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Kappen JH, Durham SR, Veen HI', Shamji MH. Applications and mechanisms of immunotherapy in allergic rhinitis and asthma. Ther Adv Respir Dis 2016; 11:73-86. [PMID: 27678500 DOI: 10.1177/1753465816669662] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Clinical and immunologic tolerance are hallmarks of successful allergen immunotherapy (AIT). Clinical benefits such as reduced symptoms, pharmacotherapy intake and improvement of quality of life persist following cessation of treatment. Successful AIT is associated with suppression of allergic inflammatory cells such as mast cells, eosinophils and basophils in target organs. Furthermore, AIT down-regulates type 2 innate lymphoid cells and allergen-specific type 2 T-helper (Th2) cells. The immunologic tolerant state following AIT is associated with the induction of distinct phenotypes of regulatory T-cells (T-regs) including interleukin (IL)-10-, IL-35- and transforming growth factor (TGF)-β- producing T-regs and FoxP3+ T-regs. B-cell responses, including the induction of IL-10+ regulatory B-cells (B-regs) and the production of IgG4-associated blocking antibodies are also induced following successful AIT. These events are associated with the suppression of antigen-specific Th2 responses and delayed immune deviation in favour of Th1 type responses. Insight into the mechanisms of AIT has allowed identification of novel biomarkers with potential to predict the clinical response to AIT and also novel therapeutic strategies for more effective and safer AIT.
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Affiliation(s)
- Jasper H Kappen
- Department of Pulmonology, STZ centre of excellence for Asthma & COPD, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Stephen R Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK
| | - Hans In 't Veen
- Department of Pulmonology, STZ centre of excellence for Asthma & COPD, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Mohamed H Shamji
- Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London SW7 2AZ, UK
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Abstract
One key approach to increase the efficacy and the safety of immunotherapy is the use of adjuvants. However, many of the adjuvants currently in use can cause adverse events, raising concerns regarding their clinical use, and are geared toward productive immune responses but not necessarily tolerogenic responses. Thus, novel adjuvants for immunotherapy are needed and are being developed. Essential is their potential to boost appropriate tolerogenic adaptive immune responses to allergens while limiting side effects. This review provides an overview of adjuvants currently in clinical use or under development and discusses their therapeutic effect in enhancing allergen-induced tolerance.
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Abstract
Biomarkers (BMKs) are biological parameters that can be measured to predict or monitor disease severity or treatment efficacy. The induction of regulatory dendritic cells (DCs) concomitantly with a downregulation of proallergic DC2s (ie, DCs supporting the differentiation of T-helper lymphocyte type 2 cells) in the blood of patients allergic to grass pollen has been correlated with the early onset of allergen immunotherapy efficacy. The combined use of omics technologies to compare biological samples from clinical responders and nonresponders is being implemented in the context of nonhypothesis-driven approaches. Such comprehensive "panoromic" strategies help identify completely novel candidate BMKs, to be subsequently validated as companion diagnostics in large-scale clinical trials.
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Affiliation(s)
- Philippe Moingeon
- Research and Development, Stallergenes SA, 6 Rue Alexis de Tocqueville, Antony Cedex 92183, France.
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Bonura A, Vlah S, Longo A, Bulati M, Melis MR, Cibella F, Colombo P. Hydroxytyrosol modulates Par j 1-induced IL-10 production by PBMCs in healthy subjects. Immunobiology 2016; 221:1374-1377. [PMID: 27475990 DOI: 10.1016/j.imbio.2016.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/14/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
Several papers have demonstrated the importance of substances from natural sources which can exert powerful anti-inflammatory effects. In this respect, hydroxytyrosol, one of the major elements of the phenolic components of olive oil, has been extensively studied for its anti-inflammatory activities and safety profile. In this report, we demonstrate that the co-stimulation of human PBMCs from healthy subjects with the Par j 1 allergen and hydroxytyrosol induced a statistically significant increase in the amount of Par j 1-induced IL-10, demonstrating that hydroxytyrosol can modulate an allergen-specific immune response potentiating a suppressive immune response towards an allergen. Our work opens the way to further studies to elaborate the possibility of using hydroxytyrosol as a nutrient for allergy prevention.
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Affiliation(s)
- Angela Bonura
- Istituto di Biomedicina e di Immunologia Molecolare del Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Sara Vlah
- Istituto di Biomedicina e di Immunologia Molecolare del Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Alessandra Longo
- Istituto di Biomedicina e di Immunologia Molecolare del Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Matteo Bulati
- Istituto di Biomedicina e di Immunologia Molecolare del Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Mario R Melis
- Istituto di Biomedicina e di Immunologia Molecolare del Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Fabio Cibella
- Istituto di Biomedicina e di Immunologia Molecolare del Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Paolo Colombo
- Istituto di Biomedicina e di Immunologia Molecolare del Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, 90146 Palermo, Italy.
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Nomura T, Suzuki M, Yokota M, Nakamura Y, Ozeki K, Ito Y, Tsuge I, Saitoh S. Effect of Japanese cedar-specific sublingual immunotherapy on allergen-specific TH2 cell counts in blood. Ann Allergy Asthma Immunol 2016; 117:72-78.e4. [PMID: 27156747 DOI: 10.1016/j.anai.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/20/2016] [Accepted: 04/08/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The contribution of antigen-specific TH cells in peripheral blood to immunologic mechanisms underlying sublingual immunotherapy (SLIT) remains unclear, partly because of the lack of a standardized method for the analysis of this rare lymphocyte subset. OBJECTIVE To clarify the role of antigen-specific TH cells during SLIT using a sensitive method analyzing activation marker CD154-positive TH cells with multicolor flow cytometry. METHODS We assessed antigen-specific TH cells using multicolor flow cytometry based on the expression of the activation marker CD154 and intracellular cytokines in patients with Japanese cedar pollinosis receiving SLIT at baseline and during the first pollen season after the initiation of SLIT. RESULTS A total of 18 patients between 12 and 44 years of age were enrolled in the present study. Of these, 8 patients received SLIT (SLIT group) and 10 patients received symptomatic treatment only (control group). Although seasonal pollen exposure significantly increased the number of Japanese cedar-specific interleukin 5- and interleukin 4-producing TH cells in the control group (P < .01 for both), SLIT ameliorated this increase in the SLIT group (P = .64 and P = .84, respectively). CONCLUSION The present study indicates that allergen-specific TH2 cells in peripheral blood are involved in mechanisms underlying SLIT. The analysis of antigen-specific TH cells using multicolor flow cytometry based on the expression of the activation marker CD154 represents a sensitive and relatively simple, standardized method for monitoring peripheral antigen-specific TH cells during allergen-specific immunotherapy.
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Affiliation(s)
- Takayasu Nomura
- Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
| | - Motohiko Suzuki
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Makoto Yokota
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yoshihisa Nakamura
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kazuyoshi Ozeki
- Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Ikuya Tsuge
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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56
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Schmid JM, Würtzen PA, Dahl R, Hoffmann HJ. Pretreatment IgE sensitization patterns determine the molecular profile of the IgG4 response during updosing of subcutaneous immunotherapy with timothy grass pollen extract. J Allergy Clin Immunol 2016; 137:562-70. [DOI: 10.1016/j.jaci.2015.05.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
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Steveling EH, Lao-Araya M, Koulias C, Scadding G, Eifan A, James LK, Dumitru A, Penagos M, Calderón M, Andersen PS, Shamji M, Durham SR. Protocol for a randomised, double-blind, placebo-controlled study of grass allergen immunotherapy tablet for seasonal allergic rhinitis: time course of nasal, cutaneous and immunological outcomes. Clin Transl Allergy 2015; 5:43. [PMID: 26682038 PMCID: PMC4682243 DOI: 10.1186/s13601-015-0087-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/29/2015] [Indexed: 12/21/2022] Open
Abstract
Background Seasonal Allergic Rhinitis is characterised by inflammation of the nasal mucosa upon exposure to common aeroallergens, affecting up to 20–25 % of the population. For those patients whose symptoms are not controlled by standard medical treatment, allergen specific immunotherapy is a therapeutic alternative. Although several studies have shown changes in immunologic responses as well as long term tolerance following treatment with a sublingual allergy immunotherapy tablet, a detailed time course of the early mechanistic changes of local and systemic T and B cell responses and the effects on B cell repertoire in the nasal mucosa have not been fully examined. Methods/design This is a randomized, double-blind, single-centre, placebo controlled, two arm time course study based in the United Kingdom comparing sublingual allergy immunotherapy tablet (GRAZAX®, ALK-Abello Horsholm, Denmark) plus standard treatment with placebo plus standard treatment. Up to 50 moderate to severe grass pollen allergic participants will be enrolled to ensure randomisation of at least 44. Further, we shall enrol 20 non-atopic volunteers. Screening will be completed before eligible atopic participants are randomised to one of the two treatment arms in a 1 to 1 ratio. The primary endpoint will be the total nasal symptom score assessed over 60 min following grass pollen nasal allergen challenge after 12 months of treatment. Clinical assessments and/or mechanistic analyses on blood, nasal fluid, brushing and biopsies will be performed at baseline at 1, 2, 3, 4 (coinciding with the peak pollen season), 6 and 12 months of treatment. After 12 months of treatment, unblinding will take place. Those atopic participants receiving active treatment will continue therapy for another 12 months followed by a post treatment phase of 12 months. Assessments and collection of biologic samples from these participants will take place again at 24 and at 36 months from the start of treatment. The 20 healthy, non-atopic controls will undergo screening and one visit only coinciding with the 12 month visit for the atopic participants. Discussion The trial will end in April 2017. The trial is registered with ClinicalTrials.gov and the trial identifying number is NCT02005627. Trial registration: Primary Registry: ClinicalTrials.gov, Trial Identifying number: NCT02005627, Secondary identifying numbers: EudraCT number: 2013-003732-72 REC: 13/EM/0351, Imperial College London (Sponsor): 13IC0847, Protocol Version 6.0, Date: 16.05.2014 Electronic supplementary material The online version of this article (doi:10.1186/s13601-015-0087-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther Helen Steveling
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Mongkol Lao-Araya
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Christopher Koulias
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Guy Scadding
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Aarif Eifan
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Louisa K James
- Allergy and Clinical Immunology, Randall Division of Cell and Molecular Biophysics, King's College London, New Hunt's House, Guy's Campus, London, SE1 1UL UK
| | - Alina Dumitru
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Martin Penagos
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Moisés Calderón
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | | | - Mohamed Shamji
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Stephen R Durham
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
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Levin M, King JJ, Glanville J, Jackson KJL, Looney TJ, Hoh RA, Mari A, Andersson M, Greiff L, Fire AZ, Boyd SD, Ohlin M. Persistence and evolution of allergen-specific IgE repertoires during subcutaneous specific immunotherapy. J Allergy Clin Immunol 2015; 137:1535-44. [PMID: 26559321 DOI: 10.1016/j.jaci.2015.09.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/24/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Specific immunotherapy (SIT) is the only treatment with proved long-term curative potential in patients with allergic disease. Allergen-specific IgE is the causative agent of allergic disease, and antibodies contribute to SIT, but the effects of SIT on aeroallergen-specific B-cell repertoires are not well understood. OBJECTIVE We sought to characterize the IgE sequences expressed by allergen-specific B cells and track the fate of these B-cell clones during SIT. METHODS We used high-throughput antibody gene sequencing and identification of allergen-specific IgE with combinatorial antibody fragment library technology to analyze immunoglobulin repertoires of blood and the nasal mucosa from aeroallergen-sensitized subjects before and during the first year of subcutaneous SIT. RESULTS Of 52 distinct allergen-specific IgE heavy chains from 8 allergic donors, 37 were also detected by using high-throughput antibody gene sequencing of blood samples, nasal mucosal samples, or both. The allergen-specific clones had increased persistence, higher likelihood of belonging to clones expressing other switched isotypes, and possibly larger clone size than the rest of the IgE repertoire. Clone members in nasal tissue showed close mutational relationships. CONCLUSION In the future, combining functional binding studies, deep antibody repertoire sequencing, and information on clinical outcomes in larger studies might aid assessment of SIT mechanisms and efficacy.
