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Matsuyama T, Takahashi H, Tada H, Chikamatsu K. Circulating T Cell Subsets and ILC2s are Altered in Patients With Chronic Rhinosinusitis With Nasal Polyps After Dupilumab Treatment. Am J Rhinol Allergy 2022; 37:58-64. [DOI: 10.1177/19458924221132065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is mainly associated with type 2 inflammation and is often unmanageable, regardless of the treatment. Dupilumab, a monoclonal antibody targeting the interleukin (IL)-4 receptor alpha to inhibit IL-4 and IL-13 signaling, has recently been shown to significantly improve the condition of patients with CRSwNP. However, the mechanisms underlying this response to dupilumab are not yet fully understood. Objective We sought to examine whether circulating T cell subset proportions and their functions are altered by dupilumab treatment. Methods We first investigated the proportion of circulating T cell subsets and group 2 innate immune cells (ILC2s) in patients with CRSwNP treated with dupilumab using mass and flow cytometry. We then assessed cytokine gene expression and cytokine production in peripheral blood mononuclear cells (PBMCs) using quantitative reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Results The type 2 T helper (Th2) cell proportion significantly decreased after dupilumab treatment, whereas that of type 1 T helper (Th1) cells increased. Moreover, programmed death-1 (PD-1) expression in regulatory T (Treg) cells was significantly reduced. The proportion of ILC2s significantly increased after dupilumab treatment. Unfortunately, neither cytokine gene expression nor cytokine production in PBMCs showed significant changes. Conclusions Our findings suggest that in CRSwNP patients treated with dupilumab, Th2, Treg, and ILC2 cells, which regulate type 2 inflammation, are modulated in the peripheral circulation. Further analysis of circulating immune cells could provide novel insights into understanding the pathophysiologic mechanisms of dupilumab and the development of tailored therapeutic strategies for patients with CRSwNP.
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Affiliation(s)
- Toshiyuki Matsuyama
- Department of Otolaryngology – Head and Neck Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hideyuki Takahashi
- Department of Otolaryngology – Head and Neck Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroe Tada
- Department of Otolaryngology – Head and Neck Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kazuaki Chikamatsu
- Department of Otolaryngology – Head and Neck Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Fokkens W, Reitsma S. Unified Airway Disease. Otolaryngol Clin North Am 2022; 56:1-10. [DOI: 10.1016/j.otc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Klimek L, Förster-Ruhrmann U, Olze H, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Klimek F, Sperl A, Casper I, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Pfaar O, Gosepath J, Gröger M, Beutner C, Laudien M, Weber RK, Hildenbrand T, Hoffmann AS, Bachert C. Empfehlungen zur Überprüfung der Wirksamkeit und Verlaufsdokumentation von Dupilumab bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2022; 101:855-865. [PMID: 36150698 DOI: 10.1055/a-1908-3074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the nasal and paranasal mucosa. A Type-2 inflammation is described as the most common endotype. Since October 2019 the anti-IL-4/-IL-13 antibody dupilumab has been approved in Germany as an add-on therapy to intranasal corticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps, when systemic corticosteroids alone or surgery do not provide adequate disease control. While recommendations for the use of dupilumab in CRSwNP exist at both national and international levels, until now it has not been adequately established, how therapy should be monitored and when it should be discontinued in the German Health Care System. METHODS A literature search was performed analyzing previous data on the treatment of CRSwNP with dupilumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to 05/2022 were included. RESULTS Based on international literature and previous experience, recommendations are given by an expert panel for follow-up and possible therapy breaks, therapy intervals or termination of therapy when using dupilumab for the indication CRSwNP in the German health care system based on a documentation form. CONCLUSIONS Understanding the immunological basis of CRSwNP opens new non-surgical therapy approaches with biologics for patients with severe courses. The authors give recommendations for follow-up, possible therapy breaks, therapy intervals and a termination for dupilumab treatment as add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP that cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster.,Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Universitätsmedizin Greifswald
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Ruhr-Universität Bochum, St. Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-, Nasen-, Ohren-Heilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - A Sperl
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Mainz
| | - C Bergmann
- Praxis für Hals-, Nasen-, Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - O Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Marburg
| | - J Gosepath
- Klinik für Hals-, Nasen- und Ohrenheilkunde, HSK Wiesbaden
| | - M Gröger
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - M Laudien
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie der Christian-Albrechts-Universität zu Kiel und des Universitätsklinikums Schleswig-Holstein, Campus Kiel
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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Shen Y, Zhang N, Yang Y, Hong S, Bachert C. Local Immunoglobulin E in nasal polyps: Role and modulation. Front Immunol 2022; 13:961503. [PMID: 36159836 PMCID: PMC9492990 DOI: 10.3389/fimmu.2022.961503] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
In the airway, IgE is traditionally regarded as a key mediator in allergic diseases, such as AR and allergic asthma. However, growing evidence demonstrates the importance of local IgE in airway inflammatory diseases, irrespective of the presence of allergy. In this review, we discuss the most recent evidence for IgE in chronic rhinosinusitis with nasal polyps(CRSwNP), including the local IgE’s characteristics, the modulation of its synthesis, and its function. The levels of local IgE are significantly elevated in polyps independently of IgE serum levels and atopic status. Local IgE, which is correlated with type 2 inflammation, is polyclonal and functional. IgE is produced by active B cells and is dependent on the class switch recombination(CSR). In NPs, this process is triggered by not only allergens but also microbial colonization, especially the superantigen- Staphylococcus aureus. The production of local IgE is modulated by lymphocytes(such as Tfh, ILC2s, iTreg), cytokines(such as IL-4, IL-13, IFN-γ, TGF-β, IL-2, IL-21), transcription factors, and B cell-intrinsic factor. Due to the central role of IgE in NPs, it is regarded as an ideal target for therapy and has been proved to be clinically successful. Based on this knowledge, we believe that exploring the trigger and regulatory factors for the activation of local B cells and CSR to IgE will provide more valuable information for us to recognize the pathological mechanisms of local IgE and offer the possible option for new therapeutic targets of nasal polyps.
