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Allergic Rhinitis and Its Epidemiological Distribution in Syria: A High Prevalence and Additional Risks in War Time. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7212037. [PMID: 32596361 PMCID: PMC7273446 DOI: 10.1155/2020/7212037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/10/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023]
Abstract
Background Allergic rhinitis (AR) is a global disease that affects a huge proportion of people around the world especially in the Middle East, where multiple allergy-promoting factors can be found. Although AR is not fatal, it severely affects the quality of life. However, it is usually overlooked in developing countries due to resource scarcity. Methods An online questionnaire on social media was used which included demographics, smoking, socioeconomic-status (SES), war-related questions, and the score for allergic rhinitis (SFAR), a simple self-reporting tool with the cut-off point at 7. Findings. This study included 968 subjects with 721 (74.5%) females. The mean age was 24.69 years with AR prevalence at 47.9%. AR was associated with male gender [P = 0.001 (OR, 1.677; 95% CI 1.249-2.253)], having a job [P = 0.049 (OR, 1.309; 95% CI 1.001-1.713)], the having a chronic medical condition (P < 0.0001) mainly other allergies [P < 0.0001 (OR, 9.199; 95% CI 3.836-22.063)] and asthma [P = 0.006 (OR, 5.060; 95% CI 1.396-18.342)], using medications (P < 0.0001) and living in particular provinces (P = 0.010). However, no significant correlation was found with type of work and war factors except being distressed by war sounds [P = 0.027 (OR, 1.348; 95% CI 1.034-1.757)]. Finally, no associations were found with age, consanguinity, SES, educational level, and cigarette or/and shisha smoking (P > 0.05). Interpretation. Approximately half of the sample displayed AR symptoms, indicating a potentially high burden of AR in the community. A correlation to being distressed from war noises was found with AR which could reflect a psychological aspect. In addition, in war harmful allergens are released which can be an additional AR risk factor which adds to the environment in the Middle East that is associated with AR. However, we need further studies to discover and minimize this huge prevalence of AR.
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Calderon MA, Waserman S, Bernstein DI, Demoly P, Douglass J, Gagnon R, Katelaris CH, Kim H, Nelson HS, Okamoto Y, Okubo K, Virchow JC, DuBuske L, Casale TB, Canonica GW, Nolte H. Clinical Practice of Allergen Immunotherapy for Allergic Rhinoconjunctivitis and Asthma: An Expert Panel Report. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2920-2936.e1. [PMID: 32422372 DOI: 10.1016/j.jaip.2020.04.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/13/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022]
Abstract
Allergen immunotherapy (AIT) reduces symptoms and medication use associated with allergic rhinitis with or without conjunctivitis and allergic asthma. Although several AIT guidelines exist, there remain unanswered questions about AIT that are relevant to everyday practice. Our objective was to prepare an evidence-based overview addressing the practical aspects of AIT in clinical practice based on published evidence and the experience of international experts in the field. Topics covered include interpretation and translation of clinical trial data into everyday clinical practice (eg, allergen doses and treatment duration), assessment of risk and treatment of local and systemic allergic reactions, recommendations for improvement of AIT guidelines, and identification of appropriate data for seeking regulatory approval, to name a few. Many informational gaps in AIT practice need further evaluation as products and practices evolve.
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Affiliation(s)
- Moisés A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London-NHLI, London, United Kingdom.
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David I Bernstein
- Division of Allergy, Rheumatology and Immunology, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Pascal Demoly
- Department of Pulmonology, University Hospital of Montpellier, & IPLESP, Sorbonne Université - Inserm, Paris, France
| | - Jo Douglass
- The Royal Melbourne Hospital & The University of Melbourne, Melbourne, VIC, Australia
| | - Remi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Québec, QC, Canada
| | - Constance H Katelaris
- Campbelltown Hospital and the School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Western University, London, ON, Canada; Division of Clinical Immunology & Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Harold S Nelson
- Department of Medicine, National Jewish Health, Denver, Colo
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - Kimihiro Okubo
- Department of Otolaryngology, Nippon Medical School, Nippon, Japan
| | - J Christian Virchow
- Department of Pneumology/Intensive Care Medicine, University of Rostock, Rostock, Germany
| | - Lawrence DuBuske
- Department of Medicine, Division of Allergy and Immunology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Thomas B Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, Fla
| | - G Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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103
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Scadding GK, Hellings PW, Bachert C, Bjermer L, Diamant Z, Gevaert P, Kjeldsen A, Kleine-Tebbe J, Klimek L, Muraro A, Roberts G, Steinsvik A, Wagenmann M, Wahn U. Allergic respiratory disease care in the COVID-19 era: A EUFOREA statement. World Allergy Organ J 2020; 13:100124. [PMID: 32426089 PMCID: PMC7229977 DOI: 10.1016/j.waojou.2020.100124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 01/12/2023] Open
Abstract
Spring and Summer 2020 are unique in that the challenges of care for those suffering from pollen allergy coincide with the COVID-19 pandemic. Several considerations are important to allow optimal care of allergic rhinitis (AR) and asthma and hence prevention of coronavirus spread through sneezing, rhinorrhoea, and coughing. This compact overview of recommendations by the EUFOREA expert teams on allergic airway diseases and allergen-specific immunotherapy (AIT) is based on investigation of the current COVID-19 literature in association with the key words above and shared clinical experience of the experts involved. It deals with similarities and differences between AR and coronavirus infection, specific recommendations for allergic disease care in the COVID-19 era, including guidance on AIT.
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Affiliation(s)
- Glenis K Scadding
- Royal National TNE Hospital and Department of Immunology, University College London, United Kingdom
| | - Peter W Hellings
- University Hospitals Leuven, Department of Otorhinolaryngology-Head and Neck Surgery, Leuven, Belgium.,Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University, Belgium.,Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | - Claus Bachert
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University, Belgium.,Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Sweden.,First Affiliated Hospital, Sun Yat-sen University, International Airway Research Center, Guangzhou, China
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Sweden
| | - Zuzana Diamant
- Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden.,Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.,Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center of Groningen and QPS-NL, Groningen, the Netherlands
| | - Philippe Gevaert
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University, Belgium
| | - Anette Kjeldsen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Southern Denmark, Odense, Denmark
| | - Jorge Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient & Clinical Research Center, Berlin, Germany
| | - Ludger Klimek
- Wiesbaden Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Graham Roberts
- David Hide Centre, St Mary's Hospital, Isle of Wight, and University of Southampton, Southampton, United Kingdom
| | - Andreas Steinsvik
- Akershus University Hospital, Department of Otorhinolaryngology and Head and Neck surgery, Division of Surgery, Norway
| | - Martin Wagenmann
- Dept. of Otorhinolaryngology, Düsseldorf University Hospital, Germany
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104
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Alvaro-Lozano M, Akdis CA, Akdis M, Alviani C, Angier E, Arasi S, Arzt-Gradwohl L, Barber D, Bazire R, Cavkaytar O, Comberiati P, Dramburg S, Durham SR, Eifan AO, Forchert L, Halken S, Kirtland M, Kucuksezer UC, Layhadi JA, Matricardi PM, Muraro A, Ozdemir C, Pajno GB, Pfaar O, Potapova E, Riggioni C, Roberts G, Rodríguez Del Río P, Shamji MH, Sturm GJ, Vazquez-Ortiz M. EAACI Allergen Immunotherapy User's Guide. Pediatr Allergy Immunol 2020; 31 Suppl 25:1-101. [PMID: 32436290 PMCID: PMC7317851 DOI: 10.1111/pai.13189] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Allergen immunotherapy is a cornerstone in the treatment of allergic children. The clinical efficiency relies on a well-defined immunologic mechanism promoting regulatory T cells and downplaying the immune response induced by allergens. Clinical indications have been well documented for respiratory allergy in the presence of rhinitis and/or allergic asthma, to pollens and dust mites. Patients who have had an anaphylactic reaction to hymenoptera venom are also good candidates for allergen immunotherapy. Administration of allergen is currently mostly either by subcutaneous injections or by sublingual administration. Both methods have been extensively studied and have pros and cons. Specifically in children, the choice of the method of administration according to the patient's profile is important. Although allergen immunotherapy is widely used, there is a need for improvement. More particularly, biomarkers for prediction of the success of the treatments are needed. The strength and efficiency of the immune response may also be boosted by the use of better adjuvants. Finally, novel formulations might be more efficient and might improve the patient's adherence to the treatment. This user's guide reviews current knowledge and aims to provide clinical guidance to healthcare professionals taking care of children undergoing allergen immunotherapy.