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Affiliation(s)
- Mattias Levin
- Department of Immunotechnology, Lund University, Lund, Sweden
| | - Jasmine J King
- Department of Biology, Stanford University, Stanford, Calif; Department of Pathology, Stanford University, Stanford, Calif
| | - Jacob Glanville
- Department of Immunology, Stanford University, Stanford, Calif
| | | | | | - Ramona A Hoh
- Department of Pathology, Stanford University, Stanford, Calif
| | - Adriano Mari
- Center for Molecular Allergology, IDI-IRCCS, Rome, Italy; Associated Centers for Molecular Allergology, Rome, Italy
| | - Morgan Andersson
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Lennart Greiff
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Andrew Z Fire
- Department of Pathology, Stanford University, Stanford, Calif; Department of Genetics, Stanford University, Stanford, Calif
| | - Scott D Boyd
- Department of Pathology, Stanford University, Stanford, Calif
| | - Mats Ohlin
- Department of Immunotechnology, Lund University, Lund, Sweden.
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Gueguen C, Bouley J, Moussu H, Luce S, Duchateau M, Chamot-Rooke J, Pallardy M, Lombardi V, Nony E, Baron-Bodo V, Mascarell L, Moingeon P. Changes in markers associated with dendritic cells driving the differentiation of either TH2 cells or regulatory T cells correlate with clinical benefit during allergen immunotherapy. J Allergy Clin Immunol 2015; 137:545-58. [PMID: 26522402 DOI: 10.1016/j.jaci.2015.09.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/27/2015] [Accepted: 09/11/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Regulatory dendritic cell (DC) markers, such as C1Q, are upregulated in PBMCs of patients with grass pollen allergy exhibiting clinical benefit during allergen immunotherapy (AIT). OBJECTIVES We sought to define markers differentially expressed in human monocyte-derived DCs differentiated toward a proallergic (DCs driving the differentiation of TH2 cells [DC2s]) phenotype and investigate whether changes in such markers in the blood correlate with AIT efficacy. METHODS Transcriptomes and proteomes of monocyte-derived DCs polarized toward DCs driving the differentiation of TH1 cells (DC1s), DC2s, or DCs driving the differentiation of regulatory T cells (DCreg cells) profiles were compared by using genome-wide cDNA microarrays and label-free quantitative proteomics, respectively. Markers differentially regulated in DC2s and DCreg cells were assessed by means of quantitative PCR in PBMCs from 80 patients with grass pollen allergy before and after 2 or 4 months of sublingual AIT in parallel with rhinoconjunctivitis symptom scores. RESULTS We identified 20 and 26 new genes/proteins overexpressed in DC2s and DCreg cells, respectively. At an individual patient level, DC2-associated markers, such as CD141, GATA3, OX40 ligand, and receptor-interacting serine/threonine-protein kinase 4 (RIPK4), were downregulated after a 4-month sublingual AIT course concomitantly with an upregulation of DCreg cell-associated markers, including complement C1q subcomponent subunit A (C1QA), FcγRIIIA, ferritin light chain (FTL), and solute carrier organic anion transporter family member 2B1 (SLCO2B1), in the blood of clinical responders as opposed to nonresponders. Changes in such markers were better correlated with clinical benefit than alterations of allergen-specific CD4(+) T-cell or IgG responses. CONCLUSIONS A combination of 5 markers predominantly expressed by blood DCs (ie, C1Q and CD141) or shared with lymphoid cells (ie, FcγRIIIA, GATA3, and RIPK4) reflecting changes in the balance of regulatory/proallergic responses in peripheral blood can be used as early as after 2 months to monitor the early onset of AIT efficacy.
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Affiliation(s)
- Claire Gueguen
- Research and Pharmaceutical Development, Stallergenes, Antony, France
| | - Julien Bouley
- Research and Pharmaceutical Development, Stallergenes, Antony, France
| | - Hélène Moussu
- Research and Pharmaceutical Development, Stallergenes, Antony, France
| | - Sonia Luce
- Research and Pharmaceutical Development, Stallergenes, Antony, France
| | - Magalie Duchateau
- Unité de Spectrométrie de Masse Structurale et Protéomique, Institut Pasteur, Paris, France
| | - Julia Chamot-Rooke
- Unité de Spectrométrie de Masse Structurale et Protéomique, Institut Pasteur, Paris, France
| | - Marc Pallardy
- Université Paris-Sud, INSERM UMR 996, Faculté de Pharmacie, Châtenay-Malabry, France
| | - Vincent Lombardi
- Research and Pharmaceutical Development, Stallergenes, Antony, France
| | - Emmanuel Nony
- Research and Pharmaceutical Development, Stallergenes, Antony, France
| | | | - Laurent Mascarell
- Research and Pharmaceutical Development, Stallergenes, Antony, France
| | - Philippe Moingeon
- Research and Pharmaceutical Development, Stallergenes, Antony, France.
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Holt PG, Strickland D, Bosco A, Belgrave D, Hales B, Simpson A, Hollams E, Holt B, Kusel M, Ahlstedt S, Sly PD, Custovic A. Distinguishing benign from pathologic TH2 immunity in atopic children. J Allergy Clin Immunol 2015; 137:379-87. [PMID: 26518094 DOI: 10.1016/j.jaci.2015.08.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most children with asthma and rhinitis are sensitized to aeroallergens, only a minority of sensitized children are symptomatic, implying the underlying operation of efficient anti-inflammatory control mechanisms. OBJECTIVE We sought to identify endogenous control mechanisms that attenuate expression of IgE-associated responsiveness to aeroallergens in sensitized children. METHODS In 3 independent population samples we analyzed relationships between aeroallergen-specific IgE and corresponding allergen-specific IgG (sIgG) and associated immunophenotypes in atopic children and susceptibility to asthma and rhinitis, focusing on responses to house dust mite and grass. RESULTS Among mite-sensitized children across all populations and at different ages, house dust mite-specific IgG/IgE ratios (but not IgG4/IgE ratios) were significantly lower in children with asthma compared with ratios in those without asthma and lowest among the most severely symptomatic. This finding was mirrored by relationships between rhinitis and antibody responses to grass. Depending on age/allergen specificity, 20% to 40% of children with allergen-specific IgE (sIgE) of 0.35 kU/L or greater had negative skin test responses, and these children also expressed the high sIgG/sIgE immunophenotype. sIgG1 from these children inhibited allergen-induced IgE-dependent basophil activation in a dose-dependent fashion. Profiling of aeroallergen-specific CD4(+) TH memory responses revealed positive associations between sIgG/sIgE ratios and IL-10-dependent gene signatures and significantly higher IL-10/TH2 cytokine (protein) ratios among nonsymptomatic children. CONCLUSION In addition to its role in blocking TH2 effector activation in the late-phase allergic response, IL-10 is a known IgG1 switch factor. We posit that its production during allergen-induced memory responses contributes significantly to attenuation of inflammation through promoting IgG1-mediated damping of the FcεRI-dependent acute-phase reaction. sIgG1/sIgE balance might represent a readily accessible therapeutic target for asthma/rhinitis control.