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Affiliation(s)
- Yang Shen
- Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nan Zhang
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Yucheng Yang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suling Hong
- Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
- Division of Otorhinolaryngology Diseases, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- *Correspondence: Claus Bachert,
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55
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Silva DD, Singh C, Arasi S, Muraro A, Zuberbier T, Ebisawa M, Alvaro Lozano M, Roberts G. Systematic review of monotherapy with biologicals for children and adults with IgE‐mediated food allergy. Clin Transl Allergy 2022; 12:e12123. [PMID: 36204600 PMCID: PMC9515515 DOI: 10.1002/clt2.12123] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/03/2022] [Accepted: 01/29/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | | | | | - Torsten Zuberbier
- Department of Dermatology Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | | | | | - Graham Roberts
- Paediatric Allergy and Respiratory Medicine University of Southampton Southampton UK
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56
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Biological Therapy of Severe Asthma and Nasal Polyps. J Pers Med 2022; 12:jpm12060976. [PMID: 35743760 PMCID: PMC9225008 DOI: 10.3390/jpm12060976] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/03/2023] Open
Abstract
Chronic rhinosinusitis is a common disease worldwide and can be categorized into chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma. Severe asthma is effectively treated with biologics and the coexistence of severe asthma with chronic rhinosinusitis with nasal polyps presents a phenotype that is more likely to respond to such treatment. In this review, we focus on the link between asthma and nasal polyps, and we review the treatment effect of various monoclonal antibodies in patients with severe asthma and nasal polyps as well as in patients with nasal polyps without asthma or with mild-to-moderate asthma. With the enhancement of our armamentarium with new monoclonal antibodies the right choice of biologic becomes an important target and one that is difficult to achieve due to the lack of comparative head-to-head studies.
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57
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Kychygina A, Cassagne M, Tauber M, Galiacy S, Paul C, Fournié P, Simon M. Dupilumab-Associated Adverse Events During Treatment of Allergic Diseases. Clin Rev Allergy Immunol 2022; 62:519-533. [PMID: 35275334 DOI: 10.1007/s12016-022-08934-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 12/12/2022]
Abstract
Among the new biological therapies for atopic diseases, dupilumab is a fully human monoclonal antibody directed against IL-4Rα, the common chain of interleukin-4 and interleukin-13 receptors. Dupilumab showed clinical improvements in patients with atopic dermatitis, asthma, and chronic rhinosinusitis and is currently under development for other indications. While dupilumab is considered to be well tolerated, a number of recent publications have reported various adverse events. This review aims to summarize the current knowledge about these adverse events, which may help clinicians to improve the follow-up of patients on dupilumab. Injection-site reactions are the most common reported adverse event. However, dupilumab has also been shown to cause ophthalmic complications (e.g., dry eyes, conjunctivitis, blepharitis, keratitis, and ocular pruritus), head and neck dermatitis, onset of psoriatic lesions, progression of cutaneous T-cell lymphoma exacerbation, alopecia areata, hypereosinophilia, and arthritis. Most are managed during dupilumab treatment continuation, but some (e.g., severe conjunctivitis) may result in a discontinuation of treatment. Their molecular origin is unclear and requires further investigations. Among other hypothesis, it has been suggested that T helper (Th)2-mediated pathway inhibition may worsen Th1/Th17-dependent immune responses. An ophthalmological examination for the presence of potential predictive indicators of ophthalmic adverse events is recommended before initiation of dupilumab therapy.