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Affiliation(s)
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Cherry Alviani
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.,Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elisabeth Angier
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Stefania Arasi
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy
| | - Lisa Arzt-Gradwohl
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - Domingo Barber
- School of Medicine, Institute for Applied Molecular Medicine (IMMA), Universidad CEU San Pablo, Madrid, Spain.,RETIC ARADYAL RD16/0006/0015, Instituto de Salud Carlos III, Madrid, Spain
| | - Raphaëlle Bazire
- Allergy Department, Hospital Infantil Niño Jesús, ARADyAL RD16/0006/0026, Madrid, Spain
| | - Ozlem Cavkaytar
- Department of Paediatric Allergy and Immunology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Pasquale Comberiati
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Stephen R Durham
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Aarif O Eifan
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospitals NHS Foundation Trust, London, UK
| | - Leandra Forchert
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Max Kirtland
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - Umut C Kucuksezer
- Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul University, Istanbul, Turkey
| | - Janice A Layhadi
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.,Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - Paolo Maria Matricardi
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Antonella Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Women and Child Health, University of Padua, Padua, Italy
| | - Cevdet Ozdemir
- Institute of Child Health, Department of Pediatric Basic Sciences, Istanbul University, Istanbul, Turkey.,Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology, Istanbul University, Istanbul, Turkey
| | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Ekaterina Potapova
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Carmen Riggioni
- Pediatric Allergy and Clinical Immunology Service, Institut de Reserca Sant Joan de Deú, Barcelona, Spain
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Allergy and Respiratory Medicine (MP803), Clinical & Experimental Sciences & Human Development in Health Academic Units University of Southampton Faculty of Medicine & University Hospital Southampton, Southampton, UK
| | | | - Mohamed H Shamji
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Gunter J Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
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105
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Passalacqua G, Bagnasco D, Canonica GW. 30 years of sublingual immunotherapy. Allergy 2020; 75:1107-1120. [PMID: 31715001 DOI: 10.1111/all.14113] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
Allergen Immunotherapy (AIT) was introduced in clinical practice on an empirical basis more than 100 years ago. Since the first attempts, AIT was administered subcutaneously. Indeed, other routes of administration were proposed and studied, in particular to improve the safety, but only the sublingual route (SLIT) achieved a credibility based on evidence and was then accepted as a viable "alternative" option to the subcutaneous route. SLIT was largely used in clinical trials and clinical practice in this last 30 years. Thus, a large amount of data is available, coming from either controlled trials and postmarketing surveillance studies. It is clear that SLIT is overall effective, but it is also clear that the efficacy is not "class-related," as derived from meta-analyses, but restricted to each specific product. The 30-year lasting use of SLIT allowed to clarify many clinical aspects, such as efficacy, safety, use in asthma, regimens of administration, and optimal doses. In parallel, the mechanisms of action of AIT were elucidated, and new indications were proposed (eg food allergy, atopic dermatitis). In addition, the introduction of molecular-based diagnosis, allowed to better refine the prescription of SLIT, based on specific sensitization profiles. The present article will describe the origin and evolution of SLIT for respiratory allergy, taking into account the clinical context that suggested this form of treatment, the recently developed aspects, the future perspectives and unmet needs, This is not, therefore, a systematic review, rather a narrative historical description of the past history, and a look forward to the future opportunities.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
- Personalized Medicine Asthma & Allergy ‐ Humanitas Clinical and Research Center IRCCS Rozzano (MI) Italy
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106
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Alberca-Custodio RW, Faustino LD, Gomes E, Nunes FPB, de Siqueira MK, Labrada A, Almeida RR, Câmara NOS, da Fonseca DM, Russo M. Allergen-Specific Immunotherapy With Liposome Containing CpG-ODN in Murine Model of Asthma Relies on MyD88 Signaling in Dendritic Cells. Front Immunol 2020; 11:692. [PMID: 32391011 PMCID: PMC7191058 DOI: 10.3389/fimmu.2020.00692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/26/2020] [Indexed: 01/05/2023] Open
Abstract
Changing the immune responses to allergens is the cornerstone of allergen immunotherapy. Allergen-specific immunotherapy that consists of repeated administration of increasing doses of allergen extract is potentially curative. The major inconveniences of allergen-specific immunotherapy include failure to modify immune responses, long-term treatment leading to non-compliance and the potential for developing life-threating anaphylaxis. Here we investigated the effect of a novel liposomal formulation carrying low dose of allergen combined with CpG-ODN, a synthetic TLR9 agonist, on established allergic lung inflammation. We found that challenge with allergen (OVA) encapsulated in cationic liposome induced significantly less severe cutaneous anaphylactic reaction. Notably, short-term treatment (three doses) with a liposomal formulation containing co-encapsulated allergen plus CpG-ODN, but not allergen or CpG-ODN alone, reversed an established allergic lung inflammation and provided long-term protection. This liposomal formulation was also effective against allergens derived from Blomia tropicalis mite extract. The attenuation of allergic inflammation was not associated with increased numbers of Foxp3-positive or IL-10-producing regulatory T cells or with increased levels of IFN-gamma in the lungs. Instead, the anti-allergic effect of the liposomal formulation was dependent of the innate immune signal transduction generated in CD11c-positive putative dendritic cells expressing MyD88 molecule. Therefore, we highlight the pivotal role of dendritic cells in mediating the attenuation of established allergic lung inflammation following immunotherapy with a liposomal formulation containing allergen plus CpG-ODN.
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Affiliation(s)
| | - Lucas D. Faustino
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eliane Gomes
- Institute of Biomedical Sciences, Department of Immunology, University of São Paulo, São Paulo, Brazil
| | | | | | - Alexis Labrada
- Department of Allergens, National Center of Bioproducts (BIOCEN), Havana, Cuba
| | - Rafael Ribeiro Almeida
- Institute of Biomedical Sciences, Department of Immunology, University of São Paulo, São Paulo, Brazil
| | | | - Denise Morais da Fonseca
- Institute of Biomedical Sciences, Department of Immunology, University of São Paulo, São Paulo, Brazil
| | - Momtchilo Russo
- Institute of Biomedical Sciences, Department of Immunology, University of São Paulo, São Paulo, Brazil
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107
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Nolte H, Bernstein DI, Nelson HS, Ellis AK, Kleine-Tebbe J, Lu S. Efficacy and Safety of Ragweed SLIT-Tablet in Children with Allergic Rhinoconjunctivitis in a Randomized, Placebo-Controlled Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2322-2331.e5. [PMID: 32304832 DOI: 10.1016/j.jaip.2020.03.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ragweed sublingual immunotherapy (SLIT) tablet reduces symptoms and symptom-relieving medication use in adults with allergic rhinitis with or without conjunctivitis (AR/C) but has not been evaluated in children. OBJECTIVE This international, multicenter, double-blind, placebo-controlled trial evaluated the efficacy and safety of ragweed SLIT-tablet in children with AR/C. METHODS Children (N = 1025; 77.7% polysensitized) aged 5 to 17 years with ragweed pollen-induced AR/C with or without asthma (FEV1 ≥80% predicted) were randomized 1:1 to daily ragweed SLIT-tablet (12 Amb a 1-Unit) or placebo for up to 28 weeks (NCT02478398). The primary end point was the average total combined score (TCS; sum of rhinoconjunctivitis daily symptom score [DSS] and daily medication score [DMS]) during peak ragweed pollen season (RPS). Key secondary end points were TCS during the entire RPS, and DSS and DMS during the peak RPS. RESULTS Relative TCS (95% CI) improvements with ragweed SLIT-tablet versus placebo were -38.3% (-46.0% to -29.7%; least square [LS] mean difference, -2.73; P < .001) during peak RPS and -32.4% (-40.7% to -23.3%; LS mean difference, -1.86; P < .001) during the entire RPS. DSS and DMS during peak RPS improved with SLIT-tablet versus placebo by -35.4% (-43.2% to -26.1%; LS mean difference, -1.40; P < .001) and -47.7% (-59.8% to -32.5%; LS mean difference, -1.84; P < .001), respectively. Asthma DSS, short-acting β-agonist use, and nocturnal awakenings during peak RPS improved with SLIT-tablet versus placebo by -30.7%, -68.1%, and -75.1%, respectively (all nominal P ≤ .02). No events of anaphylaxis, airway compromise, or severe treatment-related systemic allergic reactions were reported. CONCLUSIONS Ragweed SLIT-tablet significantly improved symptoms and decreased symptom-relieving medication use in children with ragweed pollen-induced AR/C and was well tolerated.
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Affiliation(s)
| | - David I Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Harold S Nelson
- Department of Medicine, Allergy/Immunology Service, National Jewish Health, Denver, Colo
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Susan Lu
- Merck & Co., Inc., Kenilworth, NJ
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108
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Jin M, Zhang L, Zhou G, Zhang S, Li X, Hu S. The effect of the standard length of the first prescription on the adherence to sublingual immunotherapy for patients with allergic rhinitis. Int Forum Allergy Rhinol 2020; 10:768-772. [PMID: 32223075 DOI: 10.1002/alr.22553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Poor adherence to sublingual immunotherapy (SLIT) has become a major cause of unsatisfactory clinical efficacy for patients with allergic rhinitis (AR). This study was designed to identify the effect of different first prescription lengths on the adherence to SLIT. METHODS The clinical data of 306 patients with AR who started SLIT between January 2017 and June 2018 were retrospectively reviewed. Patients were divided into 3 groups according to the length of their first prescription (group A: less than 3 months, group B: 3 to 6 months, group C: more than 6 months). The numbers of adherent or nonadherent patients in each group and the main reasons of nonadherence were analyzed. RESULTS Groups A, B, and C included 102, 161, and 43 patients, respectively. The average lengths of the first prescription for group A, B, and C were 62.52 ± 17.63, 102.21 ± 9.22, and 189.07 ± 17.97 days. There were significance differences among the 3 groups (p < 0.05). There were 42 (41.18%), 112 (69.57%), and 37 (86.05%) adherent patients in group A, B, and C. There were 60 (58.82%), 49 (30.43%), and 6 (13.95%) nonadherent patients in group A, B, and C. There were significant differences in the proportions of adherent and nonadherent patients among the 3 groups (p < 0.05). The following reasons were cited for nonadherence to SLIT: the long course of SLIT; inconvenience of getting the prescription; ineffectiveness; side effects; and other reasons. CONCLUSION Under certain conditions, 6 months is recommended as the standard length for the first prescription, which can significantly improve adherence to SLIT in patients with AR.
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Affiliation(s)
- Mao Jin
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Lei Zhang
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Guojin Zhou
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Shoude Zhang
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Xuan Li
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Sunhong Hu
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
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109
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Devillier P, Demoly P, Molimard M. Allergen immunotherapy: what is the added value of real-world evidence from retrospective claims database studies? Expert Rev Respir Med 2020; 14:445-452. [PMID: 32131649 DOI: 10.1080/17476348.2020.1733417] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Randomized controlled trials (RCTs) show that allergen immunotherapy (AIT) has proven long-term efficacy in patients with allergic rhinitis (AR). However, RCTs have limited generalizability and there is growing recognition that real-world evidence (RWE) is necessary to provide complementary data to those of RCTs, and corroborate their findings. Until recently, data from the real-world setting investigating the benefits of AIT for the treatment of patients with grass and birch pollen-associated AR were sparse, but new retrospective claims database studies from France and Germany have confirmed the sustained benefits of grass and birch pollen AIT in terms of significantly reduced progression of AR and asthma, and a significantly decreased risk of new-onset asthma.Areas covered: Here, we review the value of RWE used alongside data from traditional RCTs, and its potential strengths and limitations, and summarize the findings of the recent RWE studies investigating the benefits of AIT for the management of patients with grass and birch pollen-associated AR.Expert opinion: There is growing recognition of the necessity and value of RWE as a complement to data acquired in RCTs, to better understand the effects of AIT treatments in a broader, more representative patient population, and to help guide clinical decision-making.
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Affiliation(s)
- Philippe Devillier
- UPRES EA 220, Department of Airway Diseases, Hôpital Foch, University of Versailles Saint Quentin, University Paris-Saclay, Suresnes, France
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud De Villeneuve, University Hospital of Montpellier, Montpellier, France and Equipe EPAR - IPLESP, Sorbonne Université, Paris, France
| | - Mathieu Molimard
- Pharmacology Department, University of Bordeaux, INSERM Unit CR1219, Bordeaux, France
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Ohshima H, Amizuka N. Oral biosciences: The annual review 2019. J Oral Biosci 2020; 62:1-8. [PMID: 32109566 DOI: 10.1016/j.job.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Journal of Oral Biosciences is devoted to the advancement and dissemination of fundamental knowledge concerning every aspect of oral biosciences. HIGHLIGHT This review features review articles in the fields of "Bone Cell Biology," "Microbiology," "Oral Heath," "Biocompatible Materials," "Mouth Neoplasm," and "Biological Evolution" in addition to the review articles by winners of the Lion Dental Research Award ("Role of nicotinic acetylcholine receptors for modulation of microcircuits in the agranular insular cortex" and "Phospholipase C-related catalytically inactive protein: A novel signaling molecule for modulating fat metabolism and energy expenditure") and the Rising Members Award ("Pain mechanism of oral ulcerative mucositis and the therapeutic traditional herbal medicine hangeshashinto," "Mechanisms underlying the induction of regulatory T cells by sublingual immunotherapy," and "Regulation of osteoclast function via Rho-Pkn3-c-Src pathways"), presented by the Japanese Association for Oral Biology. CONCLUSION These reviews in the Journal of Oral Biosciences have inspired the readers of the journal to broaden their knowledge regarding various aspects of oral biosciences. The current editorial review introduces these exciting review articles.