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Affiliation(s)
- Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia.
| | - Deborah Strickland
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Anthony Bosco
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Danielle Belgrave
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
| | - Belinda Hales
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Angela Simpson
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
| | - Elysia Hollams
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Barbara Holt
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Merci Kusel
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
| | - Peter D Sly
- Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Adnan Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
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Larsen JN, Broge L, Jacobi H. Allergy immunotherapy: the future of allergy treatment. Drug Discov Today 2015; 21:26-37. [PMID: 26327511 DOI: 10.1016/j.drudis.2015.07.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 06/24/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022]
Abstract
Allergic respiratory disease represents a significant and expanding health problem worldwide. Allergic symptoms, such as asthma and hay fever, cause sleep impairment and reduce school and work performance. The cost to society is substantial. Allergen avoidance and pharmacotherapy cannot control the disease. Only allergy immunotherapy has disease-modifying potential and should be included in optimal treatment strategies. Allergy immunotherapy was first administered as subcutaneous injections and has been practiced for the past 100 years or so. Recently, tablet-based sublingual allergy immunotherapy (SLIT) was introduced with comprehensive clinical documentation. SLIT tablets represent a more patient-friendly concept because they can be used for self-treatment at home.
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Shim JU, Lee SE, Hwang W, Lee C, Park JW, Sohn JH, Nam JH, Kim Y, Rhee JH, Im SH, Koh YI. Flagellin suppresses experimental asthma by generating regulatory dendritic cells and T cells. J Allergy Clin Immunol 2015; 137:426-35. [PMID: 26303344 DOI: 10.1016/j.jaci.2015.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/03/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the hygiene hypothesis suggests that microbial infections could subvert asthma and thus a microbial product might serve as a therapeutic adjuvant for asthma, the relationship between bacterial components and asthma is complex. Recently, low levels of flagellin, the Toll-like receptor (TLR) 5 ligand, have been reported to promote asthma. OBJECTIVE We show that a therapeutic dose of flagellin suppresses asthma and that the effect occurs through generating regulatory dendritic cells (rDCs) and regulatory T (Treg) cells. METHODS Ovalbumin (OVA)-induced wild-type and TLR5 knockout asthmatic mice were treated intranasally with a mixture of OVA and 10 μg of a flagellin B (FlaB; of Vibrio vulnificus). OVA/FlaB-treated rDCs were adoptively transferred to mice with OVA-induced asthma. Anti-CD25 mAb was used to deplete Treg cells. A mixture of house dust mite (HDM) and FlaB was used to treat mice with HDM-induced asthma. Blood CD14(+) monocyte-derived dendritic cells from HDM-sensitive asthmatic patients were treated with FlaB and incubated with autologous CD4(+) T cells. RESULTS An OVA/FlaB mixture ameliorated OVA-induced asthma by inhibiting TH1/TH2/TH17 responses in a TLR5-dependent manner through generating rDCs and Treg cells. The adoptive transfer of OVA/FlaB-treated dendritic cells inhibited OVA-induced asthma, whereas the depletion of CD25(+) cells eliminated the inhibitory effect. A similar effect of FlaB was observed in mice with HDM-induced asthma. In patients with HDM-sensitive asthma, FlaB-treated rDCs inhibited HDM-stimulated TH1/TH2 responses while enhancing Treg cells in an IL-10-dependent manner. CONCLUSION These findings collectively suggest that flagellin could be used as a tolerogenic adjuvant to treat allergic asthma.
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Affiliation(s)
- Jae-Uoong Shim
- Division of Allergy, Asthma and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Shee Eun Lee
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Won Hwang
- School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Korea; Academy of Immunology and Microbiology (AIM), Institute for Basic Science (IBS), Pohang, Korea
| | - Changhon Lee
- Academy of Immunology and Microbiology (AIM), Institute for Basic Science (IBS), Pohang, Korea; Division of Integrative Biosciences and Biotechnology (IBB), Pohang University of Science and Technology, Pohang, Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Ho Sohn
- Division of Allergy and Immunology, Department of Internal Medicine and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Nam
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Joon Haeng Rhee
- Clinical Vaccine R&D Center, National Research Laboratory of Molecular Microbial Pathogenesis, Research Institute for Vibrio Infections, Department of Microbiology, Chonnam National University Medical School, Gwangju, Korea.
| | - Sin-Hyeog Im
- Academy of Immunology and Microbiology (AIM), Institute for Basic Science (IBS), Pohang, Korea; Division of Integrative Biosciences and Biotechnology (IBB), Pohang University of Science and Technology, Pohang, Korea.
| | - Young-Il Koh
- Division of Allergy, Asthma and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
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Baker CAR, Swainson L, Lin DL, Wong S, Hartigan-O'Connor DJ, Lifson JD, Tarantal AF, McCune JM. Exposure to SIV in utero results in reduced viral loads and altered responsiveness to postnatal challenge. Sci Transl Med 2015; 7:300ra125. [PMID: 26268312 PMCID: PMC5100009 DOI: 10.1126/scitranslmed.aac5547] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
HIV disease progression appears to be driven by increased immune activation. Given observations that fetal exposure to infectious pathogens in utero can result in reduced immune responses, or tolerance, to those pathogens postnatally, we hypothesized that fetal exposure to HIV may render the fetus tolerant to the virus, thus reducing damage caused by immune activation during infection later in life. To test this hypothesis, fetal rhesus macaques (Macaca mulatta) were injected with the attenuated virus SIVmac1A11 in utero and challenged with pathogenic SIVmac239 1 year after birth. SIVmac1A11-injected animals had significantly reduced plasma RNA viral loads (P < 0.02) up to 35 weeks after infection. Generalized estimating equations analysis was performed to identify immunologic and clinical measurements associated with plasma RNA viral load. A positive association with plasma RNA viral load was observed with the proportion of CD8(+) T cells expressing the transcription factor, FoxP3, and the proportion of CD4(+) T cells producing the lymphoproliferative cytokine, IL-2. In contrast, an inverse relationship was found with the frequencies of circulating CD4(+) and CD8(+) T cells displaying intermediate expression of the proliferation marker, Ki-67. Animals exposed to simian immunodeficiency virus (SIV) in utero appeared to have enhanced SIV-specific immune responses, a lower proportion of CD8(+) T cells expressing the exhaustion marker PD-1, and more circulating TH17 cells than controls. Although the development of tolerance was not demonstrated, these data suggest that rhesus monkeys exposed to SIVmac1A11 in utero had distinct immune responses associated with the control of viral replication after postnatal challenge.
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Affiliation(s)
- Chris A R Baker
- Graduate Group in Infectious Diseases and Immunity, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA. Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Louise Swainson
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Din L Lin
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Samson Wong
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Dennis J Hartigan-O'Connor
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA 94110, USA. Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA 95616, USA. California National Primate Research Center, Davis, CA 95616, USA
| | - Jeffrey D Lifson
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, MD 21702, USA
| | - Alice F Tarantal
- Center for Fetal Monkey Gene Transfer for Heart, Lung, and Blood Diseases, California National Primate Research Center, Davis, CA 95616, USA. Department of Pediatrics, University of California, Davis, Davis, CA 95616, USA. Department of Cell Biology and Human Anatomy, University of California, Davis, Davis, CA 95616, USA
| | - Joseph M McCune
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA 94110, USA.
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Patil SU, Ogunniyi AO, Calatroni A, Tadigotla VR, Ruiter B, Ma A, Moon J, Love J, Shreffler WG. Peanut oral immunotherapy transiently expands circulating Ara h 2-specific B cells with a homologous repertoire in unrelated subjects. J Allergy Clin Immunol 2015; 136:125-134.e12. [PMID: 25985925 PMCID: PMC4494892 DOI: 10.1016/j.jaci.2015.03.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/16/2015] [Accepted: 03/12/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Peanut oral immunotherapy (PNOIT) induces persistent tolerance to peanut in a subset of patients and induces specific antibodies that might play a role in clinical protection. However, the contribution of induced antibody clones to clinical tolerance in PNOIT is unknown. OBJECTIVE We hypothesized that PNOIT induces a clonal, allergen-specific B-cell response that could serve as a surrogate for clinical outcomes. METHODS We used a fluorescent Ara h 2 multimer for affinity selection of Ara h 2-specific B cells and subsequent single-cell immunoglobulin amplification. The diversity of related clones was evaluated by means of next-generation sequencing of immunoglobulin heavy chains from circulating memory B cells with 2x250 paired-end sequencing on the Illumina MiSeq platform. RESULTS Expression of class-switched antibodies from Ara h 2-positive cells confirms enrichment for Ara h 2 specificity. PNOIT induces an early and transient expansion of circulating Ara h 2-specific memory B cells that peaks at week 7. Ara h 2-specific sequences from memory cells have rates of nonsilent mutations consistent with affinity maturation. The repertoire of Ara h 2-specific antibodies is oligoclonal. Next-generation sequencing-based repertoire analysis of circulating memory B cells reveals evidence for convergent selection of related sequences in 3 unrelated subjects, suggesting the presence of similar Ara h 2-specific B-cell clones. CONCLUSIONS Using a novel affinity selection approach to identify antigen-specific B cells, we demonstrate that the early PNOIT-induced Ara h 2-specific B-cell receptor repertoire is oligoclonal and somatically hypermutated and shares similar clonal groups among unrelated subjects consistent with convergent selection.