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Affiliation(s)
- Anna Kychygina
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France
| | - Myriam Cassagne
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Marie Tauber
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Dermatology, CHU and Toulouse III University, Toulouse, France
| | - Stéphane Galiacy
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Carle Paul
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Dermatology, CHU and Toulouse III University, Toulouse, France
| | - Pierre Fournié
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Michel Simon
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.
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58
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Heffernan A, Phulka J, Thamboo A. Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era. J Otolaryngol Head Neck Surg 2022; 51:22. [PMID: 35606866 PMCID: PMC9128111 DOI: 10.1186/s40463-022-00580-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is an inflammatory disease that may require biological therapy. Omalizumab is an anti-IgE biologic that was recently approved by the FDA and Health Canada for use in severe CRS with nasal polyps (CRSwNP) recalcitrant to intranasal corticosteroids. Dosing is based on weight and pre-treatment serum IgE, with elevated levels of the latter being an indication for biologic treatment according to EPOS and EUFOREA guidelines. The goal of this study was to identify variables that predict IgE-high type 2 inflammation and serve as indicators for biologic treatment in CRS. METHODS Patients ≥ 19 yo diagnosed with CRS undergoing functional endoscopic sinus surgery were included retrospectively. Demographics, past medical history, preoperative blood work, Lund-Mackay (LM), Lund Kennedy (LK), and SNOT-22 scores were extracted. Descriptive statistics and binary logistic regression analyses were conducted. Model superiority was based on Nagelkerke R2 scores and receiver operating characteristic curves. RESULTS Sixty-five patients, average age 49.96 ± 13.59 years, were included. Sixty-one binary logistic regression models for elevated serum IgE were created. Among the top 3 models, the best model had sensitivity, specificity, positive predictive value and negative predictive values of 82.1, 69.2, 80.0, and 72.0. All performance measures except sensitivity exceeded the Canadian Biologics Guideline model. Serum eosinophils ≥ 300 cell/uL, CRSwNP and LM ≥ 17 increased the odds of elevated IgE. CONCLUSIONS IgE-high type-2 inflammation can be predicted by a model that includes eosinophil ≥ 300 cell/uL, CRSwNP, LM ≥ 17, asthma diagnosis and SNOT-22 ≥ 40. Patients meeting these parameters have a high pretest probability for elevated IgE and would benefit from IgE serology to determine qualification for omalizumab. This could reduce unwarranted IgE serology in patients with CRSwNP but also target a patient population for further workup that will lead to optimization of resource allocation and improve healthcare equity in rural and remote areas within Canada.
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Affiliation(s)
- Austin Heffernan
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Jobanjit Phulka
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Andrew Thamboo
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada.
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, BC, Canada.
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59
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Bentabol-Ramos G, Saenz de Santa Maria-Garcia R, Vidal-Diaz M, Eguiluz-Gracia I, Testera-Montes A. The Utility of Nasal Challenges to Phenotype Asthma Patients. Int J Mol Sci 2022; 23:ijms23094838. [PMID: 35563226 PMCID: PMC9104030 DOI: 10.3390/ijms23094838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 12/10/2022] Open
Abstract
Asthma is a heterogeneous disease in terms of both phenotype and response to therapy. Therefore, there is a great need for clinically applicable tools allowing for improved patient classification, and selection for specific management approaches. Some interventions are highly helpful in selected patients (e.g., allergen immunotherapy or aspirin desensitization), but they are costly and/or difficult to implement. Currently available biomarkers measurable in peripheral blood or exhaled air display many limitations for asthma phenotyping and cannot identify properly the specific triggers of the disease (e.g., aeroallergens or NSAID). The united airway concept illustrates the relevant epidemiological and pathophysiological links between the upper and lower airways. This concept has been largely applied to patient management and treatment, but its diagnostic implications have been less often explored. Of note, a recent document by the European Academy of Allergy and Clinical Immunology proposes the use of nasal allergen challenge to confirm the diagnosis of allergic asthma. Similarly, the nasal challenge with lysine acetylsalicylate (L-ASA) can be used to identify aspirin-sensitive asthma patients. In this review, we will summarize the main features of allergic asthma and aspirin-exacerbated respiratory disease and will discuss the methodology of nasal allergen and L-ASA challenges with a focus on their capacity to phenotype the inflammatory disease affecting both the upper and lower airways.
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Affiliation(s)
- Guillermo Bentabol-Ramos
- Pulmonology Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain; (G.B.-R.); (M.V.-D.)
| | | | - Monica Vidal-Diaz
- Pulmonology Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain; (G.B.-R.); (M.V.-D.)
