1051
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Palomares O, Akdis M, Martín-Fontecha M, Akdis CA. Mechanisms of immune regulation in allergic diseases: the role of regulatory T and B cells. Immunol Rev 2017; 278:219-236. [DOI: 10.1111/imr.12555] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Oscar Palomares
- Department of Biochemistry and Molecular Biology; School of Chemistry; Complutense University of Madrid; Madrid Spain
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - Mar Martín-Fontecha
- Department of Organic Chemistry; School of Chemistry; Complutense University of Madrid; Madrid Spain
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
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1052
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Butler MM. Exploring the strategies that midwives in British Columbia use to promote normal birth. BMC Pregnancy Childbirth 2017; 17:168. [PMID: 28583159 PMCID: PMC5460538 DOI: 10.1186/s12884-017-1323-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/08/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Rates of normal birth have been declining steadily over the past 20 years, despite the evidence of the benefits to mother and baby. This is most obvious in steadily increasing caesarean section rates across countries and studies of the factors involved suggest it may be more to do with the organization of maternity care and the preferences of healthcare providers than changes in maternal or demographic conditions. The proportion of women in British Columbia (BC) receiving care from a midwife continues to grow and there is a particular focus on promoting and supporting normal pregnancy and birth in the midwifery philosophy of care. In BC, women receiving care from a midwife are less likely to have a caesarean section and other birth interventions. METHODS An interpretive approach, based on interpretive phenomenology was used to explore the experiences of midwives in BC of normal birth and the strategies that they use to keep birth normal. Fourteen experienced midwives were purposively selected from across the range of practice, geographical, and rural/urban contexts to participate in depth interviews. Data were analyzed using Thematic Network Analysis. RESULTS Seven key themes were identified in the data: working with women from the early pregnancy, informing choice, the birth environment, careful watching and waiting, managing early labour, helping the woman to cope with labour, and tools in the tool kit. CONCLUSIONS Midwives in BC work closely with women from early pregnancy to prepare them for a normal birth, and as "instruments of care" they adopt a range of approaches to support women to achieve this. The emphasis on continuity of care in the BC model of midwifery care plays a vital role in this.
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Affiliation(s)
- Michelle M Butler
- Department of Family Practice | Midwifery Program, University of British Columbia, 320 - 5950 University Boulevard, Vancouver, BC, V6T1Z3, Canada.
- Faculty of Science and Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
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1053
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Abstract
Idiopathic anaphylaxis is a rare life-threatening disorder with symptoms similar to other forms of anaphylaxis. There is lack of a robust evidence base underpinning the treatment of anaphylaxis and even less so for idiopathic anaphylaxis. Much of the evidence therefore comes from relatively small case series and expert opinion. Idiopathic anaphylaxis is a diagnosis of exclusion, requiring a thorough history and careful diagnostic work-up investigating possible triggers and underlying predisposing factors. Key diagnostic tests include skin-prick testing, tests for specific-IgE, component-resolved diagnostics, and in some cases for allergen challenge tests. Other recognized causes of anaphylaxis, such as foods, medications, insect stings, latex, and exercise, should all be considered, as should differential diagnoses such as asthma. While the cause of idiopathic anaphylaxis remains unknown, prompt treatment with intramuscular epinephrine (adrenaline) administered into the anterolateral aspect of the thigh is associated with good prognosis. There may also be a role for H1-antihistamines and corticosteroids as second-line agents. Patients need to be carefully monitored for signs of deterioration and/or a possible protracted or biphasic reaction. Patients with frequent episodes of anaphylaxis (e.g., six or more episodes/year) should be considered for preventive therapy, which may include corticosteroids, H1- and H2-antihistamines, and, in some cases, mast cell stabilizers such as ketotifen. Alternative immune-suppressants (e.g., methotrexate) and anti-IgE may rarely also need to be considered. In many cases, the frequency of anaphylaxis declines such that regular use of corticosteroids can be discontinued after 9–12 months. Pediatric patients should be treated with similar regimens as adults, but with appropriate dose adjustments. Patients should carry their self-injectable epinephrine and other emergency medications at all times in order to deal with emergency situations.
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Affiliation(s)
- Bright I. Nwaru
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School Doorway 3, Teviot Place, Edinburgh, EH8 9AG UK
| | | | - Aziz Sheikh
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School Doorway 3, Teviot Place, Edinburgh, EH8 9AG UK
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1054
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1055
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Wagner I, Geh KJ, Hubert M, Winter G, Weber K, Classen J, Klinger C, Mueller RS. Preliminary evaluation of cytosine-phosphate-guanine oligodeoxynucleotides bound to gelatine nanoparticles as immunotherapy for canine atopic dermatitis. Vet Rec 2017; 181:118. [PMID: 28526774 DOI: 10.1136/vr.104230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/04/2022]
Abstract
Cytosine-phosphate-guanine oligodeoxynucleotides (CpG ODN) are a promising new immunotherapeutic treatment option for canine atopic dermatitis (AD). The aim of this uncontrolled pilot study was to evaluate clinical and immunological effects of gelatine nanoparticle (GNP)-bound CpG ODN (CpG GNP) on atopic dogs. Eighteen dogs with AD were treated for 8 weeks (group 1, n=8) or 18 weeks (group 2, n=10). Before inclusion and after 2 weeks, 4 weeks, 6 weeks (group 1+2), 8 weeks, 12 weeks and 16 weeks (group 2) 75 µg CpG ODN/dog (bound to 1.5 mg GNP) were injected subcutaneously. Pruritus was evaluated daily by the owner. Lesions were evaluated and serum concentrations and mRNA expressions of interferon-γ, tumour necrosis factor-α, transforming growth factor-β, interleukin (IL) 10 and IL-4 (only mRNA expression) were determined at inclusion and after 8 weeks (group 1+2) and 18 weeks (group 2). Lesions and pruritus improved significantly from baseline to week 8. Mean improvements from baseline to week 18 were 23 per cent and 44 per cent for lesions and pruritus, respectively, an improvement of ≥50 per cent was seen in six out of nine and three out of six dogs, respectively. IL-4 mRNA expression decreased significantly. The results of this study show a clinical improvement of canine AD with CpG GNP comparable to allergen immunotherapy. Controlled studies are needed to confirm these findings.
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Affiliation(s)
- I Wagner
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - K J Geh
- Department of Pharmacy, Pharmaceutical Technology & Biopharmaceutics, LMU Munich, Butenandtstrasse 5, 81377 Munich, Germany
| | - M Hubert
- Department of Pharmacy, Pharmaceutical Technology & Biopharmaceutics, LMU Munich, Butenandtstrasse 5, 81377 Munich, Germany
| | - G Winter
- Department of Pharmacy, Pharmaceutical Technology & Biopharmaceutics, LMU Munich, Butenandtstrasse 5, 81377 Munich, Germany
| | - K Weber
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - J Classen
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - C Klinger
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - R S Mueller
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
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1056
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Gutowska-Owsiak D, Ogg GS. Therapeutic vaccines for allergic disease. NPJ Vaccines 2017; 2:12. [PMID: 29263869 PMCID: PMC5604746 DOI: 10.1038/s41541-017-0014-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/03/2017] [Accepted: 03/20/2017] [Indexed: 12/14/2022] Open
Abstract
Allergic diseases are highly prevalent worldwide and affect all age groups, contributing to a high personal and socioeconomic burden. Treatment with an “allergy vaccine” or allergen immunotherapy aims to provide long-lasting benefits by inducing unresponsiveness to the relevant antigen. The consequences of the therapy are considered disease modifying and range from dampening of the immediate immune responses to the reduction of secondary tissue remodeling. Furthermore, allergen immunotherapy interventions have a potential to slow or cease the development of additional allergic manifestations with a long-term overall effect on morbidity and quality of life. Here, we review proposed mechanisms underlying the therapeutic effects of immunotherapy for allergic diseases. Further, we discuss both standard and novel approaches and possible future directions in the development of allergen immunotherapy.
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Affiliation(s)
- Danuta Gutowska-Owsiak
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Graham S Ogg
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
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1057
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Sánchez-Borges M, Cardona V, Worm M, Lockey RF, Sheikh A, Greenberger PA, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fineman S, Geller M, Gonzalez-Estrada A, Tanno L, Thong BY. In-flight allergic emergencies. World Allergy Organ J 2017; 10:15. [PMID: 28496564 PMCID: PMC5415712 DOI: 10.1186/s40413-017-0148-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/23/2017] [Indexed: 01/20/2023] Open
Abstract
Allergic and hypersensitivity reactions such as anaphylaxis and asthma exacerbations may occur during air travel. Although the exact incidence of in-flight asthma and allergic emergencies is not known, we have concerns that this subject has not received the attention it warrants. There is a need to provide passengers at risk and airlines with the necessary measures to prevent and manage these emergencies. A review of the epidemiology, management and approaches to prevention of allergic and asthma emergencies during air travel is presented with the goal of increasing awareness about these important, potentially preventable medical events.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
- Clínica El Avila, 6a.transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Group, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margitta Worm
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Richard F. Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Aziz Sheikh
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Paul A. Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bizkaia, Spain
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Yehia El-Gamal
- Pediatric Allergy & Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, Egypt
| | - Stanley Fineman
- Department of Pediatric Allergy & Immunology, Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, USA
| | - Mario Geller
- Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexei Gonzalez-Estrada
- Division of Allergy and Clinical Immunology, Department of Medicine, Quillen College of Medicine and Center for Excellence for Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, TN USA
| | - Luciana Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France
| | - Bernard Y. Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
| | - on behalf of the WAO Anaphylaxis Committee
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Group, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bizkaia, Spain
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
- Pediatric Allergy & Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, Egypt
- Department of Pediatric Allergy & Immunology, Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, USA
- Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Allergy and Clinical Immunology, Department of Medicine, Quillen College of Medicine and Center for Excellence for Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, TN USA
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
- Clínica El Avila, 6a.transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela
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1058
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Valenta R, Campana R, Niederberger V. Recombinant allergy vaccines based on allergen-derived B cell epitopes. Immunol Lett 2017; 189:19-26. [PMID: 28472641 PMCID: PMC6390931 DOI: 10.1016/j.imlet.2017.04.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/26/2017] [Indexed: 01/01/2023]
Abstract
Immunoglobulin E (IgE)-associated allergy is the most common immunologically-mediated hypersensitivity disease. It affects more than 25% of the population. In IgE-sensitized subjects, allergen encounter can causes a variety of symptoms ranging from hayfever (allergic rhinoconjunctivitis) to asthma, skin inflammation, food allergy and severe life-threatening anaphylactic shock. Allergen-specific immunotherapy (AIT) is based on vaccination with the disease-causing allergens. AIT is an extremely effective, causative and disease-modifying treatment. However, administration of natural allergens can cause severe side effects and the quality of natural allergen extracts limits its application. Research in the field of molecular allergen characterization has allowed deciphering the molecular structures of the disease-causing allergens and it has become possible to engineer novel molecular allergy vaccines which precisely target the mechanisms of the allergic immune response and even appear suitable for prophylactic allergy vaccination. Here we discuss recombinant allergy vaccines which are based on allergen-derived B cell epitopes regarding their molecular and immunological properties and review the results obtained in clinical studies with this new type of allergy vaccines.
