four of five pediatric patients reported no AEs, and only one discontinued, stating a fear of needles. HyQvia may be tailored to adults requiring alternative rates, ramp-up, and/or dosing regimens and may be especially well-suited to children. Electronic supplementary material The online version of this article (10.1007/s12325-020-01264-7) contains supplementary material, which is available to authorized users.
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19
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Wasserman RL. Captaining the PIDD ship. Ann Allergy Asthma Immunol 2020; 123:419. [PMID: 31676017 DOI: 10.1016/j.anai.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 11/19/2022]
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20
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Wasserman RL, Garcia D, Greener BN, Kestenberg K, Pinkert A, Mond J, Grossman A. Manufacturing process optimization of ADMA Biologics' intravenous immunoglobulin products, BIVIGAM® and ASCENIV™. Immunotherapy 2019; 11:1423-1433. [DOI: 10.2217/imt-2019-0157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Humoral immunodeficiency patients require immunoglobulin replacement to prevent infection. Traditional intravenous immunoglobulin manufacturing methods have had the potential for containing impurities caused by physical, chemical and thermal stressors that alter proteins. Two intravenous immunoglobulin products, BIVIGAM® and ASCENIV™, are manufactured by a modified Cohn-Oncley fractionation method followed by chromatographic purification. These products have undergone a systematic quality by design optimization to identify critical manufacturing processes to produce the highest quality product. This data driven, small-scale approach has led to manufacturing enhancements that have yielded consistent product improvements. The systematic approach to optimizing manufacturing has guided process changes, in-process, procedural and engineering controls that have reduced protein shearing and aggregation, and improved purity resulting in products with lot-to-lot consistency.
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Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas Research, 7777 Forest Lane, Building B, Suite 332, Dallas, TX 75230, USA
| | - Daniel Garcia
- ADMA Biologics, 5800 Park of Commerce Blvd, NW Boca Raton, FL 33487, USA
| | | | - Kaitlin Kestenberg
- ADMA Biologics, 5800 Park of Commerce Blvd, NW Boca Raton, FL 33487, USA
| | - Adam Pinkert
- ADMA Biologics, 5800 Park of Commerce Blvd, NW Boca Raton, FL 33487, USA
| | - James Mond
- ADMA Biologics, 5800 Park of Commerce Blvd, NW Boca Raton, FL 33487, USA
| | - Adam Grossman
- ADMA Biologics, 5800 Park of Commerce Blvd, NW Boca Raton, FL 33487, USA
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Wasserman RL, Hague AR, Pence DM, Sugerman RW, Silvers SK, Rolen JG, Herbert M. The real world is not standardized. J Allergy Clin Immunol Pract 2019; 7:2098-2099. [PMID: 31279473 DOI: 10.1016/j.jaip.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/03/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas, Dallas, Texas; Medical City Children's Hospital, Dallas, Texas.
| | | | | | - Robert W Sugerman
- Allergy Partners of North Texas, Dallas, Texas; Medical City Children's Hospital, Dallas, Texas
| | - Stacy K Silvers
- Allergy Partners of North Texas, Dallas, Texas; Medical City Children's Hospital, Dallas, Texas
| | | | - Morley Herbert
- Allergy Partners of North Texas, Dallas, Texas; Medical City Children's Hospital, Dallas, Texas
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Wasserman RL, Jones DH, Windom HH. Reaching for best practices in food oral immunotherapy: Report on the second annual Food Allergy Support Team meeting. Ann Allergy Asthma Immunol 2019; 123:129-130.e3. [PMID: 31082482 DOI: 10.1016/j.anai.2019.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/15/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas, Dallas, Texas; Medical City Children's Hospital, Dallas, Texas.
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Wasserman RL. Balancing the risks and burdens of food allergen avoidance. Ann Allergy Asthma Immunol 2019; 120:229-230. [PMID: 29391201 DOI: 10.1016/j.anai.2018.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/13/2018] [Accepted: 01/17/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas, Dallas, Texas; Medical City Children's Hospital, Dallas, Texas.