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain; (R.S.d.S.M.-G.); (I.E.-G.)
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA) and RICORS “Enfermedades Inflamatorias”, 29010 Malaga, Spain
| | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain; (R.S.d.S.M.-G.); (I.E.-G.)
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA) and RICORS “Enfermedades Inflamatorias”, 29010 Malaga, Spain
- Correspondence: ; Tel.: +34-951-290-313; Fax: +34-951-290-302
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60
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Borish L, Cohen NA, Chupp G, Hopkins C, Wagenmann M, Sousa AR, Smith SG, Silver J, Yang S, Mayer B, Yancey SW, Chan RH, Fokkens W. Evaluating enrollment and outcome criteria in trials of biologics for chronic rhinosinusitis with nasal polyps. Ann Allergy Asthma Immunol 2022; 129:160-168. [PMID: 35398492 DOI: 10.1016/j.anai.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) generally involves intranasal corticosteroids (INCS) and saline irrigation, followed by short courses of systemic corticosteroids (SCS) or surgery with postoperative medical therapy for patients who do not respond to INCS. However, both SCS use and surgery are associated with a range of adverse effects or complications, have a high recurrence rate, and are unsuitable for some patients. Biologics targeting the underlying pathophysiology are promising treatment alternatives for these patients. Dupilumab, omalizumab, and mepolizumab are approved for use in patients with severe, uncontrolled CRSwNP. However, the lack of a consistent definition of severe CRSwNP makes the decision to initiate biologic treatment particularly complex. Furthermore, the position of each biologic in the overall management of CRSwNP remains to be clarified. DATA SOURCES Publications reporting results of phase III trials of dupilumab, omalizumab, mepolizumab, and benralizumab in the treatment of CRSwNP. STUDY SELECTIONS Randomized, controlled phase III trials of biologics approved for CRSwNP. RESULTS These trials all used different enrollment criteria. We discuss the complexities of assessing CRSwNP disease severity and highlight how these impact comparisons of the populations and outcomes of the phase III biologic trials. CONCLUSION To position biologic agents appropriately within the existing CRSwNP treatment paradigm, future trials will need to include comparable patient populations and standardized outcome measures. Such trials will help to ensure that biologic treatment is targeted appropriately to support optimal clinical outcomes.
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Affiliation(s)
- Larry Borish
- Departments of Medicine and Microbiology, University of Virginia Health System, Charlottesville, Virginia.
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geoffrey Chupp
- Yale Center for Asthma and Airways Disease, Yale School of Medicine, New Haven, Connecticut
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas NHS Foundation Trust, London, UK and King's College London, London, United Kingdom
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ana R Sousa
- Respiratory Clinical Sciences, R&D, GSK House, Brentford, Middlesex, United Kingdom
| | - Steven G Smith
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, North Carolina
| | - Jared Silver
- US Value Evidence & Outcomes, US Medical Affairs-Respiratory, GSK, Research Triangle Park, North Carolina
| | - Shibing Yang
- Value Evidence and Outcomes, GSK, Collegeville, Pennsylvania
| | - Bhabita Mayer
- Clinical Statistics, GSK, GSK House, Brentford, Middlesex, United Kingdom
| | - Steven W Yancey
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, North Carolina
| | - Robert H Chan
- Respiratory Clinical Sciences, R&D, GSK House, Brentford, Middlesex, United Kingdom
| | - Wytske Fokkens
- Department of Otolaryngology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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61
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Lou H, Zhang L. Knowledge Gaps in Using Type 2 Biologics for Real-World Treatment of Chronic Rhinosinusitis with Nasal Polyps. Allergy 2022; 77:1952-1954. [PMID: 35377468 DOI: 10.1111/all.15307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Hongfei Lou
- Department of Otolaryngology, Head and Neck Surgery Beijing Tongren Hospital Capital Medical University Beijing 100730 China
- Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases Beijing Institute of Otorhinolaryngology Beijing 100005 China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100005 China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery Beijing Tongren Hospital Capital Medical University Beijing 100730 China
- Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases Beijing Institute of Otorhinolaryngology Beijing 100005 China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100005 China
- Department of Allergy Beijing Tongren Hospital Capital Medical University Beijing 100730 China
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62
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Boechat JL, Silva D, Sousa‐Pinto B, Delgado L. Comparing biologicals for severe chronic rhinosinusitis with nasal polyps: A network meta-analysis. Allergy 2022; 77:1299-1306. [PMID: 34981835 DOI: 10.1111/all.15205] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/15/2021] [Accepted: 01/02/2022] [Indexed: 12/16/2022]
Affiliation(s)
- José Laerte Boechat
- Clinical Immunology Service Internal Medicine Department Faculty of Medicine Fluminense Federal University Niteroi Brazil
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE) Faculty of Medicine University of Porto Porto Portugal
| | - Diana Silva
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de Imunoalergologia Centro Hospitalar de São João, E.P.E. Porto Portugal