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Affiliation(s)
- Hayato Ohshima
- Division of Anatomy and Cell Biology of the Hard Tissue, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Science, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan.
| | - Norio Amizuka
- Department of Developmental Biology of Hard Tissue, Graduate School of Dental Medicine, Faculty of Dental Medicine, Hokkaido University, Kita 13 Nishi 7 Kita-ku, Sapporo 060-8586, Japan
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Gao Y, Lin X, Ma J, Wei X, Wang Q, Wang M. Enhanced Efficacy of Dust Mite Sublingual Immunotherapy in Low-Response Allergic Rhinitis Patients after Dose Increment at 6 Months: A Prospective Study. Int Arch Allergy Immunol 2020; 181:311-319. [PMID: 32069460 DOI: 10.1159/000505746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies have suggested that sublingual immunotherapy (SLIT) involves a dose-response relationship and inadequate dosage might not achieve a favorable clinical effect. OBJECTIVE The aim of this prospective study was to investigate the efficacy and safety of increasing SLIT dosage at 6 months in patients with house dust mite-induced allergic rhinitis (AR) who had low response to treatment. METHODS A total of 157 AR participants aged 4-60 years were enrolled and received SLIT with Dermatophagoides farinae drops. After 6 months of SLIT, patients were interviewed and then classified into a high-response (HR) group and a low-response (LR) group based on the combined symptom and medication score (CSMS) reduction rate. Patients with a CSMS reduction rate over 50% were defined as HR and continued the original dose, while patients with a CSMS reduction rate ranging from 20 to 50% were defined as LR and received an increased dose (percentage of dosage increment, 33.33% for patients aged <14 years and 50% for patients aged ≥14 years). Patients with a CSMS reduction rate below 20% were considered nonresponse (NR) and recommended to withdraw from SLIT. CSMS, visual analog scale (VAS), and adverse events were assessed at 0.5, 1, 2, and 3 years during the 3-year treatment. RESULTS A total of 54 and 56 patients completed the treatment in the HR and LR groups, respectively. The CSMS and VAS of both groups decreased significantly at 6 months (p < 0.05). Significant differences between the two groups were found in CSMS and VAS at 6 months and 1 year (p < 0.05), but not in later follow-ups (p > 0.05). The improvement of adults in the LR group was significantly lower than that of children at 6 months (p < 0.05), but there was no difference in later follow-ups (p > 0.05). There was no difference in CSMS or VAS in patients with monosensitization and polysensitization in the same treatment group at 1 year and in subsequent visits (p> 0.05). Overall, 47 patients withdrew from this study due to NR (n = 22) and other reasons (n = 25). CONCLUSIONS Six months might be a critical time point for efficacy assessment and dosage adjustment for AR patients after SLIT. In patients with low response, dosage enhancement within a certain range may enhance the effectiveness of SLIT.
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Affiliation(s)
- Yingqin Gao
- Department of Otolaryngology - Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Xia Lin
- Department of Otorhinolaryngology - Head and Neck Surgery, Hainan General Hospital, Haikou, China,
| | - Jing Ma
- Department of Otolaryngology - Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Xin Wei
- Department of Otorhinolaryngology - Head and Neck Surgery, Hainan General Hospital, Haikou, China
| | - Qiuju Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Hainan General Hospital, Haikou, China
| | - Meilan Wang
- Department of Otolaryngology - Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
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The Effect of Birch Pollen Immunotherapy on Apple and rMal d 1 Challenges in Adults with Apple Allergy. Nutrients 2020; 12:nu12020519. [PMID: 32085633 PMCID: PMC7071292 DOI: 10.3390/nu12020519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background: A proportion of patients allergic to birch pollen are also allergic to pit fruit. The objective of this study was to investigate the effect of immunotherapy with birch pollen on birch-pollen-related apple allergy. Method: Patients with birch pollen immunotherapy underwent a skin-prick test with birch pollen, apple and rMal d 1, global assessments and nasal challenges with birch pollen, open food challenge with apple and a double-blind, placebo-controlled test with rMal d 1 at the start of and during the immunotherapy. Measurements of specific IgE in response to Bet v 1 and rMal d 1 and IgG4 in response to Bet v 1 and rMal d 1 took place. Results: Six of eight patients demonstrated an improvement of nasal challenge test results and all patients improved on global assessment during the immunotherapy. The median oral dose of apple required to elicit a reaction increased but was not statistically significant. The patients showed a decrease in skin-prick test values in response to birch pollen (1.05 to 0.36), apple (0.78 to 0.25) and rMal d 1 (0.51 to 0.10) with p-values of 0.04, 0.03 and 0.06, respectively and a decrease of specific IgE in response to Bet v 1 (10.66 kU/L to 5.19 kU/L) and rMal d 1 (0.99 to 0.61 kU/L) with p-values of 0.01 and 0.05, respectively. Only the median specific IgG4 value to Bet v 1 increased from 0.05 to 1.85 mg/L (p-value of 0.02) and not to IgG4 rMal d 1 (0.07 to 0.08 kU/L). Conclusion: The beneficial effects of immunotherapy for birch pollen were accompanied by a limited effect on apple allergy.
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Tankersley M, Han JK, Nolte H. Clinical aspects of sublingual immunotherapy tablets and drops. Ann Allergy Asthma Immunol 2020; 124:573-582. [PMID: 31923544 DOI: 10.1016/j.anai.2019.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/17/2019] [Accepted: 12/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sublingual immunotherapy (SLIT) is administered via tablets (SLIT-T) or liquid drops (SLIT-D). In North America, currently 4 SLIT-T formulations are approved by the US Food and Drug Administration for allergy immunotherapy, and SLIT-D is an off-label use of subcutaneous immunotherapy (SCIT) extracts. OBJECTIVE To compare and contrast aspects of SLIT-T and SLIT-D, including physical characteristics, mechanism of action, dosing, efficacy, safety, adherence, and cost. DATA SOURCES PubMed literature review (no limits), product prescribing information, and manufacturer websites. STUDY SELECTIONS Publications related to physical characteristics, mechanism of action, dosing, efficacy, safety, and adherence. RESULTS Published evidence indicates that tablet and drop formulations differ in regard to physical characteristics, dosing, and strength of evidence for efficacy. Whether there are any differences in absorption and mechanism of action between the 2 formulations is currently unknown. Optimal dosing, efficacy, and safety have been established for SLIT-T. In contrast, in North America there is little support for efficacy of SLIT-D from randomized double-blind, placebo-controlled trials, and dose ranges have not been appropriately evaluated. SLIT-T treats a single allergen, whereas in the United States SLIT-D often contains multiple allergens to treat polysensitization. The safety profiles of SLIT-T and SLIT-D appear similar, and both formulations are considered safer than SCIT. CONCLUSION Professional guidelines should make a clear distinction between SLIT-T and SLIT-D in their recommendations to minimize confusion with the umbrella term SLIT.
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Affiliation(s)
- Mike Tankersley
- Departments of Medicine, Pediatrics and Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee; The Tankersley Clinic, Memphis, Tennessee.
| | - Joseph K Han
- Department of Otolaryngology, Division of Rhinology and Endoscopic Sinus-Skull Base Surgery, Division of Allergy, Eastern Virginia Medical School, Norfolk, Virginia
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杨 娟, 江 洪, 向 奕, 伍 莹. [Effect of sublingual immunotherapy on patients with allergic rhinitis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:53-56. [PMID: 32086899 PMCID: PMC10128577 DOI: 10.13201/j.issn.1001-1781.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 06/10/2023]
Abstract
Objective:Study the efficacy of sublingual immunotherapy (SLIT) for monosensitized and polysensitized allergic rhinitis patients of different severity. Method:According to the results of intradermal experiments, 186 patients with AR who were treated with standardized dust mites SLIT for 2 years. These patients have been divided into mild monosensitized group and mild polysensitized group, moderate monosensitized group and moderate polysensitized group, severe monosensitized group and severe polysensitized group. Statistics and analysis of total nasal symptom score (TNSS), total medication score (TMS) , visual analog scale (VAS) about before and after SLIT treatment. Result:Before SLIT treatment and after 2 years, the TNSS: Mild monosensitized group (5. 58±1. 68)(0. 58±0. 75), mild polysensitized group(5. 34±1. 49)(0. 93±0. 75);moderate monosensitized group (4. 68±1. 55)(0. 32±0. 63), moderate polysensitized group(6. 26±1. 46)(0. 61±0. 67),which have showed a statistically significant difference(P<0.05),between the two groups have no significant difference (P>0.05). Severe monosensitized group(6. 26±0. 73)(1. 16±1. 13), severe polysensitized group(6. 49±1. 04)(1. 89±1. 07), which have showed a statistically significant difference(P<0.05), between the two groups have a statistically significant difference(P<0.05). The VAS:Mild monosensitized group (6. 09±1. 23)(1. 52±1. 25), mild polysensitized group(6. 21±0. 90)(1. 97±1. 18),moderate monosensitized group(6. 12±0. 53)(1. 16±1. 03), moderate polysensitized group(6. 65±1. 08)(1. 65±0. 98),which have showed a statistically significant difference(P<0.05),between the two groups have no significant difference (P>0.05). Severe monosensitized group(6. 26±0. 73)(1. 16±1. 13), severe polysensitized group(6. 49±1. 04)(1. 89±1. 07), which have showed a statistically significant difference(P<0.05), between the two groups have a statistically significant difference(P<0.05). The TMS:These have showed a statistically significant difference(P<0.05)with same group,between all groups have no significant difference (P>0.05). Conclusion:Dust mites under the SLIT are effective for monosensitized and polysensitized allergic patients. For patients with severe polysensitized , it is necessary to extend the treatment time (>2 years).