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Pence DM, Hague AR, Wasserman RL, Sugerman RW, Ain Kamili QU, Rolen JG, Herbert M. Changing The Outcomes Of Peanut Oral Immunotherapy (POIT). J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Wasserman RL, Guindon J, Seda J. Interim Safety Data in a Prospective, Open-label, Multi-center Study of the Efficacy, Safety, Tolerability, and Pharmacokinetics of Plasmacap Ig in Patients with Primary Immunodeficiency Diseases (Pidd). J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rickard K, MacDonald-Berko M, Anolik R, Jain N, La Force C, Wasserman RL. Measurement of exhaled nitric oxide in young children. Ann Allergy Asthma Immunol 2018; 122:343-345. [PMID: 30476548 DOI: 10.1016/j.anai.2018.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Robert Anolik
- Allergy & Asthma Specialists PC, Blue Bell, Pennsylvania
| | - Neal Jain
- Arizona Allergy & Immunology Research, Gilbert, Arizona
| | - Craig La Force
- North Carolina Clinical Research, Raleigh, North Carolina
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Jolles S, Rojavin MA, Lawo JP, Nelson R, Wasserman RL, Borte M, Tortorici MA, Imai K, Kanegane H. Long-Term Efficacy and Safety of Hizentra® in Patients with Primary Immunodeficiency in Japan, Europe, and the United States: a Review of 7 Phase 3 Trials. J Clin Immunol 2018; 38:864-875. [PMID: 30415311 PMCID: PMC6292970 DOI: 10.1007/s10875-018-0560-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/06/2018] [Accepted: 10/04/2018] [Indexed: 12/28/2022]
Abstract
Many patients with primary immunodeficiency (PID) require immunoglobulin G (IgG) replacement therapy, delivered as intravenous IgG (IVIG) or subcutaneous IgG (SCIG). We aim to identify trends in efficacy and safety that would not be evident in individual studies of small patient numbers. Seven open-label, Phase 3, prospective, multicenter studies of the efficacy and safety of Hizentra® (a SCIG), conducted in Japan, Europe, and the US were summarized. Overall, 125 unique patients received 15,013 weekly infusions during a total observation period of 250.9 patient-years. Mean weekly doses of Hizentra® were 83.22–221.3 mg/kg body weight; infusion rates per patient (total body rate) were 25.2–49.3 mL/h across studies. The rates of infections and serious bacterial infections were 3.10 and 0.03 events per patient/year, respectively. Annualized rates of days hospitalized due to infection, out of work/school, and prophylactic antibiotic use were 0.95, 5.14, and 36.78 per patient, respectively. For the equivalent monthly dose, weekly Hizentra® SCIG administration resulted in expectedly-increased serum IgG trough levels in patients switching from IVIG, and maintained levels in patients switching from previous SCIG. Adverse events (AEs) totaled 5039 (events/infusion 0.094–0.773), almost all of which were mild/moderate. Three thousand one hundred ninety-seven were considered treatment-related, the most common of which were injection site reactions (2919 events; 0.001–0.592 AEs per infusion). Systemic AEs were very uncommon. The results from these seven studies indicate that Hizentra® therapy was both efficacious and well tolerated during long-term treatment. This is particularly important in patients with PID, who may require lifelong IgG replacement therapy.
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Affiliation(s)
- Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK.
| | | | | | - Robert Nelson
- School of Medicine and the Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | | | - Michael Borte
- Hospital St. Georg GmbH Leipzig, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | | | - Kohsuke Imai
- Department of Community Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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29
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Wasserman RL, Jones DH, Windom HH. Oral immunotherapy for food allergy. Ann Allergy Asthma Immunol 2018; 121:272-275. [DOI: 10.1016/j.anai.2018.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
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Heimall JR, Hagin D, Hajjar J, Henrickson SE, Hernandez-Trujillo HS, Itan Y, Kobrynski L, Paris K, Torgerson TR, Verbsky JW, Wasserman RL, Hsieh EWY, Bleesing JJ, Chou JS, Lawrence MG, Marsh RA, Rosenzweig SD, Orange JS, Abraham RS. Correction to: Use of Genetic Testing for Primary Immunodeficiency Patients. J Clin Immunol 2018; 38:540-541. [PMID: 29781065 DOI: 10.1007/s10875-018-0510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article unfortunately contained mistakes in some of the author names and affiliations. The correct list of author names and affiliations is below, with the corrections in bold.