| | - Bernardo Sousa‐Pinto
- Center for Health Technology and Services Research (CINTESIS@RISE) Faculty of Medicine University of Porto Porto Portugal
- MEDCIDS—Department of Community Medicine Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal
| | - Luís Delgado
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE) Faculty of Medicine University of Porto Porto Portugal
- Serviço de Imunoalergologia Centro Hospitalar de São João, E.P.E. Porto Portugal
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63
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Klimek L, Olze H, Förster-Ruhrmann U, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Klimek F, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Bachert C. Positionspapier: Empfehlungen zur Anwendung von Mepolizumab bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC). Laryngorhinootologie 2022; 101:284-294. [PMID: 35168284 DOI: 10.1055/a-1752-8462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the paranasal sinus mucosa with eosinophilic inflammation as the most common endotype. The anti-IL5 antibody mepolizumab was approved for the treatment of severe CRSwNP in the EU in November 2021. METHODS A literature search was performed to analyze the immunology of CRSwNP and determine the available evidence by searching Medline, Pubmed, and the German national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 that investigated the effect of mepolizumab in CRSwNP were considered. RESULTS Based on the international literature and previous experience, recommendations for the use of mepolizumab in CRSwNP in the German health care system are given by an expert panel on the basis of a documentation form. CONCLUSIONS Understanding about the immunological basis of CRSwNP opens new non-surgical therapeutic approaches with biologics for patients with severe courses. Mepolizumab is approved since November 2021 for add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP who cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - U Förster-Ruhrmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik u. Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | | | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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64
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Lans RJLVD, Fokkens WJ, Adriaensen GFJPM, Hoven DR, Drubbel JJ, Reitsma S. Real-life observational cohort verifies high efficacy of dupilumab for chronic rhinosinusitis with nasal polyps. Allergy 2022; 77:670-674. [PMID: 34626497 PMCID: PMC9298295 DOI: 10.1111/all.15134] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 12/30/2022]
Affiliation(s)
| | - Wytske Johanna Fokkens
- Department of Otorhinolaryngology & Head and Neck Surgery Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | | | - Dinand Rienk Hoven
- Department of Otorhinolaryngology & Head and Neck Surgery Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Joekio Jade Drubbel
- Department of Otorhinolaryngology & Head and Neck Surgery Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Sietze Reitsma
- Department of Otorhinolaryngology & Head and Neck Surgery Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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65
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Ogulur I, Pat Y, Ardicli O, Barletta E, Cevhertas L, Fernandez‐Santamaria R, Huang M, Bel Imam M, Koch J, Ma S, Maurer DJ, Mitamura Y, Peng Y, Radzikowska U, Rinaldi AO, Rodriguez‐Coira J, Satitsuksanoa P, Schneider SR, Wallimann A, Zhakparov D, Ziadlou R, Brüggen M, Veen W, Sokolowska M, Baerenfaller K, Zhang L, Akdis M, Akdis CA. Advances and highlights in biomarkers of allergic diseases. Allergy 2021; 76:3659-3686. [PMID: 34519063 PMCID: PMC9292545 DOI: 10.1111/all.15089] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/19/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
During the past years, there has been a global outbreak of allergic diseases, presenting a considerable medical and socioeconomical burden. A large fraction of allergic diseases is characterized by a type 2 immune response involving Th2 cells, type 2 innate lymphoid cells, eosinophils, mast cells, and M2 macrophages. Biomarkers are valuable parameters for precision medicine as they provide information on the disease endotypes, clusters, precision diagnoses, identification of therapeutic targets, and monitoring of treatment efficacies. The availability of powerful omics technologies, together with integrated data analysis and network‐based approaches can help the identification of clinically useful biomarkers. These biomarkers need to be accurately quantified using robust and reproducible methods, such as reliable and point‐of‐care systems. Ideally, samples should be collected using quick, cost‐efficient and noninvasive methods. In recent years, a plethora of research has been directed toward finding novel biomarkers of allergic diseases. Promising biomarkers of type 2 allergic diseases include sputum eosinophils, serum periostin and exhaled nitric oxide. Several other biomarkers, such as pro‐inflammatory mediators, miRNAs, eicosanoid molecules, epithelial barrier integrity, and microbiota changes are useful for diagnosis and monitoring of allergic diseases and can be quantified in serum, body fluids and exhaled air. Herein, we review recent studies on biomarkers for the diagnosis and treatment of asthma, chronic urticaria, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, food allergies, anaphylaxis, drug hypersensitivity and allergen immunotherapy. In addition, we discuss COVID‐19 and allergic diseases within the perspective of biomarkers and recommendations on the management of allergic and asthmatic patients during the COVID‐19 pandemic.