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Affiliation(s)
- Sarita U. Patil
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Food Allergy Center, Massachusetts General Hospital and MassGeneral Hospital for Children
- Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, Cambridge, MA
| | - Adebola O. Ogunniyi
- Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, Cambridge, MA
| | | | | | - Bert Ruiter
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Food Allergy Center, Massachusetts General Hospital and MassGeneral Hospital for Children
| | - Alex Ma
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - James Moon
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - J.Christopher Love
- Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, Cambridge, MA
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard Medical School
| | - Wayne G. Shreffler
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Food Allergy Center, Massachusetts General Hospital and MassGeneral Hospital for Children
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Takahashi M, Taniuchi S, Soejima K, Hatano Y, Yamanouchi S, Kaneko K. Successful desensitization in a boy with severe cow's milk allergy by a combination therapy using omalizumab and rush oral immunotherapy. Allergy Asthma Clin Immunol 2015; 11:18. [PMID: 26064142 PMCID: PMC4461908 DOI: 10.1186/s13223-015-0084-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Rush oral immunotherapy (OIT) combined with omalizumab (OMB) has been reported to be an effective and safe treatment for severe milk allergies. However, no report has described long-term follow-up observations after OMB discontinuation. The purpose of this case report was to evaluate the safety and efficacy of rush OIT in combination with OMB during a long period of treatment. Case presentation A 5-year-old boy presented with a past history of two severe episodes of anaphylaxis (at the age of 2 and 3 years) after consuming small amounts of cow’s milk (CM). Before the OIT, the total immunoglobulin E (IgE) level was 654 IU/mL, and specific-IgE (sIgE) levels for CM, casein, and β-lactoglobulin were 77.0 kUA/L, 86.2 kUA/L and 12.0 kUA/L, respectively. The skin prick test (SPT) for CM showed a wheal (diameter, 20 mm) and erythema (diameter, 50 mm). In the open food challenge, he reacted to a 0.2 mL ingestion of CM and presented with dyspnea and laryngospasms, and he was then administrated 150 mg OMB every 2 weeks for 8 weeks. In the 9th week, he was admitted to hospital for the rush phase of the OIT. Once he was able ingest a dose of 200 mL CM without having an adverse reaction, he was discharged and allowed to continue a daily dose of 200 mL CM at home. During this phase, the sIgE levels were elevated, but the end-point titration values from the SPT gradually decreased, and the SPT was negative after 1 year of OMB treatment. Five months after discontinuation of OMB, the daily CM ingestion was ceased for a 2-week period, followed by an oral food challenge (OFC) that was negative. The patient experienced only five mild adverse events during the course of rush OIT, even after the discontinuation of OMB and his quality of life improved dramatically afterwards. Conclusions The combination therapy of rush OIT and OMB successfully maintained desensitization to CM in a boy with severe allergies. We propose that a negative SPT may be useful to guide discontinuation of OMB in such patients.
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Affiliation(s)
- Masaya Takahashi
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka 573-1191 Japan
| | - Shoichiro Taniuchi
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka 573-1191 Japan
| | - Kazuhiko Soejima
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka 573-1191 Japan
| | - Yasuko Hatano
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka 573-1191 Japan
| | - Sohsaku Yamanouchi
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka 573-1191 Japan
| | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka 573-1191 Japan
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Yeh YC, Yen HR, Jiang RS, Wang RC, Huang WC, Chen SC, Lin BS, Liang KL. Dose-response relationship of specific allergen exposure-induced immunological tolerance: a mouse model. Int Forum Allergy Rhinol 2015; 5:784-93. [PMID: 26010206 DOI: 10.1002/alr.21551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 03/22/2015] [Accepted: 04/14/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is believed that adequate allergen preimmunization exposure could induce immunologic tolerance. The purpose of this study was to investigate the dose-dependent mechanisms related to antigen-specific tolerance induction in a mouse model. METHODS Mice were assigned to 5 groups: the control (Cont) group received phosphate-buffered saline (PBS) preimmunization exposure and PBS sham immunization; the other 4 groups were exposed preimmunization to PBS (PBS group) or ovalbumin (OVA) (first mucosal doses: 1.25%, 2.5%, or 5% wt/vol aerosol from days -3 to -1) prior to OVA immunization. The OVA-immunized mice received intraperitoneal doses of 20 μg OVA (on days 1, 7, and 14), and then a second set of mucosal doses with 0.5% wt/vol OVA aerosol (on days 18 to 20). After assessment of airway hyperresponsiveness (AHR), the mice were euthanized and their blood, bronchoalveolar lavage fluids (BALFs), and lung tissues were collected for further analyses. RESULTS OVA-immunized mice exposed to OVA preimmunization had reduced AHR and immunoglobulin E production when compared to the PBS group. OVA preimmunization exposure inhibited eosinophilic inflammation in lung tissues. The proportions of BALF eosinophil counts from the groups exposed to OVA preimmunization were significantly decreased when compared with those exposed to PBS preimmunization. The balance of T helper 2 (Th2) and T regulatory (Treg) cytokines in BALFs were additionally observed in this mouse model. CONCLUSION Our results suggest that preimmunization exposure to an appropriate dose of a specific antigen could suppress allergic airway inflammation by induction of immunological tolerance.
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Affiliation(s)
- Yueh-Chiao Yeh
- Department of Natural Biotechnology, Nanhua University, Chiayi, Taiwan
| | - Hung-Rong Yen
- Research Center for Traditional Chinese Medicine, Department of Medical Research and Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Research Center for Chinese Medicine and Acupuncture, and School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Rong-San Jiang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ren-Ching Wang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wan-Chun Huang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shyh-Chang Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Bo-Shiou Lin
- Research Center for Chinese Medicine and Acupuncture, and School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Kai-Li Liang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, National Yang-Ming Medical University, Taipei, Taiwan
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Fox EM, Torrero MN, Evans H, Mitre E. Immunologic characterization of 3 murine regimens of allergen-specific immunotherapy. J Allergy Clin Immunol 2015; 135:1341-51.e1-7. [DOI: 10.1016/j.jaci.2014.07.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 07/22/2014] [Accepted: 07/28/2014] [Indexed: 02/03/2023]
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Wollmann E, Lupinek C, Kundi M, Selb R, Niederberger V, Valenta R. Reduction in allergen-specific IgE binding as measured by microarray: A possible surrogate marker for effects of specific immunotherapy. J Allergy Clin Immunol 2015; 136:806-809.e7. [PMID: 25913196 PMCID: PMC4559138 DOI: 10.1016/j.jaci.2015.02.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 01/22/2015] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Eva Wollmann
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Christian Lupinek
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Michael Kundi
- Institute of Environmental Health, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Regina Selb
- Department of Ear, Nose and Throat Diseases, Medical University of Vienna, Vienna, Austria
| | - Verena Niederberger
- Department of Ear, Nose and Throat Diseases, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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Potter PC, Baker S, Fenemore B, Nurse B. Clinical and cytokine responses to house dust mite sublingual immunotherapy. Ann Allergy Asthma Immunol 2015; 114:327-34. [PMID: 25661658 DOI: 10.1016/j.anai.2014.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/28/2014] [Accepted: 12/22/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cytokine responses accompanying sublingual immunotherapy (SLIT) responder phenotypes have not previously been reported. OBJECTIVE To investigate clinical and cytokine responses of house dust mite (HDM) sensitive patients with allergic rhinitis receiving HDM SLIT or placebo for 2 years. METHODS Sixty adults were randomized to receive SLIT or placebo. Clinical symptoms were measured using the Total 5 Symptom Score (TSS5) and Juniper Rhinitis Quality of Life Questionnaire. HDM specific IgE, IgG, skin prick tests, and HDM-stimulated release of interleukin (IL) 5 and interferon γ (IFN-γ) in peripheral blood mononuclear cells was studied at 0, 6, 12, and 24 months and IL-13, IL-4, and IL-10 at 0 and 24 months. RESULTS A total of 32 of 39 SLIT and 16 of 21 placebo patients completed the study. There was significant clinical improvement in both the SLIT and placebo groups. Median T5SS decreased from 14.75 to 5.25 in the SLIT group (P < .001) and 12.7 to 6.0 in the placebo group (P = .003). The median quality-of-life score also decreased in the SLIT group (P < .001) and the placebo group (P < .001). A subgroup analysis of patients found a 60% or greater improvement (on the T5SS and the Juniper Rhinitis Quality of Life Questionnaire) in the good responders group and a 30% to 59% improvement or no improvement in the intermediate responders group. This subgroup analysis also found more good responders in the SLIT group (47%) compared with the placebo group (25%; P = .07). Significant decreases in the IL-5/IFN-γ (P < .001), IL-13/IFN-γ (P < .001), and IL-4/IFN-γ (P = .03) ratios were found in the combined good clinical improvement group at 24 months. CONCLUSION A good clinical response (≥60% improvement in both TSS5 and quality of life) is associated with significant decreases in IL-5, IL-13, and IL-4 relative to IFN-γ during 2 years of SLIT therapy for HDMs.
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Affiliation(s)
- Paul C Potter
- Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
| | - Sheila Baker
- Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Bartha Fenemore
- Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Barbara Nurse
- Division of Immunology, National Health Laboratory Service and Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa
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Dioszeghy V, Mondoulet L, Dhelft V, Ligouis M, Puteaux E, Dupont C, Benhamou PH. The regulatory T cells induction by epicutaneous immunotherapy is sustained and mediates long-term protection from eosinophilic disorders in peanut-sensitized mice. Clin Exp Allergy 2015; 44:867-81. [PMID: 24666588 PMCID: PMC4233996 DOI: 10.1111/cea.12312] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 03/01/2014] [Accepted: 03/12/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Allergen-specific immunotherapy favours immune deviation from a Th2 to a Th1 response and increases the number of regulatory T cells (Tregs). Epicutaneous immunotherapy (EPIT) of sensitized mice decreases the clinical and the allergen-specific Th2 responses and increases local and peripheral Foxp3(+) Tregs. OBJECTIVE To investigate the role of Tregs in EPIT and characterize their phenotype and maintenance following EPIT. METHODS Tregs were investigated using in vivo depletion or adoptive transfer into BALB/c mice. Tregs were depleted using anti-CD25 antibody injection during EPIT, and allergen-specific responses were compared with Sham, EPIT alone and naïve mice. To demonstrate that Tregs can mediate protection by their own, and to study their maintenance following the end of EPIT, CD25(+) CD4(+) Tregs isolated from mice just after or 8 weeks after EPIT were transferred into peanut-sensitized mice. Foxp3-IRES-mRFP mice were transferred with EPIT-induced Tregs to analyse the induction of host Tregs. RESULTS The anti-CD25 antibody injection to EPIT mice abrogated the induction of Tregs in spleen and the expression of Foxp3 in oesophagus. This resulted in levels of peanut-induced eosinophilic infiltration in oesophagus similar to Sham and significantly higher than EPIT. Whereas the transfer of Tregs from Sham-treated mice demonstrated no effect, the transfer of Tregs isolated just after EPIT prevented peanut-induced eosinophil infiltration and eotaxin expression and induced Foxp3 in oesophagus. The transfer of Tregs isolated 8 weeks after EPIT suppressed allergen-specific responses as efficiently as did Tregs isolated just after EPIT and increased spleen Foxp3(+) CD25(+) CD4(+) cells similarly. The use of reporter mice demonstrated an increase in host Tregs. CONCLUSIONS These results confirm the Tregs-mediated mechanism of EPIT and demonstrate the persistence of efficient Tregs during a long period of time after treatment cessation. This suggests that EPIT induces long-term tolerance in peanut-sensitized mice.