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Affiliation(s)
- 娟 杨
- 重庆医科大学附属永川医院耳鼻咽喉头颈外科(重庆,402160)Department of Otolaryngology Head and Neck Surgery, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing, 402160, China
| | - 洪 江
- 重庆医科大学附属永川医院耳鼻咽喉头颈外科(重庆,402160)Department of Otolaryngology Head and Neck Surgery, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing, 402160, China
| | - 奕琳 向
- 重庆医科大学附属永川医院耳鼻咽喉头颈外科(重庆,402160)Department of Otolaryngology Head and Neck Surgery, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing, 402160, China
| | - 莹 伍
- 重庆医科大学附属永川医院耳鼻咽喉头颈外科(重庆,402160)Department of Otolaryngology Head and Neck Surgery, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing, 402160, China
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Vogelberg C, Brüggenjürgen B, Richter H, Jutel M. Real-World Adherence and Evidence of Subcutaneous and Sublingual Immunotherapy in Grass and Tree Pollen-Induced Allergic Rhinitis and Asthma. Patient Prefer Adherence 2020; 14:817-827. [PMID: 32494127 PMCID: PMC7231771 DOI: 10.2147/ppa.s242957] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Allergen immunotherapy (AIT), when continued for 3 years, is the only disease-modifying treatment for AR and asthma. Adherence is a key to ensure effectiveness, and poor adherence is a contraindication for AIT. The objective of this study was to evaluate real-world adherence to AIT with subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) preparations in patients allergic to grass or tree pollen. The impact of AIT on the consumption of asthma and rhinitis medication was also analyzed. PATIENTS AND METHODS In this retrospective cohort analysis of a German longitudinal prescription database, the adherence of a grass and tree pollen allergoid was examined and compared to two sublingual AIT tablets/drops. Patients receiving grass or tree allergen-specific immunotherapy prescriptions were compared with non-AIT patients receiving symptomatic allergic rhinitis (AR) and asthma prescriptions. The study endpoints included therapy adherence, AR progression, and asthma progression. Multivariate regression analyses were used to estimate the effects of SCIT or SLIT, adjusting for variables related to demographics and prescriptions. RESULTS SCIT adherence was 60.1-61.8% at 2 years and 35.0-37.5% at 3 years for the two allergens. SLIT adherence was distinctly lower (29.5-36.5% and 9.6-18.2%, respectively). Adherence in children was higher compared to adolescents or adults. All products were highly efficacious at reducing symptomatic AR medication consumption. SCIT also reduced asthma medication use for both allergens, whereas for SLIT these results were significant only for grasses but not trees. CONCLUSION Subcutaneous AIT in a real-world setting achieved significantly higher adherence rates compared to sublingual administration. SCIT reduced the use of rhinitis and asthma medication significantly for both allergens, while SLIT reduced the use of rhinitis medication for both allergens and the use of asthma medication for grasses only.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
- Correspondence: Christian Vogelberg University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, Dresden01307, GermanyTel +49 351 458-5699Fax +49 351 458-4334 Email
| | - Bernd Brüggenjürgen
- Institute for Health Economics, Steinbeis University Berlin, Berlin, Germany
| | | | - Marek Jutel
- All-MED Medical Research Institute, Warsaw, Poland
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
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Abstract
This article evaluates the role of allergen immunotherapy (AIT) in the treatment of allergic rhinitis (AR). AIT has been shown to be effective in treating AR symptoms with resultant improvements in overall quality of life, comorbid illnesses, and medication requirements. Persistent clinical benefits have been shown years after AIT treatment discontinuation. AIT may prevent the progression of AR to asthma. AIT may more cost-effective than pharmacotherapy. Multiple individual studies and systematic reviews provide strong evidence for the clinical effectiveness of AIT in the treatment of AR. Cost-effectiveness and disease modification of AIT compared with standard drug treatment are additional advantages.
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Affiliation(s)
- Linda Cox
- Department of Medicine, Nova Southeastern University, Davie, FL, USA; Department of Medicine, University of Miami, Coral Gables, FL, USA.
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Huang R, Qin R, Hu Q, Zhu Z, Liu Y, Luo T, Li J. Effect of Dermatophagoides pteronyssinus Immunotherapy on Upper and Lower Airway Eosinophilic Inflammatory Response to Nasal Allergen Challenge. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:844-858. [PMID: 32638564 PMCID: PMC7347002 DOI: 10.4168/aair.2020.12.5.844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
Purpose It remains unknown whether allergen-specific immunotherapy (AIT) could attenuate airway inflammatory response triggered by allergen exposure. Methods We performed Dermatophagoides pteronyssinus (Der-p) nasal provocation tests (NPTs) in allergic rhinitis (AR) and/or asthma patients without AIT (non-AIT), or at 16, 52, 104, or 156 weeks after Der-p AIT. Rhinitis and asthma visual analog scale (VAS; VAS of nasal symptoms [VAS-NS], VAS of asthma symptoms), the rhinoconjunctivitis quality of life questionnaire (RQLQ), nasal lavage, sputum induction, fractional exhaled nitric oxide (FeNO), nasal airway resistance, pulmonary function, and airway hyperresponsiveness were performed before and after NPT. Results Non-AIT subjects demonstrated significantly higher VAS-NS before and after NPT compared to AIT subjects (P < 0.05). NPT response was positive in 14 (100%) non-AIT, 7 (70%) 16 weeks-AIT, 6 (60%) 52 weeks-AIT, 6 (60%) 104 weeks-AIT, and 2 (20%) 156 weeks-AIT subjects. The NPT grade significantly correlated with AIT duration and baseline RQLQ score (r = −0.561, P < 0.001 and r = 0.525, P < 0.001, respectively). Sputum and nasal lavage eosinophil count, and FeNO in non-AIT subjects were significantly increased 6 hours after NPT (P < 0.05). AIT subjects did not change their sputum or nasal lavage eosinophil count before and after NPT. Subjects with 156 weeks-AIT demonstrated significantly lower levels of sputum and nasal lavage eosinophil count before and after NPT when compared with non-AIT patients (P < 0.05). Sputum eosinophil counts positively correlated with nasal lavage eosinophil counts at baseline and 6 hours after NPT (r = 0.719, P = 0.006 and r = 0.823, P < 0.001, respectively) in non-AIT patients. Conclusion Our results show that AIT can attenuate both upper and lower airway immune response to nasal allergen exposure in patients with AR and/or asthma.
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Affiliation(s)
- Renbin Huang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rundong Qin
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiurong Hu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zheng Zhu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - YuKai Liu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tian Luo
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Li
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Zhao J, Yan X, Gai J, Han J, Zhang H, Luo H, Huang S, Wang J. Efficacy of Bimin decoction for patients with perennial allergic rhinitis: an open-label non-inferiority randomized controlled trial. Trials 2019; 20:802. [PMID: 31888713 PMCID: PMC6937845 DOI: 10.1186/s13063-019-3763-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 09/28/2019] [Indexed: 01/28/2023] Open
Abstract
Background Allergic rhinitis (AR) is a common allergic disease. It affects people worldwide and traditional Chinese medicine is becoming popular among AR patients because it has a definite clinical effect and there are few adverse reactions. Lung qi deficiency and cold syndrome (LQDCS) is a frequent type of AR, and the Chinese herbal medicine bimin decoction (BMD) is prescribed for it. This study compared the clinical efficacy of BMD for AR patients with LQDCS to the conventional medicine loratadine and fluticasone nasal spray. Methods The study was an open-label non-inferiority randomized controlled trial. A total of 108 AR patients with LQDCS aged 19 to 60 were randomly allocated in a 1:1 ratio to the BMD group or the control group by the central computer system in Beijing Hospital of Traditional Chinese Medicine from January 2017 to April 2018. In total, 98 participants completed the study (BMD group n = 51 and control group n = 47). Patients in the BMD group received BMD while those in the control group received fluticasone nasal spray and loratadine tablets for 4 weeks. The primary outcome was the change in the Total Nasal Symptom Score (TNSS) between the baseline and the end of treatment. Changes in the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal resistance, and acoustic rhinometry parameters were secondary outcomes. All side effects due to the treatments were recorded. Results After the 4-week treatment, the total TNSS was significantly reduced in both groups compared to the baseline (P < 0.05). No significant between-groups differences were observed for changes in TNSS scores [− 0.298 (95% confidence interval −0.640 to 0.140)], which was within the defined non-inferiority margin. RQLQ in both groups decreased significantly (P < 0.001) from baseline, though a more obvious reduction was observed for the BMD group (P < 0.001). There were no significant differences in nasal resistance, nasal volume, or nasal minimum cross-sectional area between groups after treatment (P > 0.05). Conclusions These findings indicate that BMD helps relieve the symptoms of perennial AR and improves rhinitis-related quality of life. Our study indicates that BMD is non-inferior to loratadine tablets and fluticasone nasal spray for AR patients with LQDCS. Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-16010063. Registered on 2 December 2016.
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Affiliation(s)
- Jingyi Zhao
- Department of Otolaryngology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street of Art Museum, Beijing, 100010, People's Republic of China
| | - Xinyu Yan
- Department of Otolaryngology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street of Art Museum, Beijing, 100010, People's Republic of China
| | - Jianqing Gai
- Department of Otolaryngology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street of Art Museum, Beijing, 100010, People's Republic of China
| | - Jinshuai Han
- Department of Otolaryngology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street of Art Museum, Beijing, 100010, People's Republic of China
| | - Hong Zhang
- Department of Otolaryngology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street of Art Museum, Beijing, 100010, People's Republic of China
| | - Hui Luo
- Department of Otolaryngology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street of Art Museum, Beijing, 100010, People's Republic of China
| | - Shaoting Huang
- Department of Otolaryngology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street of Art Museum, Beijing, 100010, People's Republic of China
| | - Junge Wang
- Department of Otolaryngology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street of Art Museum, Beijing, 100010, People's Republic of China.
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Guan K, Liu B, Wang M, Li Z, Chang C, Cui L, Wang RQ, Wen LP, Leung PSC, Wei JF, Sun JL. Principles of Allergen Immunotherapy and Its Clinical Application in China: Contrasts and Comparisons with the USA. Clin Rev Allergy Immunol 2019; 57:128-143. [PMID: 31243705 DOI: 10.1007/s12016-019-08751-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Allergen immunotherapy (AIT) for allergic rhinitis (AR), asthma, and other allergic diseases has developed quickly. House dust mite (HDM), Artemisia (wormwood), Humulus japonicus (Japanese hop), Alternaria alternata, and Cladosporium herbarum are the five most common inhalant allergens in China. AIT has been performed in China for over 60 years. With the support of the Chinese Medical Association (CMA) and the Chinese Medical Doctors Association (CMDA), the Chinese College of Allergy and Asthma (CCAA) was established in 2016 as a specialized branch of CDMA and is the main certification authority for AIT. Chinese allergists and scientists have made tremendous progress in the development of AIT. There have been many publications by Chinese allergists and scientists worldwide encompassing original research studies, systematic reviews, case studies, and clinical trials. Currently, conventional subcutaneous immunotherapy (SCIT) is the preferred AIT in China, but sublingual immunotherapy (SLIT) is beginning to gain recognition. An increasing number of clinical trials have been conducted to investigate the clinical efficacy and side effects of SLIT and SCIT. In China, HDM is the only commercial standardized allergen extracts in clinical use, whereas the others are crude allergen extracts. Besides standardized allergen extracts, other forms of hypoallergenic extracts are still being investigated and developed in China. Immunotherapy in China is similar to that in the USA in which allergen extracts can be mixed for SCIT. However, allergen extracts cannot be mixed for SCIT in Europe.