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Affiliation(s)
- Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria.
| | - Raffaela Campana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
| | - Verena Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
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1059
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Fernandez PG, Mikhael M. Perioperative considerations for the food-allergic pediatric patient. Paediatr Anaesth 2017; 27:461-470. [PMID: 28244622 DOI: 10.1111/pan.13131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2017] [Indexed: 12/22/2022]
Abstract
Patients with a history of food allergy and food intolerance are common in the pediatric population and are encountered frequently in the perioperative setting by pediatric anesthesiologists. Perioperatively, food allergy can present on a spectrum ranging from minor acute urticaria to more severe hypovolemia and anaphylactic shock. Allergy to foods including fruits, fish, egg, soy, and peanut are most concerning for their potential to cross-react with perioperative medications. There is little in the anesthesia literature that focuses on the perioperative management of children with food allergies. This educational review will provide a brief overview of classic immunoglobulin E (IgE)-mediated food allergies, less common non-IgE food allergies, and present perioperative considerations for these patients. An audio summary of this topic is included as Supplementary Audio S1.
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Affiliation(s)
- Patrick G Fernandez
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marco Mikhael
- Department of Anesthesia and Pain Management, Cook County Hospital, Chicago, IL, USA
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1060
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Ferretti E, Corcione A, Pistoia V. The IL-31/IL-31 receptor axis: general features and role in tumor microenvironment. J Leukoc Biol 2017; 102:711-717. [PMID: 28408397 DOI: 10.1189/jlb.3mr0117-033r] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/24/2022] Open
Abstract
IL-31 is a recently identified cytokine with a well-defined role in the pathogenesis of pruritus. IL-31, whose production is induced by IL-4 and IL-33, binds a heterodimeric receptor (R) composed of the exclusive IL-31RA chain and the shared oncostatin M R. Signaling through the IL-31R involves the MAPK, PI3K/AKT and Jak/STAT pathways. Different variants and isoforms of IL-31RA with different signaling activities have been identified. IL-31 is produced predominantly by circulating Th2 lymphocytes and skin-homing CLA+CD45RO+ T cells. Studies in humans have demonstrated a pathogenic role for IL-31 in atopic dermatitis and allergic asthma. The first demonstration of the involvement of the IL-31/IL-31R axis in cancer came from studies in patients with mycosis fungoides/Sézary syndrome, the most frequent, cutaneous T cell lymphoma. Tumor cells were shown to produce IL-31, whose serum levels correlated with pruritus intensity. Follicular lymphoma (FL) B cells and their counterparts-germinal center B cells-produced IL-31 and expressed IL-31R, which signaled in the former, but not the latter, cells. IL-31 released in association with microvesicles promoted tumor growth through autocrine/paracrine loops. Malignant mast cells from patients with mastocytosis or Philadelphia-negative myeloproliferative disorder produced IL-31, which contributed to pruritus pathogenesis. Finally, patients with endometrial carcinoma displayed high serum levels of IL-31 and IL-33, which may represent promising disease biomarkers. Targeting strategies for the IL-31/IL-31R axis have been developed, including the CIMM331 humanized anti-human IL-31RA antibody recently tested in a phase I/Ib study.
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Affiliation(s)
- Elisa Ferretti
- Laboratory of Oncology, Istituto Giannina Gaslini, Genova, Italy; and
| | - Anna Corcione
- Laboratory of Oncology, Istituto Giannina Gaslini, Genova, Italy; and
| | - Vito Pistoia
- Immunology Area, Ospedale Pediatrico Bambino Gesù, Roma, Italy
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1061
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Ciprandi G, Tosca MA, Silvestri M, Ricciardolo FLM. Inflammatory biomarkers for asthma endotyping and consequent personalized therapy. Expert Rev Clin Immunol 2017; 13:715-721. [PMID: 28347164 DOI: 10.1080/1744666x.2017.1313117] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We argue that asthma be considered a syndrome caused by multiple inflammatory pathogenic processes. Bronchial hyperresponsiveness, reversible airflow limitation, and chronic airway inflammation characterize asthma pathophysiology. Personalized Medicine, i.e. a tailored management approach, is appropriate for asthma management and is based on the identification of discrete phenotypes and endotypes. Biomarkers can help define phenotypes and endotypes. Several biomarkers have been described in asthma, but most of them are not commonly available or still need external validation. Areas covered: This review presents useful pragmatic biomarkers available in daily clinical practice for assessing airway inflammation in asthmatic patients. Expert commentary: Eosinophil counts and serum allergen-specific IgE assessments are the most reliable biomarkers. Lung function, mainly concerning FEF25-75, and nasal cytology may be envisaged as ancillary biomarkers in asthma management. In conclusion, biomarkers have a clinical relevance in asthma in identifying asthma endotypes to direct personalized therapy.
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Affiliation(s)
- Giorgio Ciprandi
- a Respiratory Allergy, Department of Medicine , IRCCS - Azienda Ospedaliera Universitaria San Martino-IST , Genoa , Italy
| | - Maria Angela Tosca
- b Pediatric Pneumology and Allergy Unit and Cystic Fibrosis Center , IRCCS Istituto Giannina Gaslini , Genoa , Italy
| | - Michela Silvestri
- b Pediatric Pneumology and Allergy Unit and Cystic Fibrosis Center , IRCCS Istituto Giannina Gaslini , Genoa , Italy
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1062
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Galli SJ. Reply. J Allergy Clin Immunol 2017; 139:2029-2031. [PMID: 28410741 DOI: 10.1016/j.jaci.2016.12.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Stephen J Galli
- Departments of Pathology and Microbiology and Immunology and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif.
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1063
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Potaczek DP, Harb H, Michel S, Alhamwe BA, Renz H, Tost J. Epigenetics and allergy: from basic mechanisms to clinical applications. Epigenomics 2017; 9:539-571. [PMID: 28322581 DOI: 10.2217/epi-2016-0162] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Allergic diseases are on the rise in the Western world and well-known allergy-protecting and -driving factors such as microbial and dietary exposure, pollution and smoking mediate their influence through alterations of the epigenetic landscape. Here, we review key facts on the involvement of epigenetic modifications in allergic diseases and summarize and critically evaluate the lessons learned from epigenome-wide association studies. We show the potential of epigenetic changes for various clinical applications: as diagnostic tools, to assess tolerance following immunotherapy or possibly predict the success of therapy at an early time point. Furthermore, new technological advances such as epigenome editing and DNAzymes will allow targeted alterations of the epigenome in the future and provide novel therapeutic tools.
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Affiliation(s)
- Daniel P Potaczek
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-Universität Marburg, Marburg, Germany.,International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN).,German Centre for Lung Research (DZL).,John Paul II Hospital, Krakow, Poland
| | - Hani Harb
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-Universität Marburg, Marburg, Germany.,International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN).,German Centre for Lung Research (DZL)
| | - Sven Michel
- Secarna Pharmaceuticals GmbH & Co KG, Planegg, Germany
| | - Bilal Alashkar Alhamwe
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-Universität Marburg, Marburg, Germany
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-Universität Marburg, Marburg, Germany.,International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN).,German Centre for Lung Research (DZL)
| | - Jörg Tost
- Laboratory for Epigenetics & Environment, Centre National de Génotypage, CEA-Institut de Génomique, Evry, France
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1064
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Damm JA, Smith B, Greisen G, Krogfelt KA, Clausen ML, Agner T. The influence of probiotics for preterm neonates on the incidence of atopic dermatitis-results from a historically controlled cohort study. Arch Dermatol Res 2017; 309:259-264. [PMID: 28271213 DOI: 10.1007/s00403-017-1725-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/05/2017] [Accepted: 02/14/2017] [Indexed: 02/06/2023]
Abstract
Probiotic supplementation is a promising preventive strategy for atopic dermatitis (AD). To help clarifying the significance of timing with respect to prevention of AD, we here evaluate the benefit of prophylactic use of probiotic supplementation in neonates younger than 30 weeks of gestation. Preterm children from the Department of Neonatology, Rigshospitalet, Denmark from two different admission periods were included in a historically controlled cohort study. Neonates from January 2007 to February 2010, not treated with and neonates from March 2010 to February 2013 treated with probiotic were enrolled. Main outcome was prevalence of AD, and secondary outcomes were use of topical corticosteroids, and number of skin-related visits to GPs and dermatologists. 527 preterm neonates were included in the study, 249 treated and 278 not treated with probiotics. Response rate for the two cohorts was 76.7 and 77.7% respectively. The prevalence of AD was similar in the two groups (20.9% in the probiotic treated group versus 17.1% in the not treated group, p = 0.33). No significant differences were found between the groups with respect to treatment with topical corticosteroids, or visits at GPs or dermatologist. We found no indication that probiotics may prevent AD when administered to neonates <30 gestation weeks from birth until discharge home. Factors influencing the early maturation of the immune system have been assumed to be of particular importance in atopic dermatitis, and hence, our unique cohorts contribute information on how probiotic supplementation may affect the extremely immature immune systems of preterm infants.