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Immunotherapy for house dust mite sensitivity: where are the knowledge gaps? Curr Allergy Asthma Rep 2014; 14:482. [PMID: 25354663 DOI: 10.1007/s11882-014-0482-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
House dust mites (HDMs) are found in the environments where human habitation exists. Their density is dependent on environmental relative humidity; therefore, higher populations are present in areas of the world with higher humidity levels, e.g., coastal areas and tropics. To date, 24 HDM allergens have been identified. Many of these represent digestive enzymes since HDM feces are the major source of allergen exposure. IgE- medicated sensitization to HDM allergens is an important factor in the pathogenesis of allergic diseases since it is the most common aeroallergen detected by skin testing or in vitro IgE assays. Sensitization to HDM allergens often occurs early in life and appears to play an important role in the progression from allergic rhinitis to asthma (the so-called Allergic March) in children. HDM sensitization is also associated with asthma across all age groups. Efforts to control environmental exposure to HDM allergens have often proven to be unsuccessful. While medications can improve symptoms, only immunotherapy currently provides disease-modifying effects in allergic rhinitis and asthma. Several systemic reviews and meta-analysis indicate that both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are effective in the treatment of allergic rhinitis and asthma for HDM sensitivity. In this report, we review recent studies and the evidence for the use of HDM SCIT and SLIT. Fundamental gaps in knowledge are identified which could lead to improved approaches to HDM allergy.
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Klimek L, Uhlig J, Mösges R, Rettig K, Pfaar O. A high polymerized grass pollen extract is efficacious and safe in a randomized double-blind, placebo-controlled study using a novel up-dosing cluster-protocol. Allergy 2014; 69:1629-38. [PMID: 25130503 PMCID: PMC4238814 DOI: 10.1111/all.12513] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cluster immunotherapy represents an interesting alternative to conventional up-dosing schedules because it allows achieving the maintenance dose within a shorter time interval. In this study, the efficacy and safety of cluster immunotherapy with a high polymerized allergen extract of a grass/rye pollen mixture have been evaluated in a randomized, double-blind, placebo-controlled, multicenter study. METHODS In total, 121 patients with allergic rhinoconjunctivitis due to grass pollen were randomized 1 : 1 to verum or placebo group. A short cluster up-dosing schedule of only 1 week was applied to achieve the maintenance dose which was administered monthly during the study period of 1 year. Total combined symptom and medication score (TCS) was defined as primary outcome parameter. Secondary outcome parameters were individual symptom and medication scores, 'well days,' global improvement as well as immunological effects and nasal allergen challenge. The safety profile was evaluated based on the European academy of allergy and clinical immunology grading system. RESULTS Significant reduction in the verum compared to the placebo group (intention-to-treat, population, verum: n = 55; placebo: n = 47) was found regarding TCS (P = 0.005), rhinoconjunctivitis total symptom score (RTSS, P = 0.006), and total rescue medication score (TRMS, P = 0.002). Additionally, secondary outcomes such as 'well days,' nasal challenge results, and increase of specific IgG4 were in favor of the active treatment. All systemic adverse reactions (0.8% of all injections in the verum group) were of mild intensity. No severe reactions related to the study medication were observed. CONCLUSION Cluster immunotherapy with high polymerized grass pollen extracts resulted in significant clinical efficacy and has been shown to be a safe treatment for grass pollen-allergic patients.
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Affiliation(s)
- L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
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Szépfalusi Z, Bannert C, Ronceray L, Mayer E, Hassler M, Wissmann E, Dehlink E, Gruber S, Graf A, Lupinek C, Valenta R, Eiwegger T, Urbanek R. Preventive sublingual immunotherapy in preschool children: first evidence for safety and pro-tolerogenic effects. Pediatr Allergy Immunol 2014; 25:788-95. [PMID: 25406682 PMCID: PMC6597351 DOI: 10.1111/pai.12310] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prevention of new IgE sensitizations has been described during allergen-specific immunotherapy. However, prospective data using a preventive approach in very young children who would benefit most are missing. We initiated a prospective pilot study investigating the safety, immunomodulatory, and sensitization-preventive effect of sublingual immunotherapy (SLIT) in mono/oligoclonally sensitized, clinically asymptomatic children 2-5 yr of age. METHODS In this double-blinded, randomized, placebo-controlled pilot study, 31 mono-/oligosensitized children to house-dust mite or grass pollen were included. SLIT with the respective source (n = 15) or placebo (n = 16) was applied. After dose-up-phase therapy was continued for 2 yr. Parents recorded clinical events, vaccinations, and drug intake in a diary. Skin prick testing and specific IgE and IgG measurements were recorded at baseline, 12 and 24 months. At the same time, allergen-specific proliferation and IL10- and TGFβ-dependent Treg function were measured. RESULTS Preventive application of SLIT in young children was safe (no relevant side effects in 21,170 single applications). After 12 and 24 months of treatment, the rate of allergen-specific sensitization (specific IgE and SPT reactivity) was comparable in the treatment and the placebo group. However, verum-treated patients displayed a significant up-regulation of allergen-specific IgG (p < 0.05). Furthermore, IL10-dependent inhibition (p < 0.05) was observed in vitro in the treatment group but not in the placebo group. CONCLUSION Preventive SLIT is safe in children 2-5 yr of age and induces regulatory mechanisms involving allergen-specific IgG and IL10. Based on this pilot study, large-scale trials will need to investigate the modulation of sensitization and clinically relevant allergy.
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Affiliation(s)
- Zsolt Szépfalusi
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
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van Rijt LS, Gouveia L, Logiantara A, Canbaz D, Opstelten DJ, van der Kleij HPM, van Ree R. Birch pollen immunotherapy in mice: inhibition of Th2 inflammation is not sufficient to decrease airway hyper-reactivity. Int Arch Allergy Immunol 2014; 165:128-39. [PMID: 25412572 DOI: 10.1159/000368777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Suppression of Th2 cytokine production by allergen-specific Th2 cells is considered to be critical for the suppression of allergic symptoms by subcutaneous immunotherapy. The aim of this study was to develop a mouse model for birch pollen (BP) immunotherapy to elucidate the underlying mechanisms that contribute to the improvement of clinical symptoms. METHODS Mice with BP-induced allergic airway inflammation received weekly subcutaneous immunotherapy (SCIT) injections with BP extract (BPE) adsorbed to alum. The effect of an increasing dose of BPE adsorbed to a fixed concentration of alum on the suppression of airway inflammation and airway hyper-responsiveness (AHR) was determined. After 2, 4, 6 or 8 immunotherapy injections, the mice were rechallenged with the same allergen and all hallmarks of allergic asthma were evaluated. RESULTS Suppression of the immunological parameters by immunotherapy was dependent on the BPE dose. Two injections were sufficient to suppress IL-4, IL-5, IL-13, IL-10 and IFN-γ production, eosinophil recruitment and peribronchial inflammatory infiltrates. BP-specific immunoglobulins were upregulated, but this was not sufficient to reduce AHR. Eight injections were needed to suppress AHR. The gradual reduction in AHR was inversely associated with the increase of BP IgG2a. CONCLUSIONS BP SCIT induces an early suppression of Th2-mediated eosinophilic airway inflammation, but AHR is only effectively reduced after continued SCIT conceivably by allowing IgG2a antibody titres to build up.
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Affiliation(s)
- Leonie S van Rijt
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands
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75
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Creticos PS. Advances in synthetic peptide immuno-regulatory epitopes. World Allergy Organ J 2014; 7:30. [PMID: 25396029 PMCID: PMC4230367 DOI: 10.1186/1939-4551-7-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
Synthetic peptide immuno-regulatory epitopes (SPIRE) represent a new class of therapeutics for allergen immunotherapy that offer the potential to suppress the IgE-mediated allergic disease process through induction of T-cell tolerance. These synthetic T-cell-tolerizing peptides have been designed to induce immunologic tolerance via binding to MHC class II molecules on antigen presenting cells, with subsequent upregulation of regulatory T-cells.
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Affiliation(s)
- Peter Socrates Creticos
- Creticos Research Group, Crownsville, Maryland USA ; Division of Allergy & Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
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76
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Lockey RF. Historical perspectives of allergy and immunology and allergen immunotherapy. Ann Allergy Asthma Immunol 2014; 113:587-92. [PMID: 25454016 DOI: 10.1016/j.anai.2014.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Richard F Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida.