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Affiliation(s)
- Kai Guan
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Bin Liu
- Department of Immunology and Rheumatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266001, People's Republic of China
| | - Meng Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Zhi Li
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, 451 E Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
- Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Memorial Health Systems, Hollywood, FL, 33021, USA
| | - Le Cui
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Rui-Qi Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Li-Ping Wen
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Patrick S C Leung
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, 451 E Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
| | - Ji-Fu Wei
- Research Division of Clinical Pharmacology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People's Republic of China.
| | - Jin-Lyu Sun
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
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Li H, Chen S, Cheng L, Guo Y, Lai H, Li Y, Lin X, Liu Z, Qiu Q, Shao J, Shi L, Tian M, Wang C, Wang H, Wang X, Wei Q, Wei Y, Xiang L, Yang Q, Zhao C, Zhang H, Zhi Y, Gao J, Li Q, Liu J, Wang K, Zhou W, Zhang L. Chinese guideline on sublingual immunotherapy for allergic rhinitis and asthma. J Thorac Dis 2019; 11:4936-4950. [PMID: 32030209 DOI: 10.21037/jtd.2019.12.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Huabin Li
- Department of Otolaryngology, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Shi Chen
- Center for Prevention and Treatment of Pediatric Asthma, Hainan General Hospital, Haikou 570102, China
| | - Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing 210029, China
| | - Yinshi Guo
- Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - He Lai
- Department of Allergy, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Yong Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University, Hangzhou 310006, China
| | - Xiaoping Lin
- Department of Allergy, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qianhui Qiu
- Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Jie Shao
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Li Shi
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan 250022, China
| | - Man Tian
- Respiratory Department, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
| | - Hongtian Wang
- Department of Otolaryngology, Head and Neck Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.,Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Xueyan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Qingyu Wei
- Department of Allergy, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Yongxiang Wei
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Changqing Zhao
- Department of Otolaryngology, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Huanping Zhang
- Department of Pulmonary and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Beijing 100730, China
| | - Junxiao Gao
- Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Quansheng Li
- Department of Allergy, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Juan Liu
- Department of Otolaryngology, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Kuiji Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
| | - Wencheng Zhou
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing 210029, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
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Guéguen C, Luce S, Lombardi V, Baron‐Bodo V, Moingeon P, Mascarell L. IL-10 mRNA levels in whole blood cells correlate with house dust mite allergen immunotherapy efficacy. Allergy 2019; 74:2223-2226. [PMID: 30793324 DOI: 10.1111/all.13751] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Sonia Luce
- Research Department Stallergenes Greer Antony France
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123
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House-Dust Mite Immunotherapy in Asthma: Uncertainties and Therapeutic Strategies. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Sublingual allergen immunotherapy (SLIT), a disease-modifying treatment for allergic rhinitis, can induce long-term clinical benefits which are mediated by immune responses that include generation of regulatory B (Breg) and T (Treg) cells. The newest member of the IL-12 superfamily, IL-35, is an anti-inflammatory cytokine known to be produced by Breg and Treg cells. Limited studies are available on the role of IL-35 on allergic rhinitis and during SLIT. This review summarizes recent findings relevant to the topic of IL-35 and their role in SLIT. RECENT FINDINGS Recombinant IL-35 protein can induce the generation of IL-35-producing Breg and Treg cells with immunosuppressive capacity. Levels of IL-35 and IL-35-inducible Treg (iTR35) cells are dysregulated in allergic rhinitis patients, which can be restored with SLIT. Mechanism of IL-35-mediated tolerance to allergens includes suppressions of T cell proliferation, Th2 cytokine production, and B cell production of IgE antibodies. SUMMARY Emerging evidence supports a potential role for IL-35 and iTR35 cells in tolerance maintenance during SLIT. A better understanding for the role of IL-35 and iTR35 cells could provide new avenues for the development of clinical biomarker to assess efficacy of allergen immunotherapy and novel therapeutic strategies for allergic rhinitis.
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125
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Suzuki S, Sakurai D, Sakurai T, Yonekura S, Iinuma T, Okuma Y, Ihara F, Arai T, Hanazawa T, Fukuda-Kawaguchi E, Ishii Y, Okamoto Y. Sublingual administration of liposomes enclosing alpha-galactosylceramide as an effective adjuvant of allergen immunotherapy in a murine model of allergic rhinitis. Allergol Int 2019; 68:352-362. [PMID: 30803854 DOI: 10.1016/j.alit.2019.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sublingual immunotherapy (SLIT) is an established efficacious approach for the treatment of allergic rhinitis (AR). However, SLIT requires a long administration period to establish stable and adequate responses. This study investigated the efficacy of the sublingual administration of an allergen with liposomes enclosing α-GalCer (α-GC-liposome) as a potential adjuvant in mice with AR. METHODS Mice with AR induced by OVA received the sublingual administration of OVA, α-GC-liposomes, or OVA plus α-GC-liposomes for 7 days. After nasal re-challenge with OVA, nasal symptoms were evaluated. The serum levels of OVA-specific Ig, the cytokine production of CD4+ T cells in the cultures of cervical lymph node (CLN) cells, and the gene expression of CLNs were analyzed. RESULTS Although IL-4, IL-5 and IL-13 production from CD4+ T cells in CLN cells was significantly inhibited by the sublingual administration of OVA alone in mice with AR induced by OVA, their nasal symptoms were not significantly diminished. However, the combined sublingual administration of α-GC-liposomes and OVA completely suppressed nasal symptoms, downregulated Th2 and Th17 type cytokine production in CD4+ T cells as well as Th2 and Th17 gene expressions, and upregulated Th1 type cytokine production as well as Th1 gene expressions in CLN cells. Additionally, the serum levels of specific IgG2a were promoted, and specific IgE and IgG1 were inhibited. CONCLUSIONS Our findings suggest that the sublingual administration of an allergen with α-GC-liposomes as an adjuvant might increase the therapeutic efficacy and effectiveness of this treatment method.
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Cui L, Li J, Li Y, Xia Z. Long-Term Efficacy of Sublingual Mite Immunotherapy in Monosensitized and Polysensitized Children with Allergic Rhinitis: A 7-Year Prospective Study. Int Arch Allergy Immunol 2019; 180:144-149. [PMID: 31256165 DOI: 10.1159/000500524] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several foreign studies have shown long-term efficacy of sublingual immunotherapy (SLIT), but data on the long-term efficacy of SLIT in China are still lacking. OBJECTIVE We aimed to prospectively evaluate the long-term efficacy of a 2-year SLIT with Dermatophagoides farinae(D. farinae) drops in mono- and polysensitized children with allergic rhinitis (AR). METHODS Eighty house dust mite (HDM)-sensitized children (aged 4-11 years) with AR were enrolled in this prospective study. There were 40 children in both the monosensitized (to HDM only) and polysensitized groups. Both groups were treated with standardized SLIT (D. farinae drops) for 2 years, combined with pharmacotherapy according to their individual requirements, and were followed up for 7 years. A combined symptom and medication score (CSMS) was assessed and compared between the 2 groups during and after SLIT. Safety was evaluated based on adverse events (AEs). RESULTS There were 31 (77.5%) monosensitized and 29 (72.5%) polysensitized children who completed the study. After 2-year SLIT, the CSMS of 2 groups significantly decreased compared to baseline. The improvement persisted during the first 5 years at each visit, with a significant difference (all p < 0.01). In the monosensitized group, the CSMS significantly increased during the 6th and the 7th year compared to year 2 (both p < 0.05). Meanwhile, the polysensitized group showed a significant worsening of CSMS from the 5th to the 7th year (all p < 0.05). Furthermore, there was a statistical difference between the 2 groups in the 5th year of the study (p < 0.05). No severe AEs were reported. CONCLUSIONS The study confirmed the long-term effects which lasted for 7 years after 2-year SLIT in mono- and polysensitized children. Compared with the polysensitized children, the monosensitized children noted a more sustained benefit.
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Affiliation(s)
- Long Cui
- Department of Otorhinolaryngology, Children's Hospital of Wuhan City, Wuhan, China
| | - Jun Li
- Department of Otorhinolaryngology, Children's Hospital of Wuhan City, Wuhan, China
| | - Yong Li
- Department of Otorhinolaryngology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China,
| | - Zhongfang Xia
- Department of Otorhinolaryngology, Children's Hospital of Wuhan City, Wuhan, China
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127
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Hoshino M, Akitsu K, Kubota K. Effect of Sublingual Immunotherapy on Airway Inflammation and Airway Wall Thickness in Allergic Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2804-2811. [PMID: 31228618 DOI: 10.1016/j.jaip.2019.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/12/2019] [Accepted: 06/03/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The efficacy of the standardized quality (SQ) house dust mite (HDM) sublingual immunotherapy (SLIT) has been demonstrated for respiratory allergic disease. However, the effects of SLIT on inflammation and structural changes of the airways are still unknown. OBJECTIVE The aim of this study was to assess the effects of the 6 SQ-HDM SLIT on airway inflammation and airway geometry in allergic asthma and rhinitis. METHODS One hundred two asthmatic patients with rhinitis sensitized to HDM were randomized to receive either SLIT plus pharmacotherapy or standard pharmacotherapy alone, for 48 weeks. Fractional exhaled nitric oxide (FeNO), pulmonary function, quantitative computed tomography, and clinical symptoms were performed at baseline and end of the study. RESULTS Compared with pharmacotherapy, SLIT demonstrated a significant reduction of FeNO (P < .01), airway wall area/body surface area (WA/BSA, P < .001), wall thickness (T/√BSA, P < .001), percentage wall area (WA/Ao, P < .01), increase in luminal area (Ai/BSA, P < .05), improvement of airflow limitation (P < .001), and clinical symptom scores (P < .05). The change in forced expiratory volume in 1 second (FEV1) was correlated with both changes in FeNO and airway dimensions. Multiple regression analysis showed that the change in FeNO was independently associated with an increase in FEV1 in the SLIT group (r2 = 0.623, P = .037). CONCLUSIONS Adding 6 SQ-HDM SLIT to standard asthma therapy provides a significant improvement in symptoms and pulmonary function compared with pharmacotherapy. Improvement of airflow limitation with SLIT was associated with the decrease in eosinophilic airway inflammation.
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Affiliation(s)
- Makoto Hoshino
- Division of Clinical Allergy, Department of Internal Medicine, Atami Hospital, International University of Health and Welfare, Atami, Shizuoka, Japan.
| | - Kenta Akitsu
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Shizuoka, Japan
| | - Kengo Kubota
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Shizuoka, Japan
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[Costs of allergic diseases and saving potential by allergen-specific immunotherapy : A personal assessment]. HNO 2019; 65:801-810. [PMID: 28900663 DOI: 10.1007/s00106-017-0410-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The burden of allergic diseases is of particular relevance for the economy and the social welfare and health insurance framework. Allergic rhinitis (AR) has a life-time prevalence of approximately 30% and is one of the most common chronic diseases with considerable socioeconomic impact thus leading to substantial direct, indirect and intangible costs. This article explores the common hypothesis that allergen-specific immunotherapy (ASIT) saves national economic expenses in the long term in comparison to other standard symptomatic treatment or no therapy. METHODS We conducted a selective search and analysis of the literature in PubMed and Medline including otherwise listed publications in German. Using a predefined model and data extrapolation over 9 years for data from different sources and short-term clinical studies we further discuss the problems and difficulties in analyzing heterogeneous datasets. RESULTS Using a health-economic model with currently available and accepted variables ASIT proves to be cost-effective in comparison to symptomatic treatment in allergic rhinitis; however, numerous parameters from other models have to be controlled, such as adherence to therapy and therapy discontinuation, heterogeneous costs for different treatment modalities, effect sizes with respect to symptoms including cross-influences with symptomatic rescue medication, duration of efficacy after treatment discontinuation and asthma protection. DISCUSSION The personal appraisal of the authors demonstrates not only the current knowledge but also the problems in health economical evaluation of ASIT in allergic diseases.