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66
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Hassoun D, Malard O, Barbarot S, Magnan A, Colas L. Type 2 immunity-driven diseases: Towards a multidisciplinary approach. Clin Exp Allergy 2021; 51:1538-1552. [PMID: 34617355 PMCID: PMC9292742 DOI: 10.1111/cea.14029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 12/31/2022]
Abstract
Asthma, atopic dermatitis and chronic rhinoconjunctivitis are highly heterogeneous. However, epidemiologic associations exist between phenotypic groups of patients. Atopic march is one such association but is not the only common point. Indeed, beyond such phenotypes, hallmarks of type 2 immunity have been found in these diseases involving immune dysregulation as well as environmental triggers and epithelial dysfunction. From the canonical Th2 cytokines (IL-4, IL-5, IL-13), new cellular and molecular actors arise, from the epithelium's alarmins to new innate immune cells. Their interactions are now better understood across the different environmental barriers, and slight differences appeared. In parallel, the development of type 2-targeting biotherapies not only raised hope to treat those diseases but also raised new questions regarding their true pathophysiological involvement. Here, we review the place of type 2 immunity in the different phenotypes of asthma, chronic rhinitis, chronic rhinosinusitis and atopic dermatitis, highlighting nuances between them. New hypotheses rising from the use of biotherapies will be discussed along with the uncertainties and unmet needs of this field.
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Affiliation(s)
- Dorian Hassoun
- CHU Nantes, CNRS, INSERM, l'institut du Thorax, Université de Nantes, Nantes, France
| | - Olivier Malard
- Department of Otorhinolaryngology and Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Sébastien Barbarot
- Department of Dermatology, CHU Nantes, UMR 1280 PhAN, INRA, Nantes Université, Nantes, France
| | - Antoine Magnan
- INRAe UMR_S 0892, Hôpital Foch, Université de Versailles Saint-Quentin, Paris Saclay, France
| | - Luc Colas
- Plateforme Transversale d'Allergologie et d'Immunologie Clinique, Institut du Thorax, CHU de Nantes, Nantes, France.,INSERM, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, Nantes Université, ITUN, Nantes, France
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67
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Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis. J Allergy Clin Immunol 2021; 149:1286-1295. [PMID: 34543652 DOI: 10.1016/j.jaci.2021.09.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory condition of the upper airways. Optimal management is unclear. OBJECTIVE We compared the effects of mAbs and aspirin desensitization (ASA-D) for treatment of CRSwNP. METHODS We searched the Medline, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, US Food and Drug Administration, and the European Medicines Agency databases from inception to August 4, 2021, for randomized controlled trials comparing the effects of mAbs and ASA-D for CRSwNP. We conducted network meta-analysis of sinusitis symptoms, heath-related quality of life, rescue oral corticosteroids and surgery, endoscopic and radiologic scores, and adverse events. We used the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach to assess certainty of evidence. PROSPERO CRD42020177334. RESULTS Twenty-nine randomized controlled trials evaluating 8 treatments (n = 3461) were included in the network meta-analysis. Compared to placebo, moderate to high certainty evidence showed that health-related quality of life (SNOT-22) improved with dupilumab (mean difference [MD] -19.91 [95% confidence interval (CI) -22.50, -17.32]), omalizumab (MD -16.09 [95% CI -19.88, -12.30]), mepolizumab (MD -12.89 [95% CI -16.58, -9.19], ASA-D (MD -10.61 [95% CI -14.51, -6.71]), and benralizumab (MD -7.68 [95% CI -12.09, -3.27]). The risk of rescue nasal polyp surgery likely decreased with dupilumab (risk difference [RD] -16.35% [95% CI -18.13, -13.48]), omalizumab (RD -7.40% [95% CI -11.04, -2.43]), mepolizumab (RD -12.33% [95% CI -15.56, -7.22]), and ASA-D (RD -16.00% [95% CI -19.79, 0.21]; all moderate certainty). Comparisons among agents show with moderate to high certainty that dupilumab ranks among the most beneficial for 7 of 7 outcomes, omalizumab for 2 of 7, mepolizumab for 1 of 7, and ASA-D for 1 of 7. CONCLUSIONS Multiple biologics and ASA-D credibly improve patient-important outcomes, with clinically important differences in effects among agents; dupilumab uniquely ranks among the most beneficial for all outcomes studied.