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77
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Lao-Araya M, Steveling E, Scadding GW, Durham SR, Shamji MH. Seasonal increases in peripheral innate lymphoid type 2 cells are inhibited by subcutaneous grass pollen immunotherapy. J Allergy Clin Immunol 2014; 134:1193-5.e4. [PMID: 25212194 DOI: 10.1016/j.jaci.2014.07.029] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/30/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Mongkol Lao-Araya
- Allergy and Clinical Immunology, Section Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Esther Steveling
- Allergy and Clinical Immunology, Section Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Guy W Scadding
- Allergy and Clinical Immunology, Section Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Stephen R Durham
- Allergy and Clinical Immunology, Section Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Mohamed H Shamji
- Allergy and Clinical Immunology, Section Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
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78
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Baiula M, Spampinato S. Phase II drugs under investigation for allergic conjunctivitis. Expert Opin Investig Drugs 2014; 23:1671-86. [DOI: 10.1517/13543784.2014.944640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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79
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Mari A, Antonietta Ciardiello M, Passalacqua G, Vliagoftis H, Wardlaw AJ, Wickman M. Developments in the field of allergy in 2012 through the eyes of Clinical & Experimental Allergy. Clin Exp Allergy 2014; 43:1309-32. [PMID: 24118214 DOI: 10.1111/cea.12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In 2012, we received 683 submissions and published 20 editorials, 38 reviews, 11 letters and 128 original articles. This represents an acceptance rate for original papers in the range of 20%. About 30% of original papers were triaged not to go out to review, either because the editors did not feel they had sufficient priority for publication or because the topic did not feel right for the readers of the journal. We place great emphasis on obtaining sufficient high-quality reviews to make our decisions on publication fair and consistent. Inevitably, however, there is a degree of luck about what gets published and which papers miss out, and we are always happy to receive an appeal on our decisions either at the triage stage or after review. This gives us the opportunity to revisit the decision and revise it or explain in more detail to the authors the basis for the decision. Once again in 2012, we were delighted by the quality of the papers submitted and the breadth and depth of research into allergic disease that it revealed. The pattern of papers submitted was similar in previous years with considerable emphasis on all aspects of asthma and rhinitis. We were particularly pleased with our special issue on severe asthma. Elucidating mechanisms using either animal models or patients has always been a major theme of the journal, and the excellent work in these areas has been summarized by Harissios Vliagoftis with a particularly interesting section on early-life events guiding the development of allergic disease, which understandably continue to be a major theme of research. Magnus Wickman summarized the papers looking at the epidemiology of allergic disease including work from birth cohorts, which are an increasingly rich source of data on risk factors for allergic disease, and two papers on the epidemiology of anaphylaxis. Giovanni Passalacqua discussed the papers in the clinical allergy section of the journal, and Adriano Mari who runs the excellent Allergome website discussed the papers looking at allergens including characterization and the relative usefulness of allergen arrays versus single extracts in diagnosis and management.
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Affiliation(s)
- A Mari
- Allergome, Allergy Data Laboratories s.c., Latina, Italy
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80
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Food Allergy and the Oral Immunotherapy Approach. Arch Immunol Ther Exp (Warsz) 2014; 63:31-9. [DOI: 10.1007/s00005-014-0304-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/15/2014] [Indexed: 12/17/2022]
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81
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Matsuoka D, Mizutani N, Sae-Wong C, Yoshino S. Allergen-specific regulation of allergic rhinitis in mice by intranasal exposure to IgG1 monoclonal antibody Fab fragments against pathogenic allergen. Immunol Lett 2014; 161:149-56. [PMID: 24954639 DOI: 10.1016/j.imlet.2014.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/23/2014] [Accepted: 06/12/2014] [Indexed: 12/27/2022]
Abstract
Fab fragments (Fabs) have the ability to bind to specific antigens but lack the Fc portion for binding to receptors on immune and inflammatory cells that play a critical role in allergic diseases. In the present study, we investigated whether Fabs of an allergen-specific IgG1 monoclonal antibody (mAb) inhibited allergic rhinitis in mice. BALB/c mice sensitized by intraperitoneal injections of ovalbumin (OVA) plus alum on days 0 and 14 were intranasally challenged with OVA on days 28-30, and 35. Fabs prepared by the digestion of an anti-OVA IgG1 mAb (O1-10) with papain were also intranasally administered 15min before each OVA challenge. The results showed that treatment with O1-10 Fabs significantly suppressed the sneezing frequency, associated with decrease of OVA-specific IgE in the serum and infiltration by mast cells in the nasal mucosa seen following the fourth antigenic challenge; additionally, the level of mouse mast cell protease-1, a marker of mast cell activation, in serum was decreased. Furthermore, infiltration of eosinophils and goblet cell hyperplasia in the nasal mucosa at the fourth challenge were inhibited by treatment with O1-10 Fabs. In conclusion, these results suggest that intranasal exposure to Fabs of a pathogenic antigen-specific IgG1 mAb may be effective in regulating allergic rhinitis through allergen capture by Fabs in the nasal mucosa before the interaction of the intact antibody and allergen.
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Affiliation(s)
- Daiko Matsuoka
- Department of Pharmacology, Kobe Pharmaceutical University, 4-19-1 Motoyamakita, Higashinada, Kobe 658-8558, Japan
| | - Nobuaki Mizutani
- Department of Pharmacology, Kobe Pharmaceutical University, 4-19-1 Motoyamakita, Higashinada, Kobe 658-8558, Japan.
| | - Chutha Sae-Wong
- Department of Pharmacology, Kobe Pharmaceutical University, 4-19-1 Motoyamakita, Higashinada, Kobe 658-8558, Japan
| | - Shin Yoshino
- Department of Pharmacology, Kobe Pharmaceutical University, 4-19-1 Motoyamakita, Higashinada, Kobe 658-8558, Japan
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82
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Pajno GB, Cox L, Caminiti L, Ramistella V, Crisafulli G. Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated Food Allergy: The Transition to Clinical Practice. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2014; 27:42-50. [PMID: 24963452 PMCID: PMC4062106 DOI: 10.1089/ped.2014.0332] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/24/2014] [Indexed: 01/15/2023]
Abstract
Today, there is neither an effective nor an active treatment for food allergy. Allergy immunotherapy has been proposed as an attractive strategy to actively treat food allergy. Oral immunotherapy (OIT), also known as oral desensitization, is a method of inducing the body's immune system to tolerate a food that causes an allergic overreaction. It has been studied for the use in treatment of immunoglobulin E-mediated food allergy to the most common foods, including milk, egg, and peanut. OIT has been able to desensitize subjects to varying degrees. However, many questions remain unanswered, including efficient formulation, optimal dosing, and induction protocol to achieve full tolerance, transition of OIT to clinical practice, and maximal safety profile. This review focuses on the use of OIT as a new and active treatment for food allergy. The possibility of transition of OIT to clinical practice represents, in this field, the next pivotal step with the goal of improving the quality of life of patients with food allergy and their families.
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Affiliation(s)
- Giovanni B. Pajno
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Linda Cox
- Nova Southeastern University, Fort Lauderdale, Florida
| | - Lucia Caminiti
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Vincenzo Ramistella
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Giuseppe Crisafulli
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
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83
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Calderon MA, Cox LS. Monoallergen sublingual immunotherapy versus multiallergen subcutaneous immunotherapy for allergic respiratory diseases: a debate during the AAAAI 2013 Annual Meeting in San Antonio, Texas. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:136-43. [PMID: 24607039 DOI: 10.1016/j.jaip.2013.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/18/2013] [Accepted: 12/30/2013] [Indexed: 02/03/2023]
Affiliation(s)
- Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom.
| | - Linda S Cox
- College of Osteopathic Medicine, Nova Southeastern University, Davie, Fla
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84
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Ciepiela O, Zawadzka-Krajewska A, Kotuła I, van Overveld F, Kulus M, Demkow U. Sublingual Immunotherapy for Asthma: Affects T-Cells but Does not Impact Basophil Activation. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014; 27:17-23. [PMID: 24669352 DOI: 10.1089/ped.2014.0328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/03/2014] [Indexed: 01/04/2023]
Abstract
Objective: Allergen-specific immunotherapy (SIT) is the unique modifying treatment of atopic diseases. Dysregulation of T-cell apoptosis plays a crucial role in the in the development of asthma. Nevertheless, the effect of sublingual immunotherapy (SLIT) on T-cell apoptosis has not been elucidated. The aim of the study was to evaluate the influence of 1 year of SIT in atopic children on the frequency of Th1 and Th2 cells in peripheral blood, on T-cell apoptosis, and on the response of basophils to allergen challenge. Methods: Children suffering from bronchial asthma were treated with SLIT for 12 months (Staloral 300). Basophil activation was evaluated by measurement of CD203c antigen expression. Th1 and Th2 cells frequencies and their associated frequencies of apoptosis by the expression of Bcl-2 were evaluated with flow cytometry. Results: Basophil activation showed no difference in response before and after therapy. The frequency of Th1 cells increased (p=0.01, n=19), whereas the frequency of Th2 cells remained stable. Additionally, a significant increase of Bcl-2 positive Th1 cells was found (p=0.0465, n=19). Conclusions: We conclude that the increase in frequency of Th1 cells secondary to SLIT might be associated with increased resistance to apoptotic signals. The basophil activation is not useful in evaluation of patient desensitization.