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129
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Abstract
Adherence to allergen immunotherapy (AIT) is crucial for its efficacy. Subcutaneous AIT requires monthly visits (or more extended in the case of venom immunotherapy), while sublingual AIT is performed with a daily intake of allergen drops. Non-adherence to an AIT schedule and premature discontinuation are common problems. Various studies have shown controversial results on the rate of AIT adherence. The aim of this review is to describe the problem of non-adherence and to offer some evidence-based advice to allergologists on how to increase it. Better patient education at the beginning of treatment, sharing with patients the decision on which type of immunotherapy to select and showing sincere interest in their treatment concerns are some tips that can help to increase adherence. A well organized allergologist time schedule not only increases safety but also offers the possibility of close follow-up and an increase in patient loyalty.
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Affiliation(s)
| | - Nikolas Dietis
- a Medical School, University of Cyprus , Nicosia , Cyprus
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Tanaka Y, Fukumoto S, Sugawara S. Mechanisms underlying the induction of regulatory T cells by sublingual immunotherapy. J Oral Biosci 2019; 61:73-77. [DOI: 10.1016/j.job.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/04/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Gerstlauer M, Szepfalusi Z, Golden D, Geng B, de Blic J. Real-life safety of 5-grass pollen tablet in 5-to-9-year-old children with allergic rhinoconjunctivitis. Ann Allergy Asthma Immunol 2019; 123:70-80. [PMID: 31009701 DOI: 10.1016/j.anai.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although 5-grass pollen sublingual immunotherapy has a good safety profile in controlled clinical trials, additional safety information among pediatric patients in a real-world setting would be useful. OBJECTIVE To further document the safety of 5-grass tablet among children aged 5 to 9 years with allergic rhinoconjunctivitis (ARC). METHODS This multicenter, observational study included allergy immunotherapy-naïve 5- to 9-year-old children with grass pollen-induced ARC prescribed with 5-grass tablet daily (3-day dose escalation to 300 index of reactivity [IR]). Patients were followed up daily for safety and tolerability over the first 30 treatment days. Adverse events (AEs) and adverse drug reactions (ADRs) were analyzed descriptively. RESULTS Three hundred seven children (mean age, 7.1 years) were enrolled. Fifty-eight percent were confirmed as polysensitized, and 36% had mild-to-moderate asthma. Of 307 patients, 233 (76%) reported AEs, and 173/307 (56%) reported ADRs, most frequently mild application-site reactions (throat irritation, oral pruritus, oral paresthesia). Sixteen of 307 (5.2%) patients withdrew because of ADRs. In 143 of 173 (83%) patients, ADRs first occurred within 1 week of starting treatment. More than half of the ADRs lasted less than 2 days, and ADRs resolved spontaneously in 161 of 173 (93%) patients. Recurrences of ADRs were reported in 45 of 173 (26%) patients and were also mainly application-site reactions. No notable differences were found in ADRs related to whether patients had asthma at inclusion. Neither epinephrine use nor admission to intensive care unit was reported. CONCLUSION The safety profile of 5-grass tablet in pediatric ARC patients aged 5 to 9 years was consistent with safety findings in older patients, most ADRs being at the application site and mild to moderate. ClinicalTrials.gov identifier: NCT02295969; EUPAS registration number: 8104.
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Affiliation(s)
- Michael Gerstlauer
- Pediatric Pneumology and Allergology unit, Medical University of Augsburg, Augsburg, Germany.
| | - Zsolt Szepfalusi
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - David Golden
- Allergy & Immunology, Medstar Franklin Square Medical Center, Baltimore, Maryland
| | - Bob Geng
- Divisions of Adult and Pediatric Allergy and Immunology, Rady Children's Hospital Severe Asthma Clinic, University of California, San Diego, California
| | - Jacques de Blic
- Pediatric Pneumology and Allergology unit, Necker-Enfants Malades Hospital, Paris, France; Université Paris Descartes, Paris, France
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Sivam A, Tankersley M. Perception and practice of sublingual immunotherapy among practicing allergists in the United States: A follow-up survey. Ann Allergy Asthma Immunol 2019; 122:623-629.e2. [PMID: 30946915 DOI: 10.1016/j.anai.2019.03.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Limited information is available regarding the current perception and practice of sublingual immunotherapy (SLIT) use among US and international allergists. In light of 4 recent US Food and Drug Administration (FDA)-approved SLIT options, perceptions and practices may be changing. OBJECTIVE To provide updated information about current allergists' practice and perception of SLIT relative to 2007 and 2011. METHODS On behalf of the American College of Allergy, Asthma, and Immunology (ACAAI) Immunotherapy and Diagnostics Committee, an electronic survey was sent to all US and international allergists who were members of the ACAAI. Data were compared with previous surveys conducted and published in 2007 and 2011. RESULTS Of the 305 respondents, 268 (87.9%) practiced in the United States. A total of 197 of 268 respondents (73.5%) reported experience using SLIT compared with 45 of 766 US allergists (5.9%) in 2007 and 59 of 519 US allergists (11.4%) in 2011 (P < .001). Of the 188 respondents in the United States who used SLIT in their practice, 129 (68.6%) used FDA-approved SLIT tablets only, 44 (23.4%) used both FDA-approved SLIT tablets and SLIT drops using an extract that is FDA approved for subcutaneous immunotherapy, and 15 (8.0%) reported using only SLIT drops. Limitation of only treating one allergen was the primary barrier in using SLIT among 197 of 268 respondents (73.5%). CONCLUSION There has been a significant increase in SLIT use in the last 5 years, with 73.5% of respondents reporting experience with it. With 4 FDA-approved SLIT therapies, this likely contributes to its more widespread use. The greatest barrier to SLIT use is the limitation of only treating one allergen.
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Affiliation(s)
- Anita Sivam
- University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Mike Tankersley
- University of Tennessee Health Science Center, Memphis, Tennessee
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Wahn U, Bachert C, Heinrich J, Richter H, Zielen S. Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma. Allergy 2019; 74:594-604. [PMID: 30183091 PMCID: PMC6585786 DOI: 10.1111/all.13598] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Real-world evidence is sparse on the benefits of allergen immunotherapy [AIT; subcutaneous/sublingual immunotherapy (SCIT/SLIT)], the only disease-modifying intervention for allergic rhinitis (AR) with long-term efficacy. This real-life study evaluated the effect of six AITs (native pollen SLIT/SCIT, four allergoid SCITs) vs symptomatic medication use, on AR symptoms and asthma symptoms/onset, in patients with birch pollen-associated AR and/or asthma. METHODS In this retrospective cohort analysis of a German longitudinal prescription database, AIT patients received ≥2 successive seasonal treatment cycles; non-AIT patients had ≥3 AR prescriptions in three seasons or previous month. Patients were matched for: index year, age, gender, main indication at index, number of seasonal cycles within treatment period, baseline AR/asthma treatment prescriptions. Multiple regression analysis compared prescription data in AIT and non-AIT groups as proxy for clinical status/disease progression. RESULTS Up to 6 years of follow-up, significantly more AIT (65.4%) vs non-AIT (47.4%) patients were AR medication-free; odds ratio (OR) [95% confidence interval (CI)]: 0.51 [(0.48-0.54); P < 0.001] (28.6% covariate-adjusted reduction vs non-AIT; P < 0.001), and significantly more AIT (49.1%) vs non-AIT (35.1%) patients were asthma medication-free [OR (95% CI): 0.59 (0.55-0.65); P < 0.001] (32% reduction vs non-AIT; P < 0.001), or reduced existing asthma medication use (32% covariate-adjusted reduction vs non-AIT; P < 0.001). During treatment, new-onset asthma risk was significantly reduced in the AIT vs non-AIT group (OR: 0.83; P = 0.001). CONCLUSIONS Birch pollen AIT demonstrated real-world benefits up to 6 years post-treatment cessation through significantly reduced AR and asthma medication intake, and significantly decreased risk of new-onset asthma medication use on-treatment.
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Affiliation(s)
- Ulrich Wahn
- Department of Paediatric Pneumology and ImmunologyCharité Medical UniversityBerlinGermany
| | - Claus Bachert
- Upper Airways Research LaboratoryGhent UniversityGhentBelgium
| | - Joachim Heinrich
- Institute of EpidemiologyHelmholtz Zentrum MunichGerman Research Centre for Environmental Health GmbHNeuherbergGermany
| | | | - Stefan Zielen
- Division of Allergology, Pulmonology and Cystic FibrosisDepartment of PaediatricsGoethe University HospitalFrankfurtGermany
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135
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Joo Chan C, Richardo T, Lim RLH. Current Trend in Immunotherapy for Peanut Allergy. Int Rev Immunol 2019; 37:279-290. [DOI: 10.1080/08830185.2018.1509967] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Chong Joo Chan
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Timmy Richardo
- Department of Biomedicine, Indonesia International Institute for Life Sciences (i3L), Jakarta, Indonesia
| | - Renee Lay Hong Lim
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
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136
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Passalacqua G, Bagnasco D, Ferrando M, Heffler E, Puggioni F, Canonica GW. Current insights in allergen immunotherapy. Ann Allergy Asthma Immunol 2019; 120:152-154. [PMID: 29413339 DOI: 10.1016/j.anai.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/26/2017] [Accepted: 11/03/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Allergen-specific immunotherapy (AIT) in its subcutaneous and sublingual forms is currently a well-established and experimentally supported treatment for respiratory allergy and hymenoptera venom allergy. There have been advances in its use linked strictly to the advancement in the knowledge of the molecular mechanisms of allergy, the production of well-characterized extracts, and diagnostic techniques. The use of AIT in asthma and the application of new approaches are expanding. We briefly review the advances and concerns in the use of AIT. DATA SOURCES PubMed and Scopus. STUDY SELECTIONS The most recent and clinically relevant literature was selected and reviewed. RESULTS The introduction of high-quality products supported by large dose-finding trials has yielded better defined indications, contraindications, and modalities of use. Some specific products in tablet form have recently been approved in the United States. Sublingual immunotherapy has been found to be effective in asthma, which until recently had been a matter of debate. Another promising therapy is oral and sublingual desensitization for food allergy, for which encouraging results have recently been reported. In the near future, other options will be available, including new routes of administration (intralymphatic and epicutaneous), allergoids, engineered allergens, and peptides. The use of component-resolved diagnosis techniques will further refine and target AIT prescriptions. CONCLUSION This condensed and updated review shows that AIT remains a viable treatment option, especially after the introduction of standardized tablets for some allergens. Food allergy and new administration routes represent a promising expansion.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, Policlinico San Martino, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, Policlinico San Martino, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Matteo Ferrando
- Allergy and Respiratory Diseases, Policlinico San Martino, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Enrico Heffler
- Personalized Medicine Clinic Asthma and Allergy, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Francesca Puggioni
- Personalized Medicine Clinic Asthma and Allergy, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases, Policlinico San Martino, Department of Internal Medicine, University of Genoa, Genoa, Italy; Personalized Medicine Clinic Asthma and Allergy, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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Cheng L, Zhou WC. Sublingual immunotherapy of house dust mite respiratory allergy in China. Allergol Immunopathol (Madr) 2019; 47:85-89. [PMID: 29921463 DOI: 10.1016/j.aller.2018.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 12/20/2022]
Abstract
Sublingual immunotherapy (SLIT) has been widely used for the treatment of allergic respiratory diseases, but many problems remain unsolved. Currently available data suggest that SLIT is very effective in children and adults with IgE-mediated respiratory diseases. Most allergists in China generally believe that SLIT is suitable for allergic rhinitis and asthma due to its safety and tolerability. SLIT for three years is suitable for patients to acquire stable therapeutic effects, and the efficacy of single-allergen SLIT for polysensitized patients has also been confirmed. Nevertheless, there are still several factors restricting its application in China, such as the uncertainty of its long-term effects and the prevention of new sensitizations onset, the risk of asthma attacks, the low public awareness of SLIT and poor compliance by patients. This is a narrative review of current evidence on SLIT coming from China.