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Affiliation(s)
- Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania, Wood Building 3rd Floor, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - David Hagin
- Allergy and Immunology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joud Hajjar
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Henrickson
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Immunology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hillary S Hernandez-Trujillo
- Division of Infectious Disease & Immunology, Connecticut Children's Medical Center, Hartford, CT, USA.,CT Asthma and Allergy Center, Hartford, West, CT, USA
| | - Yuval Itan
- Icahn School of Medicine at Mount Sinai, The Charles Bronfman Institute for Personalized Medicine, New York, NY, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kenneth Paris
- Division of Allergy-Immunology, LSU Health Sciences Center, Children's Hospital, New Orleans, LA, USA
| | - Troy R Torgerson
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - James W Verbsky
- Pediatrics and Microbiology and Molecular Genetics Section of Pediatric Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Elena W Y Hsieh
- Department of Immunology and Microbiology, Department of Pediatrics, Division of Allergy and Immunology, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Jack J Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Janet S Chou
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Monica G Lawrence
- Division of Asthma, Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, VA, USA
| | - Rebecca A Marsh
- Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jordan S Orange
- Immunology, Allergy and Rheumatology, Director, Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Roshini S Abraham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Ballow M, Wasserman RL, Jolles S, Chapel H, Berger M, Misbah SA. Correction to: Assessment of Local Adverse Reactions to Subcutaneous Immunoglobulin (SCIG) in Clinical Trials. J Clin Immunol 2018; 38:539. [PMID: 29713933 PMCID: PMC6028855 DOI: 10.1007/s10875-018-0504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The article Assessment of Local Adverse Reactions to Subcutaneous Immunoglobulin (SCIG) in Clinical Trials, written by Mark Ballow, Richard L. Wasserman, Stephen Jolles, Helen Chapel, Mel Berger, Siraj A. Misbah, was originally published Online First without open access.
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Affiliation(s)
- Mark Ballow
- Department of Pediatrics, Division of Allergy & Immunology, The Johns Hopkins All Children's Hospital, Children's Research Institute, University of South Florida, 140 7th Ave South, St Petersburg, FL, 33701, USA.
| | | | - Stephen Jolles
- Department of Immunology, University Hospital of Wales, Cardiff, UK
| | - Helen Chapel
- Oxford University Hospitals, University of Oxford, Oxford, UK
| | | | - Siraj A Misbah
- Oxford University Hospitals, University of Oxford, Oxford, UK
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32
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Heimall JR, Hagin D, Hajjar J, Henrickson SE, Hernandez-Trujillo HS, Tan Y, Kobrynski L, Paris K, Torgerson TR, Verbsky JW, Wasserman RL, Hsieh EWY, Blessing JJ, Chou JS, Lawrence MG, Marsh RA, Rosenzweig SD, Orange JS, Abraham RS. Use of Genetic Testing for Primary Immunodeficiency Patients. J Clin Immunol 2018; 38:320-329. [PMID: 29675737 DOI: 10.1007/s10875-018-0489-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/16/2018] [Indexed: 12/11/2022]
Abstract
Genetic testing plays a critical role in diagnosis for many primary immunodeficiency diseases. The goals of this report are to outline some of the challenges that clinical immunologists face routinely in the use of genetic testing for patient care. In addition, we provide a review of the types of genetic testing used in the diagnosis of PID, including their strengths and limitations. We describe the strengths and limitations of different genetic testing approaches for specific clinical contexts that raise concern for specific PID disorders in light of the challenges reported by the clinical immunologist members of the CIS in a recent membership survey. Finally, we delineate the CIS's recommendations for the use of genetic testing in light of these issues.
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Affiliation(s)
- Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania, Wood Building 3rd Floor, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - David Hagin
- Allergy and Immunology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joud Hajjar
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Henrickson
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania, Wood Building 3rd Floor, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Wherry Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - Hillary S Hernandez-Trujillo
- Division of Infectious Disease & Immunology, Connecticut Children's Medical Center, Hartford, CT, USA
- CT Asthma and Allergy Center, West Hartford, CT, USA
| | - Yuval Tan
- The Charles Bronfman Institute of Personalized Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kenneth Paris
- Division of Allergy-Immunology, LSU Health Sciences Center, Children's Hospital, New Orleans, LA, USA
| | - Troy R Torgerson
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - James W Verbsky
- Pediatrics and Microbiology and Molecular Genetics Section of Pediatric Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Elena W Y Hsieh
- Department of Immunology and Microbiology, Department of Pediatrics, Division of Allergy and Immunology, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Jack J Blessing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Janet S Chou
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Monica G Lawrence
- Division of Asthma, Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, VA, USA
| | - Rebecca A Marsh
- Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jordan S Orange
- Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Roshini S Abraham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Abstract
Twenty-three adult patients evaluated at a university medical center for severe refractory sinusitis were found to have a primary immunodeficiency on the basis of total immunoglobulin, IgG subclass, and vaccine response determinations. The most common finding was IgG3 deficiency with antibody hyporesponsiveness to pneumococcal vaccine. Treatment options included prophylactic antibiotics and aggressive management of associated allergies with intravenous immunoglobulin reserved for severely affected patients who failed more conservative therapy.