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Affiliation(s)
- Olga Ciepiela
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw , Poland
| | | | - Iwona Kotuła
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw , Poland
| | | | - Marek Kulus
- Department of Pediatric Pneumonology and Allergology, Medical University of Warsaw , Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw , Poland
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85
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Bartholow A, Pleskovic N, Drori J, Skoner DP. Review of the Use of Sublingual Allergen Immunotherapy in Children. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014. [DOI: 10.1089/ped.2013.0309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ashton Bartholow
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Nicole Pleskovic
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Jonathan Drori
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - David P. Skoner
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
- Temple University School of Medicine, Philadelphia, Pennsylvania
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86
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Aasbjerg K, Backer V, Lund G, Holm J, Nielsen NC, Holse M, Wagtmann VR, Würtzen PA. Immunological comparison of allergen immunotherapy tablet treatment and subcutaneous immunotherapy against grass allergy. Clin Exp Allergy 2014; 44:417-28. [DOI: 10.1111/cea.12241] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- K. Aasbjerg
- Respiratory Research Unit; Department of Lung Medicine; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
| | - V. Backer
- Respiratory Research Unit; Department of Lung Medicine; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
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87
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The use of single versus multiple antigens in specific allergen immunotherapy for allergic rhinitis. Curr Opin Allergy Clin Immunol 2014; 14:20-4. [DOI: 10.1097/aci.0000000000000018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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88
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Aasbjerg K, Backer V. Steroids vs immunotherapy for allergic rhinitis - out with the old, in with the new. Expert Rev Clin Immunol 2014; 10:171-3. [PMID: 24410534 DOI: 10.1586/1744666x.2014.875469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment for seasonal allergic rhinitis induced by airborne allergens can be divided into two major groups: symptom-dampening drugs, such as antihistamines and corticosteroids, and disease-modifying drugs in the form of immunotherapy. It has been speculated that depot-injection corticosteroids given once or twice a year are a safe and patient-friendly alternative to the time-consuming immunotherapy. Our data indicate otherwise.
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Affiliation(s)
- Kristian Aasbjerg
- Respiratory Research Unit, Department of Lung Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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89
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Holt PG, Sly PD, Sampson HA, Robinson P, Loh R, Lowenstein H, Calatroni A, Sayre P. Prophylactic use of sublingual allergen immunotherapy in high-risk children: A pilot study. J Allergy Clin Immunol 2013; 132:991-3.e1. [DOI: 10.1016/j.jaci.2013.04.049] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/12/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
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90
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Baranyi U, Gattringer M, Farkas AM, Hock K, Pilat N, Iacomini J, Valenta R, Wekerle T. The site of allergen expression in hematopoietic cells determines the degree and quality of tolerance induced through molecular chimerism. Eur J Immunol 2013; 43:2451-60. [PMID: 23765421 PMCID: PMC3816328 DOI: 10.1002/eji.201243277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 04/15/2013] [Accepted: 06/10/2013] [Indexed: 12/28/2022]
Abstract
The transplantation of allergens (e.g. Phl p 5 or Bet v 1) expressed on BM cells as membrane-anchored full-length proteins leads to permanent tolerance at the T-cell, B-cell, and effector-cell levels. Since the exposure of complete allergens bears the risk of inducing anaphylaxis, we investigated here whether expression of Phl p 5 in the cytoplasm (rather than on the cell surface) is sufficient for tolerance induction. Transplantation of BALB/c BM retrovirally transduced to express Phl p 5 in the cytoplasm led to stable and durable molecular chimerism in syngeneic recipients (∼20% chimerism at 6 months). Chimeras showed allergen-specific T-cell hyporesponsiveness. Further, Phl p 5-specific TH 1-dependent humoral responses were tolerized in several chimeras. Surprisingly, Phl p 5-specific IgE and IgG1 levels were significantly reduced but still detectable in sera of chimeric mice, indicating incomplete B-cell tolerance. No Phl p 5-specific sIgM developed in cytoplasmic chimeras, which is in marked contrast to mice transplanted with BM expressing membrane-anchored Phl p 5. Thus, the expression site of the allergen substantially influences the degree and quality of tolerance achieved with molecular chimerism in IgE-mediated allergy.
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Affiliation(s)
- Ulrike Baranyi
- Division of Transplantation, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Martina Gattringer
- Division of Transplantation, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Andreas M Farkas
- Division of Transplantation, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Karin Hock
- Division of Transplantation, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Nina Pilat
- Division of Transplantation, Department of Surgery, Medical University of ViennaVienna, Austria
| | - John Iacomini
- Renal Division, Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Physiology and Pathophysiology, Infectiology and Immunology, Medical University of ViennaVienna, Austria
| | - Thomas Wekerle
- Division of Transplantation, Department of Surgery, Medical University of ViennaVienna, Austria
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91
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Shamji MH, Ljørring C, Würtzen PA. Predictive biomarkers of clinical efficacy of allergen-specific immunotherapy: how to proceed. Immunotherapy 2013; 5:203-6. [PMID: 23444948 DOI: 10.2217/imt.13.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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92
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Wu Z. Antigen specific immunotherapy generates CD27(+) CD35(+) tolerogenic dendritic cells. Cell Immunol 2013; 283:75-80. [PMID: 23887049 DOI: 10.1016/j.cellimm.2013.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/05/2013] [Accepted: 06/24/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS The mechanism of antigen specific immunotherapy (ASIT) remains to be further understood. The present study aims to investigate the role of ASIT in the generation of tolerogenic dendritic cells (DC) in patients with food allergy (FA). METHODS Twenty patients with egg FA and 10 healthy subjects were recruited into this study. Blood samples were obtained from each subject before and after the ASIT and analyzed by flow cytometry. RESULTS In FA patients, the frequencies of CD27(+) B cells and TGF-b(+) DCs were significantly lower than that in healthy subjects. More than 90% CD27(+) B cells also express CD35; about 90% CD27(+) CD35(+) B cells expressed TGF-b. Coculture of CD27(+) CD35(+) B cells with immature DCs generated TGF-b-expressing tolerogenic DCs; the latter was able to induce CD4(+) CD25(+) Foxp3(+) regulatory T cells. CONCLUSIONS Treatment with ASIT can induce TGF-b-expressing tolerogenic DCs in patients with FA.
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Affiliation(s)
- Zhiqiang Wu
- Department of Gastroenterology, First Affiliated Hospital, The PLA General Hospital, Beijing 100037, China.
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93
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Wisniewski J, Agrawal R, Woodfolk JA. Mechanisms of tolerance induction in allergic disease: integrating current and emerging concepts. Clin Exp Allergy 2013; 43:164-76. [PMID: 23331558 DOI: 10.1111/cea.12016] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The prevalence of atopy and allergic disease continues to escalate worldwide. Defining immune mechanisms that suppress the underlying Th2-driven inflammatory process is critical for the rational design of new treatments to prevent or attenuate disease. Allergen immunotherapy has provided a useful framework for evaluating changes in the immune response that occur during the development of tolerance. Despite this, elucidating the phenotypic and functional properties of regulatory cells, has proven challenging in humans with allergic disease. This article provides an overview of our current understanding of the immune pathways that orchestrate allergen tolerance, with an emphasis on emerging concepts related to human disease. A variety of regulatory cell types, including IL-10-secreting T and B cells, play a pivotal role in suppressing allergic responses to inhaled, ingested and injected allergens. These cells may inhibit Th2 effectors directly, or else indirectly, through other cell types and mediators. Protective antibodies, including IgG4, Fc sialylated IgG, and IgA, have the capacity to modulate the response by preventing allergen binding to surface-bound IgE, or inhibiting dendritic cell maturation. Immune cell plasticity may augment suppression of Th2 cells by T regulatory cells, through mechanisms that involve T cell conversion, or else unconventional roles of classical effector cells. These actions depend upon external cues provided by the in vivo milieu. As such, specific anatomical sites may preferentially favour tolerance induction. Recent scientific advances now allow a global analysis of immune parameters that capture novel markers of tolerance induction in allergic patients. Such markers could provide new molecular targets for assessing tolerance, and for designing treatments that confer long-lasting protection in a safe and efficacious fashion.
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Affiliation(s)
- J Wisniewski
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908-1355, USA
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94
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Arshad SH, Dharmage SC, Ferreira F, Fixman ED, Gadermaier G, Hauser M, Sampson AP, Teran LM, Wallner M, Wardlaw AJ. Developments in the field of allergy in 2011 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2013. [PMID: 23181787 DOI: 10.1111/cea.12037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As in previous years, we felt it would be of value to our readership to summarize the new information provided by the authors who have published in Clinical and Experimental Allergy in 2011 and set this in the context of recent advances in our understanding of the pathogenesis and management of allergic disease in all its many manifestations. In 2011, about 210 articles were published in Clinical and Experimental Allergy including editorials, reviews, opinion articles, guidelines, letters, book reviews and of course at the heart of the journal, papers containing original data. As before, this review is divided into sections based on the way the journal is structured, although this year we have grouped together all the papers dealing with mechanisms of allergic disease, whether they involve patients (clinical mechanisms), pure in vitro studies (basic mechanisms) or animal models (experimental models), as we felt this was a more coherent way to deal with the subject. In the field of asthma and rhinitis, the relationship between airway inflammation and airway dysfunction was of perennial interest to investigators, as were phenotypes and biomarkers. Aspirin hypersensitivity appeared in studies in several papers and there was new interest in asthma in the elderly. The mechanisms involved in allergic disease describe advances in our understanding of T cell responses, the relationship between inflammation and disease, mast cell and basophil activation, steroid resistance and novel therapies. In the section dealing with epidemiology, studies seeking to identify risk factors for allergic disease including vitamin D are prominent, as once again are studies investigating gene-environment interactions. The clinical allergy section focuses on drug allergy, food allergy and immunotherapy. The area of oral immunotherapy for food allergy is well covered and we were grateful to Stephen Durham for guest editing an outstanding special issue on immunotherapy in the centenary year of Leonard Noon's pioneering work. Lastly, in the field of allergens, the interest in component-resolved diagnosis continues to grow and there are also articles describing important novel cultivars and the effect of food processing on the allergenic properties of foods. Another terrific year, full of important and high-quality work,which the journal has been proud to bring to the allergy community.