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68
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Lommatzsch M, Stoll P, Winkler J, Zeise‐Wehry D, Tronnier M, Weber M, Virchow JC. Eosinophilic pleural effusion and stroke with cutaneous vasculitis: Two cases of dupilumab-induced hypereosinophilia. Allergy 2021; 76:2920-2923. [PMID: 34047387 DOI: 10.1111/all.14964] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/10/2021] [Accepted: 05/24/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Marek Lommatzsch
- Department of Pneumology and Critical Care Medicine University of Rostock Rostock Germany
| | - Paul Stoll
- Department of Pneumology and Critical Care Medicine University of Rostock Rostock Germany
| | - Jörg Winkler
- Outpatient Clinic for Pneumology and Allergology Leipzig Germany
| | - Daniel Zeise‐Wehry
- Stroke Unit Department of Neurology Helios‐Klinikum Berlin‐Buch Berlin Germany
| | - Michael Tronnier
- Department of Dermatology Helios‐Klinikum Hildesheim Hildesheim Germany
| | - Marc‐André Weber
- Institute of Diagnostic and Interventional Radiology Pediatric Radiology and Neuroradiology University of Rostock Rostock Germany
| | - J. Christian Virchow
- Department of Pneumology and Critical Care Medicine University of Rostock Rostock Germany
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69
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Pfaar O, Klimek L, Hamelmann E, Kleine-Tebbe J, Taube C, Wagenmann M, Werfel T, Brehler R, Novak N, Mülleneisen NK, Becker S, Worm M. COVID-19-Impfungen von Patienten mit Allergien und Typ2-entzündlichen Erkrankungen bei gleichzeitiger Antikörpertherapie (Biologika). ALLERGO JOURNAL 2021; 30:24-33. [PMID: 34393383 PMCID: PMC8349605 DOI: 10.1007/s15007-021-4846-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Oliver Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Sektion für Rhinologie und Allergologie, Baldingerstraße, 35043 Marburg, Germany
| | - Ludger Klimek
- FA für Dermatologie u. Allergologie, Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Eckard Hamelmann
- Kinderzentrum Bethel, Evangelisches Krankenhaus Bielefeld gGmbH, Grenzweg 10, 33617 Bielefeld, Germany
| | - Jörg Kleine-Tebbe
- Dermatologie, Umweltmedizin, Allergie- und Asthmazentrum Westend, Spandauer Damm 130, Haus 9, 14050 Berlin, Germany
| | - Christian Taube
- Direktor d. Abt. f. Pneumologie, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147 Essen, Germany
| | - Martin Wagenmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Med. Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Randolf Brehler
- - Klinik für Hautkrankheiten -, Wilhelm-Univ. Münster, Abtlg. Dermatologie, Von-Esmarch-Str. 58, 48149 Münster, Germany
| | - Natalija Novak
- - Universitätsklinikum Bonn -, Klinik u. Poliklinik f. Dermatologie u. Allergologie, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | | | - Sven Becker
- Universitätsklinik für Hals-, Nasen-, und Ohrenheilkunde, Universitätsklinik Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| | - Margitta Worm
- Klinik für Dermatologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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70
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Briegel I, Felicio-Briegel A, Mertsch P, Kneidinger N, Haubner F, Milger K. Hypereosinophilia with systemic manifestations under dupilumab and possibility of dual benralizumab and dupilumab therapy in patients with asthma and CRSwNP. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4477-4479. [PMID: 34384930 DOI: 10.1016/j.jaip.2021.07.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ignaz Briegel
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), LMU and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Axelle Felicio-Briegel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Germany
| | - Pontus Mertsch
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), LMU and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), LMU and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), LMU and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
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Rupani H, Murphy A, Bluer K, Renwick C, McQuitty P, Jackson DJ, Heaney LG, Chaudhuri R, Menzies-Gow A, Calvert J, Siddiqui S. Biologics in severe asthma: Which one, When and Where? Clin Exp Allergy 2021; 51:1225-1228. [PMID: 34289191 DOI: 10.1111/cea.13989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/03/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Hitasha Rupani
- University Hospitals Southampton NHS Foundation Trust and School of Medicine, University of Southampton, Southampton, UK
| | - Anna Murphy
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Katie Bluer
- Improving Value, Specialised Commissioning NHS England and Improvement, London, UK
| | | | | | - David J Jackson
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust and School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen University Belfast and Belfast Health & Social Care Trust, Belfast, UK
| | - Rekha Chaudhuri
- Gartnavel General Hospital, Glasgow and University of Glasgow, Glasgow, UK
| | | | | | - Salman Siddiqui
- NIHR Biomedical Research Centre (Leicester) and College of Life Sciences, University of Leicester, Leicester, UK
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De Filippo M, Votto M, Licari A, Pagella F, Benazzo M, Ciprandi G, Marseglia GL. Novel therapeutic approaches targeting endotypes of severe airway disease. Expert Rev Respir Med 2021; 15:1303-1316. [PMID: 34056983 DOI: 10.1080/17476348.2021.1937132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Severe asthma and chronic rhinosinusitis (CRS), with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP), are heterogeneous diseases characterized by different mechanistic pathways (endotypes) and variable clinical presentations (phenotypes).Areas covered: This review provides the clinician with an overview of the prevalence and clinical impact of severe chronic upper and lower airways disease and suggests a novel therapeutic approach with biological agents with possible biomarkers. To select relevant literature for inclusion in this review, we conducted a literature search using the PubMed database, using terms 'severe airways disease' AND 'endotype' AND 'treatment.' The literature review was performed for publication years 2010-2020, restricting the articles to humans and English language publications.Expert opinion: The coronavirus disease (COVID-19) pandemic has brought forth many challenges for patients with severe airway disease and healthcare practitioners involved in care. These patients could have an increased risk of developing severe SARS-CoV-2 disease, although treatment with biologics is not associated with a worse prognosis. Eosinopenia on hospital admission plays a key role as a diagnostic and prognostic biomarker.