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Affiliation(s)
- Scott C. Manning
- Department of Otolaryngology, University of Texas Southwestern Medical at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9035
| | | | | | - John Truelson
- Department of Otolaryngology, University of Texas Southwestern Medical at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9035
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Pence DM, Wasserman RL, Sugerman RW, Kamili QUA, Hague AR, Rolen JG, Herbert M. Nut Oral Immunotherapy (NOIT) Using Two or More Nuts Successfully Desensitizes Most Patients. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jain N, Wasserman RL, LaForce CF, Anolik R, MacDonald-Berko M, Rickard KA. Fractional Exhaled Nitric Oxide (FeNO) Measurements with the NIOX VERO ® in Children 4 to 6 Years Old using the 6 and 10 Second Exhalation Modes. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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36
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Wasserman RL, Sugerman RW, Kamili QUA, Pence DM, Hague AR, Herbert M. Eosinophilic Esophagitis Like Oral Immunotherapy Related Syndrome (ELORS). J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wasserman RL, Greener BN, Mond J. RI-002, an intravenous immunoglobulin containing high titer neutralizing antibody to RSV and other respiratory viruses for use in primary immunodeficiency disease and other immune compromised populations. Expert Rev Clin Immunol 2017; 13:1107-1119. [PMID: 29035131 PMCID: PMC7103707 DOI: 10.1080/1744666x.2017.1389647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/16/2023]
Abstract
Introduction: Novel immune globulin (IG) products (RI-002, RI-001) have been designed to provide protection against respiratory syncytial virus (RSV) mediated respiratory illness while at the same time meeting the manufacturing requirements established by FDA for antibody supplementation in immunocompromised subjects. Areas covered: This review covers the manufacture and development of both RI-001 and RI-002, including the selection of plasma donors for IG preparation with high-titers of anti-RSV antibody, in vitro, and preclinical data in the cotton rat model S. hispidus, and clinical trials including Phase II and compassionate use studies of RI-001 and a multi-center, pivotal Phase III study of RI-002 in PIDD patients. Expert commentary: The data demonstrate that RI-002 is efficacious in the prevention and treatment of RSV in preclinical normal and immune suppressed animal models and is safe and efficacious in the treatment of patients with various forms of primary immunodeficiency disease (PIDD). This product offers potential advantages over other available IG’s for prophylaxis in immunocompromised patients requiring polyclonal immunoglobulin supplementation because of its unique antibody composition. In addition to its enhanced neutralizing anti-RSV activity and its polyclonal IG composition, there is preclinical data to support the use of RI-002 for humoral protection against other respiratory pathogens.
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Affiliation(s)
| | - Benjamin N Greener
- b Clinical Scientist - PPD Inc. , 2400 Research Blvd ., Rockville , MD , USA
| | - James Mond
- c Chief Medical and Scientific Officer- ADMA Biologics Inc ., Ramsey , NJ , USA
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38
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Abstract
Immunoglobulin G is used to both prevent infection in primary immunodeficiency diseases (PIDs) and prevent bleeding in immune thrombocytopenic purpura. Gammaplex is a highly purified human intravenous immunoglobulin G available as 5 and 10% liquid formulations. Gammaplex 5% has proven efficacy and safety in PID and immune thrombocytopenic purpura, protecting against serious acute bacterial infections and treating bleeding by improving platelet counts, respectively. The therapeutic effect of Gammaplex 10% is expected to be similar to that of Gammaplex 5% based on demonstrated bioequivalence in a bridging study in PID. The availability of Gammaplex 10% provides another option to individualize therapy according to patient needs, allowing a 34% reduction in infusion time without compromising safety and tolerability.