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Affiliation(s)
- Julie A Damm
- Department of Pediatrics, University of Copenhagen, Herlev Hospital, 2730, Herlev, Denmark.
| | - Birgitte Smith
- Department of Microbiology and Infection Control, Statens Serum Institute, 2300, Copenhagen S, Denmark
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, 2100, Copenhagen Ø, Denmark
| | - Karen A Krogfelt
- Department of Microbiology and Infection Control, Statens Serum Institute, 2300, Copenhagen S, Denmark
| | - Maja-Lisa Clausen
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, 2400, Copenhagen NV, Denmark
| | - Tove Agner
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, 2400, Copenhagen NV, Denmark
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1065
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Okamoto Y, Fujieda S, Okano M, Yoshida Y, Kakudo S, Masuyama K. House dust mite sublingual tablet is effective and safe in patients with allergic rhinitis. Allergy 2017; 72:435-443. [PMID: 27471838 PMCID: PMC5324568 DOI: 10.1111/all.12996] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND House dust mite (HDM) is the major indoor allergen for allergic diseases such as allergic rhinitis (AR) and asthma. Although sublingual immunotherapy is a curative treatment for HDM-induced AR, data from large-scale studies are limited. We evaluated the efficacy and safety of HDM tablets in adolescent and adult patients (aged 12-64 years) with HDM-induced AR with or without intermittent asthma. METHODS In a double-blind trial in Japan, 968 subjects were randomized 1 : 1 : 1 to 300 index of reactivity (IR), 500 IR, or placebo groups. The primary endpoint was the Average Adjusted Symptom Score (AASS) in the last eight weeks of the 52-week treatment. Secondary endpoints included individual nasal and ocular symptom scores, rescue medication use, and the Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ) scores. RESULTS The AASS in the last eight weeks of treatment significantly improved in both the 300 IR and the 500 IR groups compared to that in the placebo group (P < 0.001). In the 300 IR group, the onset of action occurred at week 8-10. All four nasal symptoms significantly improved in both active treatment groups; rescue medication use and JRQLQ outcome improved in the 300 IR group. Most adverse events (AEs) were mild, and 16 serious AEs (SAEs) were reported; however, none of them were drug-related. CONCLUSIONS One-year treatment with 300 IR and 500 IR HDM tablets was effective without major safety concerns. The recommended therapeutic dose for AR is 300 IR.
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Affiliation(s)
- Y. Okamoto
- Department of Otorhinolaryngology‐Head and Neck SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - S. Fujieda
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of FukuiFukuiJapan
| | - M. Okano
- Department of Otolaryngology‐Head and Neck SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Y. Yoshida
- Biostatistics DepartmentShionogi & Co., Ltd.OsakaJapan
| | - S. Kakudo
- Clinical Development DepartmentShionogi & Co., Ltd.OsakaJapan
| | - K. Masuyama
- Department of Otorhinolaryngology‐Head and Neck SurgeryGraduate School of Medical ScienceUniversity of YamanashiYamanashiJapan
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1066
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The Role of Synthetic Peptide Immuno-Regulatory Epitope (SPIRE) in the Treatment of Allergic Disease. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0115-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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1067
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Klimek L, Schmidt-Weber CB, Kramer MF, Skinner MA, Heath MD. Clinical use of adjuvants in allergen-immunotherapy. Expert Rev Clin Immunol 2017; 13:599-610. [DOI: 10.1080/1744666x.2017.1292133] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Carsten B. Schmidt-Weber
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
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1068
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Ricketti PA, Alandijani S, Lin CH, Casale TB. Investigational new drugs for allergic rhinitis. Expert Opin Investig Drugs 2017; 26:279-292. [DOI: 10.1080/13543784.2017.1290079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Peter A. Ricketti
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Sultan Alandijani
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Chen Hsing Lin
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Thomas B. Casale
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
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1069
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van den Elzen MT, van Os-Medendorp H, van den Brink I, van den Hurk K, Kouznetsova OI, Lokin ASHJ, Laheij-de Boer AM, Röckmann H, Bruijnzeel-Koomen CAFM, Knulst AC. Effectiveness and safety of antihistamines up to fourfold or higher in treatment of chronic spontaneous urticaria. Clin Transl Allergy 2017; 7:4. [PMID: 28289538 PMCID: PMC5309999 DOI: 10.1186/s13601-017-0141-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Treatment with second-generation antihistamines is recommended in patients with chronic spontaneous urticaria (CSU). Some patients remain unresponsive even after up-dosing up to fourfold. Many third line treatment options have limited availability and/or give rise to significant side effects. We investigated effectiveness and safety of antihistamine treatment with dosages up to fourfold and higher. Methods This retrospective analysis of patients’ records was performed in adult CSU patients suffering wheals and/or angioedema (AE). Demographic, clinical, and therapeutic data was extracted from their medical records. We recorded the type, maximum prescribed dosage, effectiveness, and reported side effects of antihistamine treatment. Results Of 200 screened patients, 178 were included. Treatment was commenced with a once daily dose of antihistamines. Persisting symptoms meant that up-dosing up to fourfold occurred in 138 (78%) of patients, yielding sufficient response in 41 (23%). Up-dosing antihistamines was necessary in 110 (80%) patient with weals alone or weals with angioedema and 28 (64%) with AE only (p = 0.039). Of the remaining 97 patients with insufficient response, 59 were treated with dosages higher than fourfold (median dosage 8, range 5–12). This was sufficient in 29 patients (49%). Side effects were reported in 36 patients (20%), whereof 30 (17%) experienced somnolence. Side effects after up-dosing higher than fourfold were reported in six out of 59 patients (10%). Conclusion Up-dosing antihistamines higher than fourfold dosage seems a feasible therapeutic option with regards to effectiveness and safety. The need for third line therapies could be decreased by 49%, with a very limited increase of reported side effects.
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Affiliation(s)
- Mignon T van den Elzen
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Imke van den Brink
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Karin van den Hurk
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Ouliana I Kouznetsova
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Alexander S H J Lokin
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Anna-Marijke Laheij-de Boer
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Heike Röckmann
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Carla A F M Bruijnzeel-Koomen
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - André C Knulst
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
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1070
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Li X, Wang X, Lin X, Xu G, Tao Z, Jiang W, Cheng L, Guo Y, Lai H, Shen K. Semi-depot house-dust mite allergen extract for Chinese with allergic rhinitis and asthma. Am J Rhinol Allergy 2017; 30:201-8. [PMID: 27216351 DOI: 10.2500/ajra.2016.30.4316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Real-world data of the subcutaneous immunotherapy (SCIT) with semi-depot house-dust mite (HDM) allergen extract (a HDM allergen extract that contains a 50%-50% mixture of Dermatophagoides pteronyssinus and Dermatophagoides farina) for allergic rhinitis and asthma was unavailable in China until recently. AIM To investigate the effectiveness and safety of a HDM-SCIT for allergic rhinitis and asthma in Chinese patients. METHODS A multicenter, single-arm, open-label, self-controlled study. Chinese patients with allergic rhinitis or allergic asthma and with a history of symptoms from HDM exposure were included and received allergen-specific immunotherapy for 1 year by subcutaneous injection of HDM-SCIT. The primary outcome measure was the percentage of patients with an improvement in symptom severity assessed at 12 months after initiation of the treatment. The occurrence of adverse events and compliance of treatment were also evaluated. RESULTS A total of 272 outpatients were included for effectiveness analysis. The subject-evaluated improvement rate in the visual analog scale (VAS) was 76.1% and 71.3% at 6 and 12 months, respectively; corresponding values for investigator-evaluated VAS were 77.9% and 71.7%, respectively (p < 0.0001). Symptom score changes were -2.43 and -3.79 at 6 and 12 months, respectively (both p < 0.0001); the VAS improvement rate and symptom score change did not differ significantly between children and adolescents and/or adults. Good injection schedule adherence was found in 98.8% of the patients. No study drug-related serious adverse events or serious systemic allergic reactions occurred. CONCLUSION HDM-SCIT was safe and effective in the treatment of allergic rhinitis and asthma in a Chinese population, with good compliance.