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Affiliation(s)
- L Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China; International Centre for Allergy Research, Nanjing Medical University, Nanjing 210029, China.
| | - W-C Zhou
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
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Pfaar O, Lou H, Zhang Y, Klimek L, Zhang L. Recent developments and highlights in allergen immunotherapy. Allergy 2018; 73:2274-2289. [PMID: 30372537 DOI: 10.1111/all.13652] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
Abstract
Allergen immunotherapy (AIT) is the only disease-modifying treatment option for patients with IgE-mediated inhalant allergies. Though used in clinical practice for more than 100 years, most innovations in AIT efficacy and safety have been developed in the last two decades. This expert review aimed to highlight the recent progress in AIT for both application routes, the sublingual (SLIT) and subcutaneous (SCIT) forms. As such, it covers recent aspects regarding efficacy and safety in clinical trials and real-life data and outlines new concepts in consensus and position papers as well as in guidelines for AIT. Potential clinical and nonclinical biomarkers are discussed. This review also focuses on potential future perspectives in AIT, such as alternative application routes, immune-modulating adjuvants, and recombinant vaccines. In conclusion, this state of the art review provides a comprehensive overview of AIT and highlights unmet needs for the future.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Section of Rhinology and Allergy; University Hospital Marburg; Philipps-Universität Marburg; Marburg Germany
| | - Hongfei Lou
- Department of Otolaryngology; Head and Neck Surgery; Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
- Department of Allergy; Beijing TongRen Hospital; Capital Medical University; Beijing China
| | - Yuan Zhang
- Department of Otolaryngology; Head and Neck Surgery; Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
- Department of Allergy; Beijing TongRen Hospital; Capital Medical University; Beijing China
| | - Ludger Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - Luo Zhang
- Department of Otolaryngology; Head and Neck Surgery; Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
- Department of Allergy; Beijing TongRen Hospital; Capital Medical University; Beijing China
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139
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Pfaar O, Bachert C, Kuna P, Panzner P, Džupinová M, Klimek L, van Nimwegen MJ, Boot JD, Yu D, Opstelten DJE, de Kam PJ. Sublingual allergen immunotherapy with a liquid birch pollen product in patients with seasonal allergic rhinoconjunctivitis with or without asthma. J Allergy Clin Immunol 2018; 143:970-977. [PMID: 30508538 DOI: 10.1016/j.jaci.2018.11.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/16/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sublingual allergen immunotherapy (SLIT) has been demonstrated to be both clinically efficacious and safe. However, in line with the current regulatory guidance from the European Medicines Agency, allergen immunotherapy (AIT) products must demonstrate their efficacy and safety in pivotal phase III trials for registration. OBJECTIVE We sought to investigate the efficacy and safety of sublingual high-dose liquid birch pollen extract (40,000 allergy units native [AUN]/mL) in adults with birch pollen allergy. METHODS A randomized, double-blind, placebo-controlled, parallel-group multicenter trial was conducted in 406 adult patients with moderate-to-severe birch pollen-induced allergic rhinoconjunctivitis with or without mild-to-moderate controlled asthma. Treatment was started 3 to 6 months before the birch pollen season and continued during the season in 40 clinical study centers in 5 European countries. For primary end point assessment, the recommended combined symptom and medication score of the European Academy of Allergy and Clinical Immunology was used. Secondary end points included quality-of-life assessments, immunologic parameters, and safety. RESULTS Primary efficacy results demonstrated a significant (P < .0001) and clinically relevant (32%) reduction in the combined symptom and medication score compared with placebo after 3 to 6 months of SLIT. Significantly better rhinoconjunctivitis quality-of-life scores (P < .0001) and the patient's own overall assessment of his or her health status, including the visual analog scale score (Euro Quality of Life Visual Analogue Scale; P = .0025), were also demonstrated. In total, a good safety profile of SLIT was observed. CONCLUSION This study confirmed both the clinical efficacy and safety of a sublingual liquid birch pollen extract in adults with birch pollen allergy in a pivotal phase III trial (EudraCT: 2013-005550-30; ClinicalTrials.gov: NCT02231307).
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany.
| | - Claus Bachert
- Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Petr Panzner
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Mária Džupinová
- ALIAN s.r.o. Ambulancia alergológie a klinickej imunológie, Bardejov, Slovakia
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
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Impact of Adverse Event Solicitation on the Safety Profile of SQ House Dust Mite Sublingual Immunotherapy Tablet. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:2081-2086.e1. [DOI: 10.1016/j.jaip.2018.01.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/18/2018] [Accepted: 01/23/2018] [Indexed: 11/22/2022]
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141
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Portnoy J, Cox LS. Is the Benefit From Prescribing Epinephrine Autoinjectors for Sublingual Immunotherapy Worth the Cost? Lessons Learned From Clinical Trials. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:90-91. [PMID: 28065345 DOI: 10.1016/j.jaip.2016.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jay Portnoy
- Section of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Mo; Department of Pediatrics, University of Missouri - Kansas City School of Medicine, Kansas City, Mo
| | - Linda S Cox
- Department of Medicine, University of Miami Miller School of Medicine at Holy Cross Hospital, Ft Lauderdale, Fla.
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Kawashima K, Ishihara S, Masuhara M, Mikami H, Okimoto E, Oshima N, Ishimura N, Araki A, Maruyama R, Kinoshita Y. Development of eosinophilic esophagitis following sublingual immunotherapy with cedar pollen extract: A case report. Allergol Int 2018; 67:515-517. [PMID: 29699935 DOI: 10.1016/j.alit.2018.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan.
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Masaaki Masuhara
- Department of Internal Medicine, Ohda Municipal Hospital, Shimane, Japan
| | - Hironobu Mikami
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Eiko Okimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Asuka Araki
- Department of Pathology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Riruke Maruyama
- Department of Pathology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
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143
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Abstract
Allergen-specific immunotherapy is a potentially disease-modifying therapy that is effective for the treatment of allergic rhinitis/conjunctivitis, allergic asthma and stinging insect hypersensitivity. However, despite its proven efficacy in these conditions, it is frequently underutilized in Canada. The decision to proceed with allergen-specific immunotherapy should be made on a case-by-case basis, taking into account individual patient factors, such as the degree to which symptoms can be reduced by avoidance measures and pharmacological therapy, the amount and type of medication required to control symptoms, the adverse effects of pharmacological treatment, and patient preferences. Since this form of therapy carries a risk of anaphylactic reactions, it should only be prescribed by physicians who are adequately trained in the treatment of allergic conditions. Furthermore, for subcutaneous therapy, injections must be given under medical supervision in clinics that are equipped to manage anaphylaxis. In this article, the authors review the indications and contraindications, patient selection criteria, and details regarding the administration, safety and efficacy of allergen-specific immunotherapy.
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Affiliation(s)
- William Moote
- 1Division of Clinical Immunology & Allergy, Western University, London, ON Canada
| | - Harold Kim
- 1Division of Clinical Immunology & Allergy, Western University, London, ON Canada.,2McMaster University, Hamilton, ON Canada
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144
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Abstract
Allergic rhinitis is a common disorder that is strongly linked to asthma and conjunctivitis. It is usually a long-standing condition that often goes undetected in the primary-care setting. The classic symptoms of the disorder are nasal congestion, nasal itch, rhinorrhea and sneezing. A thorough history, physical examination and allergen skin testing are important for establishing the diagnosis of allergic rhinitis. Second-generation oral antihistamines and intranasal corticosteroids are the mainstay of treatment. Allergen immunotherapy is an effective immune-modulating treatment that should be recommended if pharmacologic therapy for allergic rhinitis is not effective or is not tolerated, or if chosen by the patient. This article provides an overview of the pathophysiology, diagnosis, and appropriate management of this disorder.
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Affiliation(s)
- Peter Small
- 1Division of Allergy & Clinical Immunology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC Canada
| | - Paul K Keith
- 2Division of Allergy and Clinical Immunology, McMaster University, Hamilton, ON Canada
| | - Harold Kim
- 2Division of Allergy and Clinical Immunology, McMaster University, Hamilton, ON Canada.,3Western University, London, ON Canada
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145
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Pfaar O, Alvaro M, Cardona V, Hamelmann E, Mösges R, Kleine-Tebbe J. Clinical trials in allergen immunotherapy: current concepts and future needs. Allergy 2018; 73:1775-1783. [PMID: 29446469 PMCID: PMC6175179 DOI: 10.1111/all.13429] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 02/07/2023]
Abstract
Allergen immunotherapy (AIT) is a safe, effective treatment for allergic rhinoconjunctivitis and allergic asthma. However, AIT's clinical effect is still contested—primarily due to heterogeneity in clinical trial designs, study populations, therapeutic formulations, and efficacy criteria. After discussing current concepts and unmet needs, an international panel of experts made several recommendations: (i) explore and validate definitions for (clinical) responders in AIT trials; (ii) use of well‐documented, standardized provocation tests prior to inclusion of subjects with relevant diseases in AIT trials; (iii) monitoring neo‐sensitizations and occurrence of new allergy in extended AIT trials, and exclusion of polyallergic participants; (iv) validation of allergen exposure chambers with regard to natural exposure; (v) in studies of seasonal allergies, focus on peak exposure but also consider organizing two parallel, geographically distinct but otherwise identical trials; (vi) discuss adaptive trial designs with the regulatory authorities; (vii) use e‐health and m‐health technologies to capture more information on individual exposure to allergens; (viii) initiate research on potential psychological, biochemical, immune, neural, and even genomic markers of the placebo response; (ix) identify trial designs and primary endpoints that will give children with allergies easier, faster access to AIT formulations; and (x) promote and apply standardized methods for reporting systemic and local adverse events. The latest technologies and trial designs may provide novel, ethical ways of reducing bias and heterogeneity in AIT clinical trials. There is scope for physicians, patient organizations, companies, and regulators to improve clinical trials in AIT and, ultimately, to provide patients with better treatments.