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Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas, 7777 Forest Lane, Building B, Suite 332, Dallas, TX 75230, USA
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Wasserman RL. Recombinant human hyaluronidase-facilitated subcutaneous immunoglobulin infusion in primary immunodeficiency diseases. Immunotherapy 2017; 9:1035-1050. [DOI: 10.2217/imt-2017-0092] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Most primary immunodeficiency diseases (PIDDs) resulting in antibody deficiency require intravenous or subcutaneous immunoglobulin G (SCIG) replacement therapy. The flow and distribution of SCIG to the vasculature is impeded by the glycosaminoglycan hyaluronan in the extracellular matrix, which limits the infusion rate and volume per site, necessitating frequent infusions and multiple infusion sites. Hyaluronidase depolymerizes hyaluronan and is a spreading factor for injectable biologics. Recombinant human hyaluronidase (rHuPH20) increases SCIG absorption and dispersion. In patients with PIDD, SCIG facilitated with rHuPH20 (IGHy) has been shown to prevent infections, be well-tolerated and reduce infusion frequency and number of infusion sites as compared with conventional SCIG. This article reviews IGHy clinical studies and real-world practice data in patients with PIDD.
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Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas, Medical City Children's Hospital, Dallas, TX, USA
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Hague AR, Silvers SK, Wasserman RL, Sugerman RW, Pence DM, Herbert MA. Food Oral Immunotherapy (FOIT) Failures: Who and Why. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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41
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Wasserman RL, Gupta S, Stein MR, Melamed IR, Puck JM, Engl W, Leibl H, Rabbat CJ, Yel L. Analyses of a Subset of Patients with Primary Immunodeficiency Diseases (PIDD) Who Switched Modes of Administration of Immunoglobulin (Ig) Therapy during Three Consecutive Studies. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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42
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Silvers SK, Hague AR, Pence DM, Herbert MA, Sugerman RW, Wasserman RL. Eosinophilic Esophagitis Like Oral Immunotherapy Related Syndrome (ELORS). J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Mattison CP, Grimm CC, Li Y, Chial HJ, McCaslin DR, Chung SY, Bren-Mattison Y, Wasserman RL. Identification and Characterization of Ana o 3 Modifications on Arginine-111 Residue in Heated Cashew Nuts. J Agric Food Chem 2017; 65:411-420. [PMID: 27966914 DOI: 10.1021/acs.jafc.6b04134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Raw and roasted cashew nut extracts were evaluated for protein modifications by mass spectrometry. Independent modifications on the Arg-111 residue of Ana o 3 were observed in roasted but not raw cashew nuts. The mass changes of 72.0064 or 53.9529 Da are consistent with the formation of carboxyethyl and hydroimidazolone modifications at the Arg-111 residue. These same modifications were observed in Ana o 3 purified from roasted but not raw cashew nuts, albeit at a relatively low occurrence. Circular dichroism indicated that Ana o 3 purified from raw and roasted cashew nuts had similar secondary structure, and dynamic light scattering analysis indicated there was no observable difference in particle size. The stability of Ana o 3 purified from raw and roasted cashew nuts to trypsin was similar in the absence of or following treatment with a reducing agent. Only minor differences in IgE binding to Ana o 3 were observed by ELISA among a cohort of cashew-allergic patient sera.
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Affiliation(s)
- Christopher P Mattison
- Southern Regional Research Center, FPSQ, ARS, U.S. Department of Agriculture , 1100 Robert E. Lee Boulevard, New Orleans, Louisiana 70124, United States
| | - Casey C Grimm
- Southern Regional Research Center, FPSQ, ARS, U.S. Department of Agriculture , 1100 Robert E. Lee Boulevard, New Orleans, Louisiana 70124, United States
| | - Yichen Li
- Southern Regional Research Center, FPSQ, ARS, U.S. Department of Agriculture , 1100 Robert E. Lee Boulevard, New Orleans, Louisiana 70124, United States
| | - Heidi J Chial
- BioMed Bridge, LLC , 3700 Quebec Street, Suite 100-230, Denver, Colorado 80207, United States
| | - Darrell R McCaslin
- Biophysics Instrumentation Facility, Biochemistry Department, University of Wisconsin , 433 Babcock Drive, Madison, Wisconsin 53706, United States
| | - Si-Yin Chung
- Southern Regional Research Center, FPSQ, ARS, U.S. Department of Agriculture , 1100 Robert E. Lee Boulevard, New Orleans, Louisiana 70124, United States