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Affiliation(s)
- Xiang Li
- Respiratory Center, Beijing Children's Hospital, Beijing, China
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1071
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Hanagata N. CpG oligodeoxynucleotide nanomedicines for the prophylaxis or treatment of cancers, infectious diseases, and allergies. Int J Nanomedicine 2017; 12:515-531. [PMID: 28144136 PMCID: PMC5248940 DOI: 10.2147/ijn.s114477] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Unmethylated cytosine-guanine dinucleotide-containing oligodeoxynucleotides (CpG ODNs), which are synthetic agonists of Toll-like receptor 9 (TLR9), activate humoral and cellular immunity and are being developed as vaccine adjuvants to prevent or treat cancers, infectious diseases, and allergies. Free CpG ODNs have been used in many clinical trials implemented to verify their effects. However, recent research has reported that self-assembled CpG ODNs, protein/peptide–CpG ODN conjugates, and nanomaterial–CpG ODN complexes demonstrate higher adjuvant effects than free CpG ODNs, owing to their improved uptake efficiency into cells expressing TLR9. Moreover, protein/peptide–CpG ODN conjugates and nanomaterial–CpG ODN complexes are able to deliver CpG ODNs and antigens (or allergens) to the same types of cells, which enables a higher degree of prophylaxis or therapeutic effect. In this review, the author describes recent trends in the research and development of CpG ODN nanomedicines containing self-assembled CpG ODNs, protein/peptide–CpG ODN conjugates, and nanomaterial–CpG ODN complexes, focusing mainly on the results of preclinical and clinical studies.
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Affiliation(s)
- Nobutaka Hanagata
- Nanotechnology Innovation Station, National Institute for Materials Science, Tsukuba, Ibaraki; Graduate School of Life Science, Hokkaido University, Sapporo, Hokkaido, Japan
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1072
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Cabauatan CR, Campana R, Niespodziana K, Reinisch C, Lundberg U, Meinke A, Henning R, Neubauer A, Valenta R. Heat-labile Escherichia coli toxin enhances the induction of allergen-specific IgG antibodies in epicutaneous patch vaccination. Allergy 2017; 72:164-168. [PMID: 27568860 PMCID: PMC5215485 DOI: 10.1111/all.13036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/27/2022]
Abstract
Epicutaneous allergen-specific immunotherapy (EPIT) is proposed as an alternative route for allergen-specific immunotherapy (AIT). The induction of allergen-specific blocking IgG antibodies represents an important mechanism underlying AIT, but has not been investigated for EPIT. Here, we compared the induction of allergen-specific blocking IgG in outbred guinea pigs which had been immunized with recombinant birch pollen allergen Bet v 1 using patch delivery system (PDS) with or without heat-labile toxin (LT) from Escherichia coli or subcutaneously with aluminum hydroxide (Alum)-adsorbed rBet v 1. Only subcutaneous immunization with Alum-adsorbed rBet v 1 and epicutaneous administration of rBet v 1 with PDS in combination with LT from E. coli induced allergen-specific IgG antibodies blocking allergic patients' IgE, but not immunization with rBet v 1 via PDS alone. Our results suggest that patch vaccination with rBet v 1 in combination with LT may be a promising strategy for allergen-specific immunotherapy against birch pollen allergy.
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Affiliation(s)
- C. R. Cabauatan
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - R. Campana
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - K. Niespodziana
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - C. Reinisch
- Valneva Austria GmbH; Campus Vienna Biocenter; Vienna Austria
| | - U. Lundberg
- Valneva Austria GmbH; Campus Vienna Biocenter; Vienna Austria
| | - A. Meinke
- Valneva Austria GmbH; Campus Vienna Biocenter; Vienna Austria
| | | | | | - R. 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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1073
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Tsabouri S, Mavroudi A, Feketea G, Guibas GV. Subcutaneous and Sublingual Immunotherapy in Allergic Asthma in Children. Front Pediatr 2017; 5:82. [PMID: 28484690 PMCID: PMC5399038 DOI: 10.3389/fped.2017.00082] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/05/2017] [Indexed: 12/15/2022] Open
Abstract
This review presents up-to-date understanding of immunotherapy in the treatment of children with allergic asthma. The principal types of allergen immunotherapy (AIT) are subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Both of them are indicated for patients with allergic rhinitis and/or asthma, who have evidence of clinically relevant allergen-specific IgE, and significant symptoms despite reasonable avoidance measures and/or maximal medical therapy. Studies have shown a significant decrease in asthma symptom scores and in the use of rescue medication, and a preventive effect on asthma onset. Although the safety profile of SLIT appears to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT is better and that SCIT has an earlier onset than SLIT in children with allergic asthma. Severe, not controlled asthma, and medical error were the most frequent causes of SCIT-induced adverse events.
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Affiliation(s)
- Sophia Tsabouri
- Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Antigoni Mavroudi
- Allergy Unit of the 3rd Pediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gavriela Feketea
- General Hospital of Ilias, Amaliada Hospital Unit, Amaliada, Greece
| | - George V Guibas
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, University Hospitals South Manchester NHS Trust, Manchester, UK
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1074
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Jesenak M, Zelieskova M, Babusikova E. Oxidative Stress and Bronchial Asthma in Children-Causes or Consequences? Front Pediatr 2017; 5:162. [PMID: 28791280 PMCID: PMC5523023 DOI: 10.3389/fped.2017.00162] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 07/06/2017] [Indexed: 12/13/2022] Open
Abstract
Bronchial asthma is one of the most common chronic inflammatory diseases of the airways. In the pathogenesis of this disease, the interplay among the genes, intrinsic, and extrinsic factors are crucial. Various combinations of the involved factors determine and modify the final clinical phenotype/endotype of asthma. Oxidative stress results from an imbalance between the production of reactive oxygen species and reactive nitrogen species and the capacity of antioxidant defense mechanisms. It was shown that oxidative damage of biomolecules is strongly involved in the asthmatic inflammation. It is evident that asthma is accompanied by oxidative stress in the airways and in the systemic circulation. The oxidative stress is more pronounced during the acute exacerbation or allergen challenge. On the other hand, the genetic variations in the genes for anti-oxidative and pro-oxidative enzymes are variably associated with various asthmatic subtypes. Whether oxidative stress is the consequence of, or the cause for, chronic changes in asthmatic airways is still being discussed. Contribution of oxidative stress to asthma pathology remains at least partially controversial, since antioxidant interventions have proven rather unsuccessful. According to current knowledge, the relationship between oxidative stress and asthmatic inflammation is bidirectional, and genetic predisposition could modify the balance between these two positions-oxidative stress as a cause for or consequence of asthmatic inflammation.
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Affiliation(s)
- Milos Jesenak
- Jessenius Faculty of Medicine, Department of Pediatrics, Comenius University in Bratislava, University Hospital, Martin, Slovakia
| | - Maria Zelieskova
- Jessenius Faculty of Medicine, Department of Pediatrics, Comenius University in Bratislava, University Hospital, Martin, Slovakia
| | - Eva Babusikova
- Jessenius Faculty of Medicine, Department of Medical Biochemistry, Comenius University in Bratislava, Martin, Slovakia
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1075
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Hisham M, Sivakumar MN, Senthil Kumar RS, Nandakumar P. Ludwig's Angina: A Nightmare Worsened by Adverse Drug Reaction to Antibiotics. Indian J Crit Care Med 2017; 21:179-181. [PMID: 28400693 PMCID: PMC5363111 DOI: 10.4103/ijccm.ijccm_189_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 52-year-old obese gentleman presented to the hospital with complaints of fever and shortness of breath for 10 days. He was admitted in the ward and treated for acute exacerbation of asthma. He was shifted to the Intensive Care Unit (ICU) for persistent fever, neck swelling, airway obstruction and desaturation. Ludwig's angina was suspected and computed tomography of neck confirmed it. A difficult airway was anticipated and preceded with surgical tracheostomy. The patient had hypersensitivity reactions to piperacillin/tazobactam; hence, he was treated with clindamycin and metronidazole. The patient improved and was discharged after five days of ICU stay and 12 days of hospitalization. This case summarizes the rare incidence of Ludwig's angina with antibiotic adverse reactions. If angioneurotic edema is coincidental with features of Ludwig's angina, it becomes more challenging. Early identification, securing the airway, and antibiotic administration are the keystone to better survival.
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Affiliation(s)
- Mohamed Hisham
- Department of Critical Care Medicine, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | | | - R S Senthil Kumar
- Department of Critical Care Medicine, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - P Nandakumar
- Department of Critical Care Medicine, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
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1076
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Use-patterns of personal care and household cleaning products in Switzerland. Food Chem Toxicol 2017; 99:24-39. [DOI: 10.1016/j.fct.2016.10.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/07/2016] [Accepted: 10/25/2016] [Indexed: 01/01/2023]
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1077
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Hesse L, Nawijn MC. Subcutaneous and Sublingual Immunotherapy in a Mouse Model of Allergic Asthma. Methods Mol Biol 2017; 1559:137-168. [PMID: 28063043 DOI: 10.1007/978-1-4939-6786-5_11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Allergic asthma, caused by inhaled allergens such as house dust mite or grass pollen, is characterized by reversible airway obstruction, associated with an eosinophilic inflammation of the airways, as well as airway hyper responsiveness and remodeling. The inhaled allergens trigger a type-2 inflammatory response with involvement of innate lymphoid cells (ILC2) and Th2 cells, resulting in high production of immunoglobulin E (IgE) antibodies. Consequently, renewed allergen exposure results in a classic allergic response with a distinct early and late phase, both resulting in bronchoconstriction and shortness of breath. Allergen specific immunotherapy (AIT) is the only treatment that is capable of modifying the immunological process underlying allergic responses including allergic asthma and both subcutaneous AIT (SCIT) as well as sublingual AIT (SLIT) have proven clinical efficacy in long term suppression of the allergic response. Although these treatments are very successful for rhinitis, application of AIT in asthma is hampered by variable efficacy, long duration of treatment, and the risk of severe side-effects. A more profound understanding of the mechanisms by which AIT achieves tolerance to allergens in sensitized individuals is needed to improve its efficacy. Mouse models have been very valuable as a preclinical model to characterize the mechanisms of desensitization in AIT and to evaluate novel approaches for improved efficacy. Here, we present a rapid and reproducible mouse model for allergen-specific immunotherapy. In this model, mice are sensitized with two injections of allergen absorbed to aluminum hydroxide to induce allergic sensitization, followed by subcutaneous injections (SCIT) or sublingual administrations (SLIT) of the allergen as immunotherapy treatment. Finally, mice are challenged by three intranasal allergen administrations. We will describe the protocols as well as the most important read-out parameters including measurement of invasive lung function measurements, serum immunoglobulin levels, isolation of broncho-alveolar lavage fluid (BALF), and preparation of cytospins. Moreover, we describe how to restimulate lung single cell suspensions, perform flow cytometry measurements to identify populations of relevant immune cells, and perform ELISAs and Luminex assays to measure the cytokine concentrations in BALF and lung tissue.