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Affiliation(s)
- S H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
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95
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Didier A, Malling HJ, Worm M, Horak F, Sussman G, Melac M, Soulié S, Zeldin RK. Post-treatment efficacy of discontinuous treatment with 300IR 5-grass pollen sublingual tablet in adults with grass pollen-induced allergic rhinoconjunctivitis. Clin Exp Allergy 2013; 43:568-77. [PMID: 23600548 DOI: 10.1111/cea.12100] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A. Didier
- Respiratory Diseases Department; Rangueil-Larrey Hospital; Toulouse; France
| | - H.-J. Malling
- Allergy Clinic; Gentofte University Hospital; Copenhagen; Denmark
| | - M. Worm
- Department of Dermatology and Allergy; Allergy Center Charité, CCM; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - F. Horak
- Allergy Center Vienna West; Vienna; Austria
| | - G. Sussman
- The University of Toronto; Toronto; ON; Canada
| | - M. Melac
- Global Clinical Development; Stallergenes S.A.; Antony; France
| | - S. Soulié
- Global Clinical Development; Stallergenes S.A.; Antony; France
| | - R. K. Zeldin
- Global Clinical Development; Stallergenes S.A.; Antony; France
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96
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Yang Q, Liang Y, Si L, Ji Q, Xu Q, Zhang Y, Li X. Antigen-specific immunotherapy regulates B cell activities in the intestine. J Biol Chem 2013; 288:16383-16390. [PMID: 23589293 DOI: 10.1074/jbc.m113.456202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mature B cells (BCs) express CD23 and B cell receptors. Whether activation of CD23 and B cell receptors has different effects on BC activities is unclear. This study aims to investigate the mechanism by which the specific antigen immunotherapy regulates the activation of BCs in the skewed Th2 responses. Mice were sensitized to ovalbumin. The specific antigen vaccination (SAV) at graded doses was employed to modulate the activities of BCs in which the expression of IL-10, IgE, matrix metalloproteinase-9 (MMP9), CD23, and serum soluble CD23 by BCs was evaluated. The immune regulatory effect of BCs primed by lower or higher SAV doses was observed with an adoptive transfer mouse experiment. SAV activated CD23 to produce IL-10 in BCs at lower doses. The higher doses of SAV increased the expression of MMP9 in BCs that reduced the amounts of CD23 in BCs and increased the serum levels of soluble CD23, which was abrogated by the pretreatment with MMP9 inhibitor. Adoptively transfer with BCs primed by lower doses of SAV inhibited the ongoing antigen-specific Th2 responses whereas the BCs primed by higher doses of SAV exacerbated the ongoing Th2 responses. Exposure to specific antigens at optimal doses can activate BCs to produce IL-10 to suppress the skewed antigen-specific Th2 responses. The antigen doses of SAV higher than the optimal doses may promote the production of soluble CD23 to exacerbate the ongoing immune responses.
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Affiliation(s)
- Qihong Yang
- Department of Geriatrics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| | - Yong Liang
- Department of Orthopedics, First Affiliated Hospital of Chongqing Medical University, Chongqing 40016, China
| | - Liangyi Si
- Department of Geriatrics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qing Ji
- Department of Gastroenterology, Southwest Hospital, Third Military Medical University, Chongqing 40038, China
| | - Qiang Xu
- Department of Geriatrics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Yi Zhang
- Department of Geriatrics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Xuejun Li
- Department of Geriatrics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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97
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Smith KA, Gray NJ, Cheek E, Saleh F, Lavender J, Frew AJ, Kern F, Tarzi MD. Characterisation of CD154+ T cells following ex vivo birch allergen stimulation defines a close relationship between T cell subsets in healthy volunteers. BMC Immunol 2013; 14:14. [PMID: 23521868 PMCID: PMC3614533 DOI: 10.1186/1471-2172-14-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/19/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Allergic sensitisation has been ascribed to a dysregulated relationship between allergen-specific Th1, Th2 and regulatory T cells. We hypothesised that the relationship between these T cell subsets could be better defined using a short-term allergen stimulation system followed by direct analysis of CD154-positive T cells. Using peripheral blood samples from birch pollinosis patients and healthy non-atopic controls, we sought to explore the frequencies and phenotype of birch-stimulated CD154-positive T helper cells following ex vivo birch allergen stimulation. RESULTS Activated CD154-positive Th1, Th2 and Tr1-like cells, that co-expressed IFNγ, IL-4 and IL-10 respectively, were identified in both birch-allergic and non-allergic participants. We observed a close correlation between Th1, Th2 and Tr1-like cell frequency in non-allergic volunteers, such that the three parameters increased together to maintain a low Th2: Th1 ratio. The relationship between Th1, Th2 and Tr1-like responses was dysregulated in birch-allergic patients, with abrogation of the IL-10 response and a higher Th2: Th1 ratio. A close correlation was observed between Th2 cell frequency and the absolute concentration of birch-specific IgE within the birch-allergic group, and we confirmed previous reports of a more differentiated T cell phenotype in allergic subjects. CONCLUSIONS The findings demonstrate an important balance between IFNγ, IL-4 and IL-10 T cell responses to birch allergen in health, where Th2 responses to allergens were frequently observed, but apparently balanced by Th1 and regulatory responses. The detection of CD154 positive T cells after short-term antigen stimulation may be a useful method for the detection of T cell responses to allergens when cost, speed and convenience are priorities.
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Affiliation(s)
- Karen A Smith
- Brighton and Sussex Medical School, Division of Clinical Medicine, Pathogen-Host-Interactions Group, University of Sussex, Brighton, BN1 9PS, UK
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98
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Nomura T, Tsuge I, Inuo C, Nakajima Y, Tanaka K, Naruse N, Suzuki S, Ando H, Kondo Y, Saitoh S, Urisu A. Effect of Japanese cedar specific immunotherapy on allergen-specific T(H)2 cells in peripheral blood. Ann Allergy Asthma Immunol 2013; 110:380-385.e1. [PMID: 23622011 DOI: 10.1016/j.anai.2013.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/16/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The involvement of a shift from TH2 to TH1 responses in peripheral blood in pollen subcutaneous immunotherapy (SCIT) has been contentious, partly because of difficulties analyzing antigen-specific TH cells. OBJECTIVES To use recent technical advances to establish a more direct and simple method to analyze antigen-specific TH cells and to clarify the involvement of a TH2/TH1 shift in peripheral blood in pollen specific immunotherapy. METHODS After short-term (6-hour) antigen stimulation, antigen-specific TH cells in peripheral blood of Japanese children and young adults with Japanese cedar pollinosis undergoing SCIT were analyzed by multicolor flow cytometry for the presence of the activation marker CD154 and intracellular cytokines. RESULTS Twenty-eight patients between 5 and 22 years of age were enrolled in the study; 22 had started SCIT after enrolling in the study (SCIT group), and the remaining 6 were planning to start SCIT in the next off-season (control group). The number of Japanese cedar-specific interleukin (IL) 5-, IL-4-, interferon γ-, IL-17A-, IL-10-, and tumor necrosis factor α-producing TH cells without antigen-driven cell proliferation was determined. The seasonal increase in the number of Japanese cedar-specific IL-5- and IL-4-producing TH cells seen in the control group was suppressed in the SCIT group (P < .005 and <.001, respectively). CONCLUSION We report a powerful method for the analysis of antigen-specific TH cells in peripheral blood. This method will contribute to our understanding of immune mechanisms of immunotherapy and help us develop more sophisticated allergen specific immunotherapy.
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Affiliation(s)
- Takayasu Nomura
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan.
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99
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De Swert L, Veereman G, Bublin M, Breiteneder H, Dilissen E, Bosmans E, Mattelaer C, Bullens D. Eosinophilic gastrointestinal disease suggestive of pathogenesis-related class 10 (PR-10) protein allergy resolved after immunotherapy. J Allergy Clin Immunol 2013; 131:600-2.e1-3. [DOI: 10.1016/j.jaci.2012.10.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 10/02/2012] [Accepted: 10/23/2012] [Indexed: 11/28/2022]
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100
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Maneechotesuwan K, Kasetsinsombat K, Wamanuttajinda V, Wongkajornsilp A, Barnes PJ. Statins enhance the effects of corticosteroids on the balance between regulatory T cells and Th17 cells. Clin Exp Allergy 2013; 43:212-22. [PMID: 23331562 DOI: 10.1111/cea.12067] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 10/09/2012] [Accepted: 11/01/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Plasticity of CD4(+) lymphocyte Th17/regulatory T cell (Treg) subsets is involved in the pathogenesis of chronic airway inflammatory diseases, such as asthma. Reversal of Th17/Treg cell balance towards Treg cells may be beneficial for the suppression of chronic Th2 cell-mediated inflammatory diseases, such as asthma. However, the effect of the combination of corticosteroids and a statin on the ratio of Treg/Th17 cells is unknown. OBJECTIVE We investigated the in vitro effects of the combination of simvastatin and fluticasone propionate (FP) on the numbers of Treg and Th17 cells in asthmatic patients after co-incubation with monocyte-derived DCs (mDCs), and explored the underlying signalling pathways involved. METHODS Using flow cytometry, we determined the effects of FP and simvastatin on Treg/Th17 balance after co-incubation of asthmatic CD4(+) T cells with mDCs. We also measured the relevant Treg and Th17-polarizing cytokines released from mDCs and also investigated the role of indoleamine 2, 3-dioxygenase (IDO) in this response. RESULTS The combination of simvastatin and FP significantly increased Treg and concomitantly reduced Th17 cell numbers to a greater extent than FP or statin treatment alone. The enhancing effects of simvastatin on FP effects were mediated through the up-regulation of indoleamine 2, 3-dioxygenase and interleukin (IL)-10, together with down-regulation of IL-6 and IL-23 expression in mDCs. CONCLUSION On the basis of this in vitro model of asthma, we suggest that the combination of a statin and a corticosteroid could augment the Treg/Th17 cell ratio and thus more effectively suppress airway inflammation in asthma patients. This may be particularly relevant in the treatment of severe asthma where Th17 cells are activated and linked to neutrophilic inflammation.
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Affiliation(s)
- K Maneechotesuwan
- Division of Respiratory Disease and Tuberculosis, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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