| | - Yvette Bren-Mattison
- BioMed Bridge, LLC , 3700 Quebec Street, Suite 100-230, Denver, Colorado 80207, United States
| | - Richard L Wasserman
- Allergy Partners of North Texas Research, Department of Pediatrics, Medical City Children's Hospital , 7777 Forest Lane, Dallas, Texas 75230, United States
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Wasserman RL. The Nuts and Bolts of Immunoglobulin Treatment for Antibody Deficiency. The Journal of Allergy and Clinical Immunology: In Practice 2016; 4:1076-1081.e3. [DOI: 10.1016/j.jaip.2016.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/14/2016] [Accepted: 09/21/2016] [Indexed: 01/09/2023]
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Wasserman RL, Melamed I, Kobrynski L, Puck J, Gupta S, Doralt J, Sharkhawy M, Engl W, Leibl H, Gelmont D, Yel L. Recombinant human hyaluronidase facilitated subcutaneous immunoglobulin treatment in pediatric patients with primary immunodeficiencies: long-term efficacy, safety and tolerability. Immunotherapy 2016; 8:1175-86. [PMID: 27468136 DOI: 10.2217/imt-2016-0066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM To assess the long-term efficacy, safety and tolerability of recombinant human hyaluronidase-facilitated subcutaneous infusion of immunoglobulin (Ig) (fSCIG; HYQVIA(®); IGHy) in children aged <18 years. PATIENTS & METHODS Patients with primary immunodeficiency diseases were included in the studies. IGHy was administered every 3 or 4 weeks. RESULTS Validated acute serious bacterial infections were reported at 0.08/patient-year (four pneumonia episodes in three patients). No serious adverse drug reaction (ADR) was reported, and rates of local and systemic ADRs were low (0.09/infusion and 0.1/infusion). Infection rates were low (3.02/patient-year) with sustained Ig trough levels (median: 1009 mg/dl). Of 674 IGHy infusions, 97.2% required no change of administration due to ADR, in most (82.5%) with one infusion site. No patient developed neutralizing anti-rHuPH20 antibodies. Postpivotal study, 100% of patients aged <14 years or their caregivers and 85.7% of patients aged 14 to <18 years expressed preference for IGHy compared with Ig administered intravenously or Ig administered subcutaneously. CONCLUSION These studies, with the longest (maximum: 3.3 years) duration of any reported Ig replacement trials in children with primary immunodeficiency diseases, showed low infection, local and systemic reaction rates along with well-tolerated infusions given in a single site.
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Affiliation(s)
| | | | | | - Jennifer Puck
- University of California, San Francisco, San Francisco, CA, USA
| | - Sudhir Gupta
- University of California, Irvine, Irvine, CA, USA
| | - Jennifer Doralt
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | | | - Werner Engl
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - Heinz Leibl
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - David Gelmont
- Baxalta US Inc., now part of Shire, Cambridge, MA, USA
| | - Leman Yel
- University of California, Irvine, Irvine, CA, USA.,Baxalta US Inc., now part of Shire, Cambridge, MA, USA
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Wasserman RL, Stein MR, Younger MEM, Fatteh S, Haddad E. 20% subcutaneous immunoglobulin dosed biweekly for primary immunodeficiency. Ann Allergy Asthma Immunol 2016; 117:93-4. [PMID: 27236217 DOI: 10.1016/j.anai.2016.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Mark R Stein
- Allergy Associates of the Palm Beaches, North Palm Beach, Florida
| | | | | | - Elie Haddad
- Department of Pediatrics and Department of Microbiology, Infectiology and Immunology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
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47
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Wasserman RL, Melamed I, Stein MR, Engl W, Sharkhawy M, Leibl H, Puck J, Rubinstein A, Kobrynski L, Gupta S, Grant AJ, Ratnayake A, Richmond WG, Church J, Yel L, Gelmont D. Long-Term Tolerability, Safety, and Efficacy of Recombinant Human Hyaluronidase-Facilitated Subcutaneous Infusion of Human Immunoglobulin for Primary Immunodeficiency. J Clin Immunol 2016; 36:571-82. [PMID: 27220317 PMCID: PMC4940441 DOI: 10.1007/s10875-016-0298-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/11/2016] [Indexed: 11/27/2022]
Abstract