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Affiliation(s)
- Laura Hesse
- Department of Pathology and Medical Biology, Laboratory of Experimental Pulmonology and Inflammation Research (EXPIRE), University Medical Center Groningen, University of Groningen, Hanzeplein 1 (EA52/T2.212), 9713 GZ, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martijn C Nawijn
- Department of Pathology and Medical Biology, Laboratory of Experimental Pulmonology and Inflammation Research (EXPIRE), University Medical Center Groningen, University of Groningen, Hanzeplein 1 (EA52/T2.212), 9713 GZ, Groningen, The Netherlands. .,Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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1078
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Agache I, Rogozea L. Asthma Biomarkers: Do They Bring Precision Medicine Closer to the Clinic? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:466-476. [PMID: 28913985 PMCID: PMC5603474 DOI: 10.4168/aair.2017.9.6.466] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/03/2017] [Accepted: 03/13/2017] [Indexed: 12/11/2022]
Abstract
Measurement of biomarkers has been incorporated within clinical research of asthma to characterize the population and to associate the disease with environmental and therapeutic effects. Regrettably, at present, there are no specific biomarkers, none is validated or qualified, and endotype-driven choices overlap. Biomarkers have not yet reached clinical practice and are not included in current asthma guidelines. Last but not least, the choice of the outcome upholding the value of the biomarkers is extremely difficult, since it has to reflect the mechanistic intervention while being relevant to both the disease and the particular person. On the verge of a new age of asthma healthcare standard, we must embrace and adapt to the key drivers of change. Disease endotypes, biomarkers, and precision medicine represent an emerging model of patient care building on large-scale biologic databases, omics and diverse cellular assays, health information technology, and computational tools for analyzing sizable sets of data. A profound transformation of clinical and research pattern from population to individual risk and from investigator-imposed subjective disease clustering (hypothesis driven) to unbiased, data-driven models is facilitated by the endotype/biomarker-driven approach.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University of Brasov, Brasov, Romania.
| | - Liliana Rogozea
- Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University of Brasov, Brasov, Romania
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1079
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Mahajan A, Youssef LA, Cleyrat C, Grattan R, Lucero SR, Mattison CP, Erasmus MF, Jacobson B, Tapia L, Hlavacek WS, Schuyler M, Wilson BS. Allergen Valency, Dose, and FcεRI Occupancy Set Thresholds for Secretory Responses to Pen a 1 and Motivate Design of Hypoallergens. THE JOURNAL OF IMMUNOLOGY 2016; 198:1034-1046. [PMID: 28039304 DOI: 10.4049/jimmunol.1601334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/30/2016] [Indexed: 11/19/2022]
Abstract
Ag-mediated crosslinking of IgE-FcεRI complexes activates mast cells and basophils, initiating the allergic response. Of 34 donors recruited having self-reported shrimp allergy, only 35% had significant levels of shrimp-specific IgE in serum and measurable basophil secretory responses to rPen a 1 (shrimp tropomyosin). We report that degranulation is linked to the number of FcεRI occupied with allergen-specific IgE, as well as the dose and valency of Pen a 1. Using clustered regularly interspaced palindromic repeat-based gene editing, human RBLrαKO cells were created that exclusively express the human FcεRIα subunit. Pen a 1-specific IgE was affinity purified from shrimp-positive plasma. Cells primed with a range of Pen a 1-specific IgE and challenged with Pen a 1 showed a bell-shaped dose response for secretion, with optimal Pen a 1 doses of 0.1-10 ng/ml. Mathematical modeling provided estimates of receptor aggregation kinetics based on FcεRI occupancy with IgE and allergen dose. Maximal degranulation was elicited when ∼2700 IgE-FcεRI complexes were occupied with specific IgE and challenged with Pen a 1 (IgE epitope valency of ≥8), although measurable responses were achieved when only a few hundred FcεRI were occupied. Prolonged periods of pepsin-mediated Pen a 1 proteolysis, which simulates gastric digestion, were required to diminish secretory responses. Recombinant fragments (60-79 aa), which together span the entire length of tropomyosin, were weak secretagogues. These fragments have reduced dimerization capacity, compete with intact Pen a 1 for binding to IgE-FcεRI complexes, and represent a starting point for the design of promising hypoallergens for immunotherapy.
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Affiliation(s)
- Avanika Mahajan
- Department of Pathology, University of New Mexico, Albuquerque, NM 87131
| | - Lama A Youssef
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, Damascus University, Damascus, Syria.,National Commission for Biotechnology, Damascus, Syria
| | - Cédric Cleyrat
- Department of Pathology, University of New Mexico, Albuquerque, NM 87131
| | - Rachel Grattan
- Department of Pathology, University of New Mexico, Albuquerque, NM 87131
| | - Shayna R Lucero
- Department of Pathology, University of New Mexico, Albuquerque, NM 87131
| | - Christopher P Mattison
- Southern Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, New Orleans, LA 70124
| | - M Frank Erasmus
- Department of Pathology, University of New Mexico, Albuquerque, NM 87131
| | - Bruna Jacobson
- Department of Computer Sciences, University of New Mexico, Albuquerque, NM 87131
| | - Lydia Tapia
- Department of Computer Sciences, University of New Mexico, Albuquerque, NM 87131
| | - William S Hlavacek
- Theoretical Biology and Biophysics Group, Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM 87545.,Theoretical Biology and Biophysics Group, Center for Nonlinear Studies, Los Alamos National Laboratory, Los Alamos, NM 87545; and
| | - Mark Schuyler
- Department of Medicine, University of New Mexico, Albuquerque, NM 87131
| | - Bridget S Wilson
- Department of Pathology, University of New Mexico, Albuquerque, NM 87131;
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1080
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Giavina-Bianchi P, Galvão VR, Picard M, Caiado J, Castells MC. Basophil Activation Test is a Relevant Biomarker of the Outcome of Rapid Desensitization in Platinum Compounds-Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:728-736. [PMID: 28034549 DOI: 10.1016/j.jaip.2016.11.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/30/2016] [Accepted: 11/07/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rapid drug desensitization (RDD) has become a cornerstone in the management of immediate drug hypersensitivity reactions (DHRs) to chemotherapeutic agents. Because of the inherent risk of anaphylaxis during RDD, biomarkers to predict patients at risk of developing such severe reactions are needed. The basophil activation test (BAT) has been used in DHRs as a diagnostic tool. OBJECTIVE We evaluated basophil CD63 and CD203c expression (BAT) as a biomarker to assess the safety and effectiveness of RDD in platinum compounds-allergic patients. METHODS Patients allergic to platinum compounds (n = 15) undergoing RDD were assessed through clinical history, skin testing, serum tryptase levels, and BAT. BAT was performed immediately before RDD, assessing CD203c and CD63 expression on basophils. BAT was also performed in 6 patients tolerant to platinum compounds and in 6 healthy volunteers. RESULTS BAT was positive to CD203c or CD63 in 11 out of 15 patients allergic to platinum compounds (73%), with increased expression of CD203c and CD63 in 11 (73%) and 6 (40%) patients, respectively. Increased CD63 expression tended to be associated with more severe initial reactions. All controls had negative test results. Reactions during RDD were associated with BAT positivity and increased tryptase levels. Only 1 of 4 patients with negative BAT had a mild reaction during RDD. BAT remained positive in multiple sequential RDD. CONCLUSIONS BAT identified patients allergic to platinum compounds with an increased risk of reactions during desensitization and higher CD63 expression was observed in severe reactions. Multiple RDDs to platinum compounds did not induce persistent hyporesponsiveness on basophils. BAT is a potential biomarker for RDD.
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Affiliation(s)
- Pedro Giavina-Bianchi
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil.
| | - Violeta Régnier Galvão
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - Matthieu Picard
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Canada
| | - Joana Caiado
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Immunoallergology Department, Hospital de Santa Maria/Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Mariana C Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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1081
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Steveling-Klein EH. Allergen-Specific Immunotherapy. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10314632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Allergen-specific immunotherapy remains the only causal treatment of allergic disease to date. Its efficacy in symptom reduction was demonstrated in double blind, placebo-controlled studies of allergic rhinoconjunctivitis, allergic asthma, and Hymenoptera venom hypersensitivity, including long-term effects after discontinuation of treatment. In addition, immunotherapy decreases the risk of developing new sensitisations to aeroallergens in monosensitised patients and allergic asthma in patients with mere allergic rhinitis. The mechanism of immunotherapy entails redirection of the T lymphocyte response from a T helper cell Type 2 phenotype in favour of induction of regulatory T cells and/or immune deviation toward a T helper cell Type 1 phenotype, with resulting inhibition of downstream effector pathways and induction of immunoglobulin G-associated blocking antibodies. Two main application forms are used in clinical practice: subcutaneous immunotherapy and sublingual immunotherapy. The advantage of subcutaneous immunotherapy is its proven efficacy over a broad range of indications. Disadvantages are systemic allergic reactions and inconvenience for the patient due to frequent doctor visits. Sublingual immunotherapy has been shown to result in less systemic allergic reactions and may be more convenient due to home application; however, efficacy has only been proven for allergic rhinitis. For clinicians, the adherence to practice guidelines and thorough knowledge of allergen products, application routes, indications, immunomodulatory mechanisms, efficacy, safety, and cost-effectiveness is important for successful treatment and will be addressed in this review article.