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Affiliation(s)
- O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology Wiesbaden; Wiesbaden Germany
| | - M. Alvaro
- Allergy and Clinical Immunology Section; Hospital Sant Joan de Déu; Universitat de Barcelona; Barcelona Spain
| | - V. Cardona
- Allergy Section; Department of Internal Medicine; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - E. Hamelmann
- Children's Center Bethel, Protestant Hospital Bielefeld and Allergy Center; Ruhr-University; Bochum Germany
| | - R. Mösges
- Medical Faculty; Institute of Medical Statistics, Informatics, and Epidemiology; University of Köln; Köln Germany
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146
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Doyen V, Braun JJ, Lutz C, Khayath N, de Blay F. [The usefulness of nasal provocation tests for respiratory physicians]. Rev Mal Respir 2018; 35:788-795. [PMID: 30174237 DOI: 10.1016/j.rmr.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/15/2018] [Indexed: 10/28/2022]
Abstract
Rhinitis and asthma are common diseases that are strongly linked from both the epidemiological and patho-physiological point of view. A precise aetiological diagnosis is required in order to optimize treatment. Nasal provocation tests (NPT) determine precisely the role of the allergen in the initiation of the symptoms of rhinitis particularly when the history does not produce convincing evidence of the clinical relevance of an allergen. It may also have important consequences for the choice of an allergenic immunotherapy. NPT are not standardized but simple methods based on international recommendations provide us with good diagnostic accuracy. In this paper, we will discuss the practical aspects of NPT as well as the clinical or research situations where they may be useful for the respiratory physician.
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Affiliation(s)
- V Doyen
- Clinique d'immuno-allergologie, CHU de Brugmann, université Libre de Bruxelles (ULB), 4, place Van Gehuchten, 1200 Bruxelles, Belgique.
| | - J-J Braun
- Service de pneumologie et d'allergologie, hôpitaux universitaires de Strasbourg, pôle de pathologie thoracique, NHC, 67000 Strasbourg, France; Service ORL-CCF, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - C Lutz
- Service de pneumologie et d'allergologie, hôpitaux universitaires de Strasbourg, pôle de pathologie thoracique, NHC, 67000 Strasbourg, France
| | - N Khayath
- Service de pneumologie et d'allergologie, hôpitaux universitaires de Strasbourg, pôle de pathologie thoracique, NHC, 67000 Strasbourg, France
| | - F de Blay
- Service de pneumologie et d'allergologie, hôpitaux universitaires de Strasbourg, pôle de pathologie thoracique, NHC, 67000 Strasbourg, France
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147
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Liu X, Ng CL, Wang DY. The efficacy of sublingual immunotherapy for allergic diseases in Asia. Allergol Int 2018; 67:309-319. [PMID: 29551278 DOI: 10.1016/j.alit.2018.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/05/2018] [Accepted: 02/14/2018] [Indexed: 01/15/2023] Open
Abstract
Sublingual immunotherapy (SLIT) has been proven to be safe and effective from an abundance of Western literature, but data from Asia is less complete. This review aims to examine the basic science, safety and efficacy of SLIT in Asian patients, and to determine future research needs in Asia. We performed a literature search on PUBMED, Scopus, and Cochrane Library database for articles on SLIT originating from Asian countries through Nov 2017. There were 18 randomized, double-blind, placebo-controlled trials, of which 9 involved solely paediatric subjects. Overall, sublingual immunotherapy is safe and is efficacious in Asian populations in allergic rhinitis (AR) and asthma. House dust-mite SLIT is effective in both mono- and polysensitized AR patients. Efficacy of SLIT is comparable to subcutaneous immunotherapy. Data on long term efficacy is lacking. A disproportionate majority of research originates from China and Japan, reflecting an asymmetry of access to SLIT within Asia. Significant disparities exist in the development of the allergy speciality, prescription patterns of SLIT, and pharmacological potencies of different SLIT products within and between Asian nations. We conclude that current available evidence suggests SLIT is efficacious in Asians but data quality of evidence is hampered by non-placebo controlled studies with methodological limitations. More data is needed in South and Southeast Asian populations. Future efforts may be directed towards improving access to SLIT in developing countries, standardization of SLIT dosage, and evaluating long term clinical outcomes.
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Affiliation(s)
- Xuandao Liu
- Department of Otolaryngology - Head & Neck Surgery, National University Health System, Singapore
| | - Chew Lip Ng
- Department of Ear, Nose & Throat (ENT) - Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore
| | - De Yun Wang
- Department of Otolaryngology, Yong loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore.
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148
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Cheng L, Chen J, Fu Q, He S, Li H, Liu Z, Tan G, Tao Z, Wang D, Wen W, Xu R, Xu Y, Yang Q, Zhang C, Zhang G, Zhang R, Zhang Y, Zhou B, Zhu D, Chen L, Cui X, Deng Y, Guo Z, Huang Z, Huang Z, Li H, Li J, Li W, Li Y, Xi L, Lou H, Lu M, Ouyang Y, Shi W, Tao X, Tian H, Wang C, Wang M, Wang N, Wang X, Xie H, Yu S, Zhao R, Zheng M, Zhou H, Zhu L, Zhang L. Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:300-353. [PMID: 29949830 PMCID: PMC6021586 DOI: 10.4168/aair.2018.10.4.300] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/17/2017] [Accepted: 10/05/2017] [Indexed: 11/20/2022]
Abstract
Allergic rhinitis (AR) is a global health problem that causes major illnesses and disabilities worldwide. Epidemiologic studies have demonstrated that the prevalence of AR has increased progressively over the last few decades in more developed countries and currently affects up to 40% of the population worldwide. Likewise, a rising trend of AR has also been observed over the last 2-3 decades in developing countries including China, with the prevalence of AR varying widely in these countries. A survey of self-reported AR over a 6-year period in the general Chinese adult population reported that the standardized prevalence of adult AR increased from 11.1% in 2005 to 17.6% in 2011. An increasing number of Journal Articles and imporclinical trials on the epidemiology, pathophysiologic mechanisms, diagnosis, management and comorbidities of AR in Chinese subjects have been published in international peer-reviewed journals over the past 2 decades, and substantially added to our understanding of this disease as a global problem. Although guidelines for the diagnosis and treatment of AR in Chinese subjects have also been published, they have not been translated into English and therefore not generally accessible for reference to non-Chinese speaking international medical communities. Moreover, methods for the diagnosis and treatment of AR in China have not been standardized entirely and some patients are still treated according to regional preferences. Thus, the present guidelines have been developed by the Chinese Society of Allergy to be accessible to both national and international medical communities involved in the management of AR patients. These guidelines have been prepared in line with existing international guidelines to provide evidence-based recommendations for the diagnosis and management of AR in China.
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Affiliation(s)
- Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoheng He
- Allergy and Clinical Immunology Research Centre, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Huabin Li
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guolin Tan
- Department of Otolaryngology Head Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zezhang Tao
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Dehui Wang
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Weiping Wen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Xu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Xu
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Qintai Yang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chonghua Zhang
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruxin Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Yuan Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Bing Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Luquan Chen
- Department of Traditional Chinese Medicine, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Xinyan Cui
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yuqin Deng
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Zhiqiang Guo
- Department of Otorhinolaryngology Head and Neck Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhenxiao Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Zizhen Huang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Houyong Li
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Jingyun Li
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Wenting Li
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanqing Li
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Lin Xi
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Meiping Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yuhui Ouyang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Wendan Shi
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Xiaoyao Tao
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huiqin Tian
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Min Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Nan Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangdong Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Hui Xie
- Department of Otorhinolaryngology, Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shaoqing Yu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji University, Shanghai, China
| | - Renwu Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Ming Zheng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Han Zhou
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Luping Zhu
- Department of Otorhinolaryngology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Luo Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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149
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Ciprandi G, Silvestri M, Tosca MA. A combination visual analog scale as an integrated outcome for assessing the perception of allergen immunotherapy effectiveness in clinical practice. Ann Allergy Asthma Immunol 2018; 121:504-506. [PMID: 29964226 DOI: 10.1016/j.anai.2018.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/09/2018] [Accepted: 06/22/2018] [Indexed: 02/06/2023]
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150
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Molnár V, Nagy A, Tamási L, Gálffy G, Böcskei R, Bikov A, Czaller I, Csoma Z, Krasznai M, Csáki C, Zsigmond G, Csontos Z, Kurucz A, Kurucz E, Fábos B, Bálint BL, Sasvári-Székely M, Székely A, Kótyuk E, Kozma GT, Cserta G, Farkas A, Gál Z, Gézsi A, Millinghoffer A, Antal P, Szalai C. From genomes to diaries: a 3-year prospective, real-life study of ragweed-specific sublingual immunotherapy. Immunotherapy 2018; 9:1279-1294. [PMID: 29130793 DOI: 10.2217/imt-2017-0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
During the last decades, the prevalence of allergy has dramatically increased. Allergen-specific immunotherapy is the only currently available medical intervention that has the potential to affect the natural course of the disease, but there are still many questions and unmet needs hindering its widespread use to fulfill its treatment potential and maximize its benefits for the society. To provide a comprehensive phenome-wide overview in sublingual immunotherapy, using ragweed allergy as a target, we planned and carried out a longitudinal, prospective, observational, open-label study (DesensIT). In this paper we present challenges of using deep and comprehensive phenotypes embracing biological, clinical and patient-reported outcomes in allergen-specific immunotherapy and show how we designed the DesensIT project to optimize data collection, processing and evaluation.
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Affiliation(s)
- Viktor Molnár
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Adrienne Nagy
- Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Renáta Böcskei
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Ibolya Czaller
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Zsuzsanna Csoma
- National Korányi Institute of TB & Pulmonology, 1121 Budapest, Pihenő út 1, Hungary
| | - Magdolna Krasznai
- Department of Otorhinolaryngology, Semmelweis University, Head & Neck Surgery, 1083 Budapest, Szigony u. 36, Hungary
| | - Csilla Csáki
- Svábhegyi Healing Facility, 1037 Budapest, Bokor u. 17, Hungary
| | | | - Zoltán Csontos
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Anikó Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Edina Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Beáta Fábos
- Somogy County Kaposi Mór Teaching Hospital, 7400 Kaposvár Tallián Gyula u. 20-32, Hungary
| | - Bálint L Bálint
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary
| | - Mária Sasvári-Székely
- Institute of Medical Chemistry, Molecular Biology & Pathobiochemistry, Semmelweis University, 1094 Budapest, Tűzoltó utca 37-47, Hungary
| | - Anna Székely
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Eszter Kótyuk
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Gergely T Kozma
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Gábor Cserta
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Anita Farkas
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Zsófia Gál
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Gézsi
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Millinghoffer
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary.,Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Péter Antal
- Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Csaba Szalai
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary.,Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary.,Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
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