Purpose Treatment of primary immunodeficiency diseases (PIDD) with subcutaneous (SC) infusions of IgG preceded by injection of recombinant human hyaluronidase (rHuPH20) (IGHy) to increase SC tissue permeability was evaluated in two consecutive, prospective, non-controlled, multi-center studies. Methods Subjects >4 years of age received SC IgG replacement at a weekly dose equivalent of 108 % of their previous intravenous (IV) dose, facilitated by prior injection of 75 U/g IgG of rHuPH20. Starting with weekly SC infusions, the interval was increased (ramped-up) to a 3- or 4-week schedule. Results Eighty-three subjects (24 < 18 years; 59 ≥ 18 years) received 2729 infusions (excluding ramp-up) at a mean dose of 0.155 g/kg/week in the pivotal and 0.156 g/kg/week in the extension study. IGHy exposure exceeded 30 months in 48 subjects. During 187.7 subject-years of IGHy exposure, 2005 adverse events (AEs) (10.68 per subject-year) occurred. The rate of related systemic AEs during consecutive 1-year periods remained low; the rate of related local AEs decreased from 3.68/subject-year in months 1–12 to approximately 1.50/subject-year after 30 months of treatment. Fifteen subjects transiently developed anti-rHuPH20 binding antibody. There was no difference in AE rates in these subjects before and after the first titer increase to ≥1:160. The rate of infections during IGHy exposure was 2.99 per subject-year and did not increase during the studies. Annual infection rates were 3.02 in subjects <18 years and 2.98 in subjects ≥18 years. Conclusions Long-term replacement therapy with IGHy was safe and effective in 83 pediatric and adult subjects with PIDD. Electronic supplementary material The online version of this article (doi:10.1007/s10875-016-0298-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Isaac Melamed
- IMMUNOe Clinical Research Center, Centennial, CO, USA
| | - Mark R Stein
- Allergy Associates of the Palm Beaches, North Palm Beach, FL, USA
| | | | | | | | - Jennifer Puck
- University of California San Francisco, San Francisco, CA, USA
| | - Arye Rubinstein
- Allergy & Immunology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Lisa Kobrynski
- Emory Children's Center, Emory University, Atlanta, GA, USA
| | | | | | | | | | - Joseph Church
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - David Gelmont
- Baxalta US Inc., Westlake Village, CA, 91362-3811, USA.
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Wasserman RL, Stein MR, Kobrynski LJ, Gupta S, Grant JA, Rubinstein A, Rabbat CJ, Engl W, McCoy B, Leibl H, Yel L. Efficacy of Recombinant Human Hyaluronidase-Facilitated Subcutaneous Infusion of Immunoglobulin G (IgG) (IGHy) in Patients with Primary Immunodeficiency Disease (PIDD): Infections over Time. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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49
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Affiliation(s)
- R L Wasserman
- University of Texas Southwestern Medical School, Dallas, TX, USA
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50
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Chung SY, Mattison CP, Reed S, Wasserman RL, Desormeaux WA. Treatment with oleic acid reduces IgE binding to peanut and cashew allergens. Food Chem 2015; 180:295-300. [PMID: 25766831 DOI: 10.1016/j.foodchem.2015.02.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/26/2015] [Accepted: 02/12/2015] [Indexed: 01/03/2023]
Abstract
Oleic acid (OA) is known to bind and change the bioactivities of proteins, such as α-lactalbumin and β-lactoglobulin in vitro. The objective of this study was to determine if OA binds to allergens from a peanut extract or cashew allergen and changes their allergenic properties. Peanut extract or cashew allergen (Ana o 2) was treated with or without 5mM sodium oleate at 70°C for 60 min (T1) or under the same conditions with an additional overnight incubation at 37°C (T2). After treatment, the samples were dialyzed and analyzed by SDS-PAGE and for OA content. IgE binding was evaluated by ELISA and western blot, using a pooled serum or plasma from individuals with peanut or cashew allergies. Results showed that OA at a concentration of 5mM reduced IgE binding to the allergens. Peanut sample T2 exhibited a lower IgE binding and a higher OA content (protein-bound) than T1. Cashew allergen T2 also showed a reduction in IgE binding. We conclude that OA reduces the allergenic properties of peanut extract and cashew allergen by binding to the allergens. Our findings indicate that OA in the form of sodium oleate may be potentially useful as a coating to reduce the allergenic properties of peanut and cashew allergens.
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Affiliation(s)
- Si-Yin Chung
- USDA-ARS, Southern Regional Research Center, New Orleans, LA, USA.
| | | | - Shawndrika Reed
- USDA-ARS, Southern Regional Research Center, New Orleans, LA, USA
| | - Richard L Wasserman
- Allergy Immunology Research Center of North Texas, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX 75390, USA
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