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1082
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Nygaard U, Riis JL, Deleuran M, Vestergaard C. Attention-Deficit/Hyperactivity Disorder in Atopic Dermatitis: An Appraisal of the Current Literature. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2016; 29:181-188. [DOI: 10.1089/ped.2016.0705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Uffe Nygaard
- Department of Dermatology and Venereology, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
| | - Jette L. Riis
- Department of Dermatology and Venereology, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
| | - Mette Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
| | - Christian Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
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1083
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Kepil Özdemir S, Öner Erkekol F, Ünal D, Büyüköztürk S, Gelincik A, Dursun AB, Karakaya G, Bavbek S. Management of Hypersensitivity Reactions to Proton Pump Inhibitors: A Retrospective Experience. Int Arch Allergy Immunol 2016; 171:54-60. [DOI: 10.1159/000450952] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022] Open
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1084
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Abstract
The off-label use of medicines is a common and extensive clinical practice. Omalizumab has been licensed for use in severe allergic asthma and chronic urticaria. Omalizumab dosing was based on body weight and baseline serum IgE concentration. All patients are required to have a baseline IgE between 30 and 700 IU/ml and body weight not more than 150 kg. The use of off-label drugs may lead to several problems including adverse effects and an increased risk/benefit balance. In this article, there are summarized off-label uses of omalizumab in the last recent years in diseases in which IgE maybe or certainly has a corner role such as allergic rhinitis, allergic bronchopulmonary aspergillosis, anaphylaxis, keratoconjunctivitis, food allergy, drug allergy, urticaria, angioedema, non-atopic asthma, atopic dermatitis, nasal polyps, Churg-Strauss syndrome, eosinophilic otitis media, chronic rhinosinusitis, bullous pemphigoid, contact dermatitis, and others. Use in pregnancy asthmatic women and pre-co-administration with specific immunotherapy will also be revised.
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Affiliation(s)
- David El-Qutob
- Unit of Allergy, University Hospital of La Plana in Vila-Real, Carretera Vila-Real-Burriana Km. 0.5, Vila-Real, Castellon, 12540, Spain.
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1085
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Tortajada-Girbés M, Mesa Del Castillo M, Larramona H, Lucas JM, Álvaro M, Tabar AI, Jerez MJ, Martínez-Cañavate A. Evidence in immunotherapy for paediatric respiratory allergy: Advances and recommendations. Allergol Immunopathol (Madr) 2016; 44 Suppl 1:1-32. [PMID: 27776895 DOI: 10.1016/j.aller.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/05/2016] [Indexed: 01/26/2023]
Abstract
Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy (AIT). AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT.
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Affiliation(s)
- M Tortajada-Girbés
- Paediatric Allergology and Pulmonology Unit, Dr. Peset University Hospital, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain.
| | - M Mesa Del Castillo
- Paediatric Allergology and Neumology Unit, Hospital El Escorial, Madrid, Spain
| | - H Larramona
- Paediatric Allergology and Pulmonology Unit, Department of Paediatrics, University Autonoma of Barcelona, and Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - J M Lucas
- Pediatric Allergy and Immunology Unit, Virgen Arrixaca Clinic Universitary Hospital, Murcia, Spain
| | - M Álvaro
- Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - A I Tabar
- Servicio de Alergología. Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Pamplona, Spain
| | - M J Jerez
- Publications Office of the European Union, Luxembourg
| | - A Martínez-Cañavate
- Paediatric Allergology and Neumology Unit, Complejo Hospitalario Universitario de Granada, Spain
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1086
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Brotons-Canto A, Martín-Arbella N, Gamazo C, Irache JM. New pharmaceutical approaches for the treatment of food allergies. Expert Opin Drug Deliv 2016; 15:675-686. [PMID: 27732129 DOI: 10.1080/17425247.2016.1247805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Allergic diseases constitute one of the most common causes of chronic illness in developed countries. The main mechanism determining allergy is an imbalance between Th1 and Th2 response towards Th2. AREAS COVERED This review describes the mechanisms underlying the natural tolerance to food components and the development of an allergic response in sensitized individuals. Furthermore, therapeutic approaches proposed to manage these abnormal immunologic responses food are also presented and discussed. EXPERT OPINION In the past, management of food allergies has consisted of the education of patients to avoid the ingestion of the culprit food and to initiate the therapy (e.g. self-injectable epinephrine) in case of accidental ingestion. In recent years, sublingual/oral immunotherapies based on the continuous administration of small amounts of the allergen have been developed. However, the long periods of time needed to obtain significant desensitization and the generation of adverse effects, limit their use. In order to solve these drawbacks, strategies to induce tolerance are being studied, such as the use of either adjuvant immunotherapy in order to facilitate the reversion of the Th2 response towards Th1 or the use of monoclonal antibodies to block the main immunogenic elements.
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Affiliation(s)
- Ana Brotons-Canto
- a Department of Pharmacy and Pharmaceutical Technology , University of Navarra , Pamplona , Spain
| | - Nekane Martín-Arbella
- a Department of Pharmacy and Pharmaceutical Technology , University of Navarra , Pamplona , Spain
| | - Carlos Gamazo
- b Department of Microbiology , University of Navarra , Pamplona , Spain
| | - Juan M Irache
- a Department of Pharmacy and Pharmaceutical Technology , University of Navarra , Pamplona , Spain
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1087
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Ariza A, Mayorga C, Salas M, Doña I, Martín-Serrano Á, Pérez-Inestrosa E, Pérez-Sala D, Guzmán AE, Montañez MI, Torres MJ. The influence of the carrier molecule on amoxicillin recognition by specific IgE in patients with immediate hypersensitivity reactions to betalactams. Sci Rep 2016; 6:35113. [PMID: 27731424 PMCID: PMC5059705 DOI: 10.1038/srep35113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/23/2016] [Indexed: 11/26/2022] Open
Abstract
The optimal recognition of penicillin determinants, including amoxicillin (AX), by specific IgE antibodies is widely believed to require covalent binding to a carrier molecule. The nature of the carrier and its contribution to the antigenic determinant is not well known. Here we aimed to evaluate the specific-IgE recognition of different AX-derived structures. We studied patients with immediate hypersensitivity reactions to AX, classified as selective or cross-reactors to penicillins. Competitive immunoassays were performed using AX itself, amoxicilloic acid, AX bound to butylamine (AXO-BA) or to human serum albumin (AXO-HSA) in the fluid phase, as inhibitors, and amoxicilloyl-poli-L-lysine (AXO-PLL) in the solid-phase. Two distinct patterns of AX recognition by IgE were found: Group A showed a higher recognition of AX itself and AX-modified components of low molecular weights, whilst Group B showed similar recognition of both unconjugated and conjugated AX. Amoxicilloic acid was poorly recognized in both groups, which reinforces the need for AX conjugation to a carrier for optimal recognition. Remarkably, IgE recognition in Group A (selective responders to AX) is influenced by the mode of binding and/or the nature of the carrier; whereas IgE in Group B (cross-responders to penicillins) recognizes AX independently of the nature of the carrier.
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Affiliation(s)
- Adriana Ariza
- Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
| | - Cristobalina Mayorga
- Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - María Salas
- Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
| | - Inmaculada Doña
- Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
| | - Ángela Martín-Serrano
- Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - Ezequiel Pérez-Inestrosa
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
- Department of Organic Chemistry, University of Málaga, IBIMA, Málaga, Spain
| | | | - Antonio E. Guzmán
- Pharmacy Unit, Regional University Hospital of Malaga, Málaga, Spain
| | - María I. Montañez
- Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - María J. Torres
- Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
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1088
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Rahmatpour S, Khan AH, Nasiri Kalmarzi R, Rajabibazl M, Tavoosidana G, Motevaseli E, Zarghami N, Sadroddiny E. Application of immuno-PCR assay for the detection of serum IgE specific to Bermuda allergen. Mol Cell Probes 2016; 32:1-4. [PMID: 27720768 DOI: 10.1016/j.mcp.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 11/19/2022]
Abstract
In vivo and in vitro tests are the two major ways of identifying the triggering allergens in sensitized individuals with allergic symptoms. Both methods are equally significant in terms of sensitivity and specificity. However, in certain circumstances, in vitro methods are highly preferred because they circumvent the use of sensitizing drugs in patients. In current study, we described a highly sensitive immuno-PCR (iPCR) assay for serum IgE specific to Bermuda allergens. Using oligonucleotide-labelled antibody, we used iPCR for the sensitive detection of serum IgE. The nucleotide sequence was amplified using conventional PCR and the bands were visualized on 2.5% agarose gel. Results demonstrated a 100-fold enhancement in sensitivity of iPCR over commercially available enzyme-linked immunosorbent assay (ELISA) kit. Our iPCR method was highly sensitive for Bermuda-specific serum IgE and could be beneficial in allergy clinics.