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Affiliation(s)
- Maria De Filippo
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Martina Votto
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabio Pagella
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Benazzo
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Pfaar O, Klimek L, Hamelmann E, Kleine-Tebbe J, Taube C, Wagenmann M, Werfel T, Brehler R, Novak N, Mülleneisen N, Becker S, Worm M. COVID-19 vaccination of patients with allergies and type-2 inflammation with concurrent antibody therapy (biologicals) - A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI) and the German Society for Applied Allergology (AeDA). Allergol Select 2021; 5:140-147. [PMID: 33842829 PMCID: PMC8028287 DOI: 10.5414/alx02241e] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND After the beginning and during the worldwide pandemic caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), patients with allergic and atopic diseases have felt and still feel insecure. Currently, four vaccines against SARS-CoV-2 have been approved by the Paul Ehrlich Institute in Germany, and vaccination campaigns have been started nationwide. In this respect, it is of utmost importance to give recommendations on possible immunological interactions and potential risks of immunomodulatory substances (monoclonal antibodies, biologicals) during concurrent vaccination with the approved vaccines. MATERIALS AND METHODS This position paper provides specific recommendations on the use of immunomodulatory drugs in the context of concurrent SARS-CoV-2 vaccinations based on current literature. RESULTS The recommendations are covering the following conditions in which biologicals are indicated and approved: 1) chronic inflammatory skin diseases (atopic dermatitis, chronic spontaneous urticaria), 2) bronchial asthma, and 3) chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with atopic dermatitis or chronic spontaneous urticaria are not at increased risk for allergic reactions after COVID-19 vaccination. Nevertheless, vaccination may result in transient eczema exacerbation due to general immune stimulation. Vaccination in patients receiving systemic therapy with biologicals can be performed. Patients with severe asthma and concomitant treatment with biologicals also do not have an increased risk of allergic reaction following COVID-19 vaccination which is recommended in these patients. Patients with CRSwNP are also not known to be at increased risk for allergic vaccine reactions, and continuation or initiation of a treatment with biologicals is also recommended with concurrent COVID-19 vaccination. In general, COVID-19 vaccination should be given within the interval between two applications of the respective biological, that is, with a time-lag of at least 1 week after the previous or at least 1 week before the next biological treatment planned. CONCLUSION Biologicals for the treatment of atopic dermatitis, chronic spontaneous urticaria, bronchial asthma, and CRSwNP should be continued during the current COVID-19 vaccination campaigns. However, the intervals of biological treatment may need to be slightly adjusted (DGAKI/AeDA recommendations as of March 22, 2021).
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg
| | | | - Eckard Hamelmann
- University Hospital for Pediatrics and Adolescent Medicine, Children’s Center Bethel, University of Bielefeld
| | | | - Christian Taube
- Clinic of Pneumology University Hospital Essen – Ruhrlandklinik, Essen
| | - Martin Wagenmann
- Clinic of Otolaryngology, University Hospital Düsseldorf, Düsseldorf
| | - Thomas Werfel
- Department of Dermatology, Allergology and Venerology, Hannover Medical School, Hannover
| | - Randolf Brehler
- Department of Dermatology, Wilhelm University of Münster, Münster
| | | | | | - Sven Becker
- Department of Otorhinolaryngology, University Hospital, Tübingen, and
| | - Margitta Worm
- Allergology and Immunology, Department of Dermatotology, Venereology and Allergology, Charité Universitätsmedizin Berlin, Germany
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