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Affiliation(s)
- Samine Rahmatpour
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amjad Hayat Khan
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasoul Nasiri Kalmarzi
- Cellular and Molecular Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masoumeh Rajabibazl
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Tavoosidana
- Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Motevaseli
- Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Esmaeil Sadroddiny
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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1089
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Croote D, Quake SR. Food allergen detection by mass spectrometry: the role of systems biology. NPJ Syst Biol Appl 2016; 2:16022. [PMID: 28725476 PMCID: PMC5516885 DOI: 10.1038/npjsba.2016.22] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 11/08/2022] Open
Abstract
Food allergy prevalence is rising worldwide, motivating the development of assays that can sensitively and reliably detect trace amounts of allergens in manufactured food. Mass spectrometry (MS) is a promising alternative to commonly employed antibody-based assays owing to its ability to quantify multiple proteins in complex matrices with high sensitivity. In this review, we discuss a targeted MS workflow for the quantitation of allergenic protein in food products that employs selected reaction monitoring (SRM). We highlight the aspects of SRM method development unique to allergen quantitation and identify opportunities for simplifying the process. One promising avenue identified through a comprehensive survey of published MS literature is the use of proteotypic peptides, which are peptides whose presence appears robust to variations in food matrix, sample preparation protocol, and MS instrumentation. We conclude that proteotypic peptides exist for a subset of allergenic milk, egg, and peanut proteins. For less studied allergens such as soy, wheat, fish, shellfish, and tree nuts, we offer guidance and tools for peptide selection and specificity verification as part of an interactive web database, the Allergen Peptide Browser (http://www.AllergenPeptideBrowser.org). With ongoing improvements in MS instrumentation, analysis software, and strategies for targeted quantitation, we expect an increasing role of MS as an analytical tool for ensuring regulatory compliance.
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Affiliation(s)
- Derek Croote
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Stephen R Quake
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Applied Physics, Stanford University, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
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1090
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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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1091
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Kowalski ML, Wardzyńska A, Makowska JS. Clinical Trials of Aspirin Treatment After Desensitization in Aspirin-Exacerbated Respiratory Disease. Immunol Allergy Clin North Am 2016; 36:705-717. [PMID: 27712765 DOI: 10.1016/j.iac.2016.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The clinical efficacy of aspirin treatment after desensitization in patients with respiratory disease exacerbated by nonsteroidal anti-inflammatory drugs has been documented in observational studies and in double-blind placebo-controlled trials. There is no general agreement with regard to the optimal maintenance dose or duration of treatment with acetylsalicylic acid after desensitization, thus further studies are necessary to offer clear guidelines to clinicians. This article summarizes data from noncontrolled, active-control, and placebo-controlled trials assessing clinical effectiveness and reporting on safety of treatment with acetylsalicylic acid in desensitized patients with respiratory disease exacerbated by nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
- Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Center, Medical University of Łódź, 251 Pomorska Street, Łódź 92-213, Poland.
| | - Aleksandra Wardzyńska
- Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Center, Medical University of Łódź, 251 Pomorska Street, Łódź 92-213, Poland
| | - Joanna S Makowska
- Department of Rheumatology, Medical University of Łódź, 30 Pieniny Street, Łódź 92-115, Poland
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1092
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Pek CH, Cheong CSJ, Yap YL, Doggett S, Lim TC, Ong WC, Lim J. Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a Patient Travelling into Singapore from Australia. J Emerg Med 2016; 51:e109-e114. [PMID: 27618477 DOI: 10.1016/j.jemermed.2016.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/04/2015] [Accepted: 02/17/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ticks are blood-sucking arachnids that feed on all classes of vertebrates, including humans. Ixodes holocyclus, also known as the Australian Paralysis Tick, is capable of causing a myriad of clinical issues in humans and companion animals, including the transmission of infectious agents, toxin-mediated paralysis, allergic and inflammatory reactions, and mammalian meat allergies in humans. The Australian Paralysis Tick is endemic to Australia, and only two other exported cases have been reported in the literature. CASE REPORT We report the third exported case of tick paralysis caused by I. holocyclus, which was imported on a patient into Singapore. We also discuss the clinical course of the patient, the salient points of management, and the proper removal of this tick species. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With increasing air travel, emergency physicians need to be aware of and to identify imported cases of tick paralysis to institute proper management and advice to the patient. We also describe the tick identification features and proper method of removal of this tick species.
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Affiliation(s)
- Chong Han Pek
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Crystal Shuk Jin Cheong
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Yan Lin Yap
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Stephen Doggett
- Department of Medical Entomology, Pathology West, Westmead Hospital, Westmead, NSW, Australia
| | - Thiam Chye Lim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Wei Chen Ong
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Jane Lim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
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1093
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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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1094
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Sindher S, Fleischer DM, Spergel JM. Advances in the Treatment of Food Allergy: Sublingual and Epicutaneous Immunotherapy. Immunol Allergy Clin North Am 2016; 36:39-54. [PMID: 26617226 DOI: 10.1016/j.iac.2015.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Food allergies continue to increase in prevalence. Standard care is a strict elimination diet, but life-threatening reactions still occur. Allergen immunotherapy has the most potential in treating food allergy. Subcutaneous immunotherapy has not been adopted into food allergy therapy. Oral immunotherapy has a high rate of adverse reactions. Sublingual immunotherapy (SLIT) uses the tolerogenic environment of the oral mucosa and epicutaneous immunotherapy (EPIT) uses the immune cells of the epidermis to transport antigens to afferent lymph nodes to activate immune responses. SLIT and EPIT can successfully desensitize patients. More research is needed to define optimal doses and administration protocols.
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Affiliation(s)
- Sayantani Sindher
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA
| | - David M Fleischer
- Section of Allergy, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver School of Medicine, 13123 East 16th Avenue, B518, Aurora, CO 80045, USA
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA.
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1095
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Epicutaneous and Oral Low-Zone Tolerance Protects from Colitis in Mice. J Invest Dermatol 2016; 136:1831-1839. [DOI: 10.1016/j.jid.2016.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/07/2016] [Accepted: 04/11/2016] [Indexed: 11/19/2022]
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1096
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Caminati M, Senna G, Stefanizzi G, Bellamoli R, Longhi S, Chieco-Bianchi F, Guarnieri G, Tognella S, Olivieri M, Micheletto C, Festi G, Bertocco E, Mazza M, Rossi A, Vianello A. Drop-out rate among patients treated with omalizumab for severe asthma: Literature review and real-life experience. BMC Pulm Med 2016; 16:128. [PMID: 27562427 PMCID: PMC5000547 DOI: 10.1186/s12890-016-0290-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 08/18/2016] [Indexed: 11/29/2022] Open
Abstract
Background In patients with asthma, particularly severe asthma, poor adherence to inhaled drugs negatively affects the achievement of disease control. A better adherence rate is expected in the case of injected drugs, such as omalizumab, as they are administered only in a hospital setting. However, adherence to omalizumab has never been systematically investigated. The aim of this study was to review the omalizumab drop-out rate in randomized controlled trials (RCTs) and real-life studies. A comparative analysis was performed between published data and the Italian North East Omalizumab Network (NEONet) database. Results In RCTs the drop-out rate ranged from 7.1 to 19.4 %. Although the reasons for withdrawal were only occasionally reported, patient decision and adverse events were the most frequently reported causes. In real-life studies the drop-out rate ranged from 0 to 45.5 %. In most cases lack of efficacy was responsible for treatment discontinuation. According to NEONet data, 32 % of treated patients dropped out, with an increasing number of drop outs observed over time. Patient decision and lack of efficacy accounted for most treatment withdrawals. Conclusions Treatment adherence is particularly crucial in patients with severe asthma considering the clinical impact of the disease and the cost of non-adherence. The risk of treatment discontinuation has to be carefully considered both in the experimental and real-life settings. Increased knowledge regarding the main reasons for patient withdrawal is important to improve adherence in clinical practice.
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Affiliation(s)
- M Caminati
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy.
| | - G Senna
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - G Stefanizzi
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - R Bellamoli
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - S Longhi
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - F Chieco-Bianchi
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
| | - G Guarnieri
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - S Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - M Olivieri
- Unit of Occupational Medicine, Verona General and University Hospital, Verona, Italy
| | - C Micheletto
- Respiratory Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | - G Festi
- Pulmonary Unit, Verona University and General Hospital, Verona, Italy
| | - E Bertocco
- Respiratory pathology Unit, Arzignano General Hospital, Vicenza, Italy
| | - M Mazza
- Pulmonary Unit, Pordenone General Hospital, Pordenone, Italy
| | - A Rossi
- Pulmonary Unit, Verona University and General Hospital, Verona, Italy
| | - A Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
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1097
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Zieglmayer P, Focke-Tejkl M, Schmutz R, Lemell P, Zieglmayer R, Weber M, Kiss R, Blatt K, Valent P, Stolz F, Huber H, Neubauer A, Knoll A, Horak F, Henning R, Valenta R. Mechanisms, safety and efficacy of a B cell epitope-based vaccine for immunotherapy of grass pollen allergy. EBioMedicine 2016; 11:43-57. [PMID: 27650868 PMCID: PMC5049999 DOI: 10.1016/j.ebiom.2016.08.022] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/13/2016] [Accepted: 08/15/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We have developed a recombinant B cell epitope-based vaccine (BM32) for allergen-specific immunotherapy (AIT) of grass pollen allergy. The vaccine contains recombinant fusion proteins consisting of allergen-derived peptides and the hepatitis B surface protein domain preS as immunological carrier. METHODS We conducted a randomized, double-blind, placebo-controlled AIT study to determine safety, clinical efficacy and immunological mechanism of three subcutaneous injections of three BM32 doses adsorbed to aluminum hydroxide versus aluminum hydroxide (placebo) applied monthly to grass pollen allergic patients (n=70). Primary efficacy endpoint was the difference in total nasal symptom score (TNSS) through grass pollen chamber exposure before treatment and 4weeks after the last injection. Secondary clinical endpoints were total ocular symptom score (TOSS) and allergen-specific skin response evaluated by titrated skin prick testing (SPT) at the same time points. Treatment-related side effects were evaluated as safety endpoints. Changes in allergen-specific antibody, cellular and cytokine responses were measured in patients before and after treatment. RESULTS Sixty-eight patients completed the trial. TNSS significantly decreased with mean changes of -1.41 (BM32/20μg) (P=0.03) and -1.34 (BM32/40μg) (P=0.003) whereas mean changes in the BM32/10μg and placebo group were not significant. TOSS and SPT reactions showed a dose-dependent decrease. No systemic immediate type side effects were observed. Only few grade 1 systemic late phase reactions occurred in BM32 treated patients. The number of local injection site reactions was similar in actively and placebo-treated patients. BM32 induced highly significant allergen-specific IgG responses (P<0.0001) but no allergen-specific IgE. Allergen-induced basophil activation was reduced in BM32 treated patients and addition of therapy-induced IgG significantly suppressed T cell activation (P=0.0063). CONCLUSION The B cell epitope-based recombinant grass pollen allergy vaccine BM32 is well tolerated and few doses are sufficient to suppress immediate allergic reactions as well as allergen-specific T cell responses via a selective induction of allergen-specific IgG antibodies. (ClinicalTrials.gov number, NCT01445002.).
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Affiliation(s)
| | - Margarete Focke-Tejkl
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Milena Weber
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Renata Kiss
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Katharina Blatt
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, 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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1098
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Efficacy of house dust mite sublingual immunotherapy tablet in North American adolescents and adults in a randomized, placebo-controlled trial. J Allergy Clin Immunol 2016; 138:1631-1638. [PMID: 27521719 DOI: 10.1016/j.jaci.2016.06.044] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The house dust mite (HDM) sublingual immunotherapy (SLIT) tablet (MK-8237; Merck & Co, Kenilworth, NJ/ALK-Abelló, Hørsholm, Denmark) has demonstrated beneficial effects on allergic rhinoconjunctivitis and asthma outcomes in European trials. OBJECTIVE This is the first trial to assess the efficacy/safety of HDM SLIT-tablets in North American subjects with HDM-induced allergic rhinitis with or without conjunctivitis (AR/C). METHODS In this double-blind, multicenter trial (NCT01700192) 1482 subjects (aged ≥12 years) with HDM-induced AR/C with or without asthma were randomized to a daily SQ HDM SLIT-tablet (12 SQ-HDM dose) or placebo for up to approximately 52 weeks. A rhinitis daily symptom score (DSS; 4 nasal symptoms, maximum score = 12) of 6 or greater, or 5 or greater with 1 symptom being severe, on 5 of 7 consecutive days before randomization was required. The primary end point was the average total combined rhinitis score, which was defined as the rhinitis DSS plus rhinitis daily medication score (DMS), during the last 8 treatment weeks. RESULTS Treatment with 12 SQ-HDM improved the total combined rhinitis score by 17% (95% CI, 10% to 25%) versus placebo. Improvements versus placebo in the secondary end points of average rhinitis DSS, rhinitis DMS, total combined rhinoconjunctivitis score, and visual analog scale-assessed AR/C symptoms were 16%, 18%, 17%, and 16%, respectively. All nominal P values were less than .001 versus placebo, except rhinitis DMS (P = 0.15). No treatment-related adverse events meeting the International Council on Harmonization definition of a serious adverse event were reported; 1 nonserious treatment-related systemic allergic reaction occurred (assessed as moderate intensity) at first administration under medical supervision and was treated with epinephrine. CONCLUSIONS In the first North American trial of use of a SLIT-tablet for HDM allergy, 12 SQ-HDM was well tolerated and improved HDM-induced rhinitis symptoms in adults and adolescents.
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1099
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Cornelius C, Schöneweis K, Georgi F, Weber M, Niederberger V, Zieglmayer P, Niespodziana K, Trauner M, Hofer H, Urban S, Valenta R. Immunotherapy With the PreS-based Grass Pollen Allergy Vaccine BM32 Induces Antibody Responses Protecting Against Hepatitis B Infection. EBioMedicine 2016; 11:58-67. [PMID: 27568223 PMCID: PMC5049759 DOI: 10.1016/j.ebiom.2016.07.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023] Open
Abstract
Background We have constructed and clinically evaluated a hypoallergenic vaccine for grass pollen allergy, BM32, which is based on fusion proteins consisting of peptides from the IgE binding sites of the major grass pollen allergens fused to preS (preS1 + preS2), a domain of the hepatitis B virus (HBV) large envelope protein which mediates the viral attachment and entry. Aim of this study was the characterization of the HBV-specific immune response induced by vaccination of allergic patients with BM32 and the investigation of the vaccines' potential to protect against infection with HBV. Methods Hepatitis B-specific antibody and T cell responses of patients vaccinated with BM32 were studied using recombinant preS and synthetic overlapping peptides spanning the preS sequence. The specificities of the antibody responses were compared with those of patients with chronic HBV infection. Furthermore, the capacity of BM32-induced antibodies, to inhibit HBV infection was investigated using HepG2-hNTCP cell-based in vitro virus neutralization assays. Findings IgG antibodies from BM32-vaccinated but not of HBV-infected individuals recognized the sequence motif implicated in NTCP (sodium-taurocholate co-transporting polypeptide)-receptor interaction of the hepatitis B virus and inhibited HBV infection. Interpretation Our study demonstrates that the recombinant hypoallergenic grass pollen allergy vaccine BM32 induces hepatitis B-specific immune responses which protect against hepatitis B virus infection in vitro. BM32 is a recombinant allergy vaccine consisting of the preS domain of the large envelope protein of hepatitis B virus (HBV) and allergen-derived peptides. Vaccination of allergic patients with BM32 induced preS-specific antibodies which inhibit hepatitis B infection in vitro. BM32 may be useful as therapeutic vaccine in HBV-infected patients.
Infection with HBV remains a major cause of morbidity and mortality worldwide. Conventional HBV vaccines, consisting of SHBs particles solely, do not elicit adequate antibody production in 5–10% of vaccines and there is a need for therapeutic HBV vaccines. We have engineered an allergy vaccine which consists of allergen-derived peptides fused to the preS domain of the large envelope protein of HBV. Here we show that vaccination of allergic patients with this vaccine induces antibodies which protect against HBV infection in vitro. The preS-containing allergy vaccine may thus be also useful for therapeutic vaccination of HBV-infected patients.
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Affiliation(s)
- Carolin Cornelius
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Katrin Schöneweis
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Fanny Georgi
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Milena Weber
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Verena Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | | | - Katarzyna Niespodziana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Harald Hofer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Stephan Urban
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany; German Centre of Infectious Research (DZIF), TTU Hepatitis, Heidelberg, Germany
| | - 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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1100
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Agache I, Strasser DS, Klenk A, Agache C, Farine H, Ciobanu C, Groenen PMA, Akdis CA. Serum IL-5 and IL-13 consistently serve as the best predictors for the blood eosinophilia phenotype in adult asthmatics. Allergy 2016; 71:1192-202. [PMID: 27060452 DOI: 10.1111/all.12906] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Molecular biomarkers that identify the phenotype of blood eosinophilia were evaluated in adult asthmatics, and their relationship with clinically significant asthma outcomes was assessed. Patients were clustered based on their molecular fingerprint. METHODS At inclusion, 64 patients were evaluated for phenotypic traits, sputum and blood eosinophilia, exhaled NO, serum cytokines and chemokines, total serum IgE, lung function (LF), and airway hyper-responsiveness (AHR). Within-patient changes were evaluated in 44 patients 6 weeks later. RESULTS Lung function, asthma control, and monocyte chemotactic protein-1 (MCP-1) were identified as the most important distinguisher and blood eosinophilia as second most important identifier in principal component analysis. A robust relationship was observed between blood eosinophilia and IL-5, IL-13, and eosinophil-derived neurotoxin (EDN), which stayed consistent after 6 weeks. Serum IL-5 and IL-13 were the two best, followed by EDN as separators of high vs low blood eosinophilia. Periostin did not identify blood or sputum eosinophilia, even after stratification for total IgE, and did not correlate with IL-5, IL-13, eotaxin, or EDN. IL-5 and IL-13 showed strong correlations with AHR and monocyte chemoattractant protein (MCP)-1 with asthma severity and fast LF decline. The presence of high or low expression of MCP-1, eotaxin, and IL-8 identified two separate blood eosinophilia patient clusters linked to asthma severity. CONCLUSION Serum IL-5 and IL-13 are reliable biomarkers for the blood eosinophilia asthma phenotype. High or low expression of MCP-1, eotaxin, and IL-8 discriminates between eosinophilic asthma severity clusters.
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Affiliation(s)
- I. Agache
- Transylvania University Brasov; Brasov Romania
| | - D. S. Strasser
- Department of Translational Science; Actelion Pharmaceuticals Ltd.; Davos Switzerland
| | - A. Klenk
- Information Management Drug Discovery; Actelion Pharmaceuticals Ltd.; Davos Switzerland
| | - C. Agache
- Theramed Medical Center; Brasov Romania
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - H. Farine
- Department of Translational Science; Actelion Pharmaceuticals Ltd.; Davos Switzerland
| | | | - P. M. A. Groenen
- Department of Translational Science; Actelion Pharmaceuticals Ltd.; Davos Switzerland
| | - C. A. Akdis
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
- Swiss Institute for Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
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