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Determination of immunogenic epitopes in major house dust mite allergen, Der p 2, via nanoallergens. Ann Allergy Asthma Immunol 2022; 129:231-240.e2. [PMID: 35405356 PMCID: PMC9808607 DOI: 10.1016/j.anai.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite the high prevalence of allergic asthma, currently, avoidance of the responsible allergens, which is nearly impossible for allergens such as house dust mite (HDM), remains among the most effective treatment. Consequently, determination of the immunogenic epitopes of allergens will aid in developing a better understanding of the condition for diagnostic and therapeutic purposes. Current methods of epitope identification, however, only evaluate immunoglobulin E-epitope binding interactions, which is not directly related to epitope immunogenicity. OBJECTIVE To determine and rank the immunogenicity of the epitopes of major HDM allergen, Der p 2. METHODS We performed degranulation assays with RBL-SX38 cells primed using patient plasma and challenged with nanoallergens which multivalently displayed epitopes to study the relative immunogenicity of various epitopes of Der p 2. Nanoallergens were used to evaluate epitopes individually or in combination. RESULTS When evaluated using 3 patient samples, 3 epitopes in 2 distal regions of Der p 2 were identified as highly immunogenic when presented in combination, whereas no individual epitope triggered relevant degranulation. One of the epitopes (69-DPNACHYMKCPLVKGQQY-86) was identified to be cooperatively immunogenic when combined with other epitopes. CONCLUSION Our study highlights the importance of conformational epitopes in HDM-related allergies. This study also provides further evidence of the versatility of nanoallergens and their value for functional characterization of allergy epitopes, by ranking the Der p 2 epitopes according to immunogenicity. We believe that nanoallergens, by aiding in identification and understanding of immunogenic epitopes, will provide a better understanding of the manifestation of the allergic condition and potentially aid in developing new treatments.
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Mormile I, Granata F, Detoraki A, Pacella D, Della Casa F, De Rosa F, Romano A, de Paulis A, Rossi FW. Predictive Response to Immunotherapy Score: A Useful Tool for Identifying Eligible Patients for Allergen Immunotherapy. Biomedicines 2022; 10:971. [PMID: 35625708 PMCID: PMC9138211 DOI: 10.3390/biomedicines10050971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
A specific predictive tool of allergen immunotherapy (AIT) outcome has not been identified yet. This study aims to evaluate the efficacy of a disease score referred to as Predictive Response to Immunotherapy Score (PRIS) to predict the response to AIT and identify eligible patients. A total of 110 patients diagnosed with allergic rhinitis with or without concomitant asthma were enrolled in this study. Before beginning sublingual immunotherapy (SLIT), patients were evaluated by analyzing clinical and laboratory parameters. A specific rating was assigned to each parameter to be combined in a total score named PRIS. At baseline (T0) and follow-up [after 12 (T12) and 24 months (T24) of SLIT], a Visual Analogue Scale (VAS) was used to calculate a mean symptom score (MSS). Finally, the percentage variation between the MSS at T0 and at T12 [ΔMSS-12(%)] and T24 [ΔMSS-24 (%)] was measured. We observed a significant improvement of symptoms at T12 and T24 compared to T0 in all groups undergoing SLIT. PRIS was effective in predicting ΔMSS-24 (%) in patients treated with single-allergen SLIT. In addition, PRIS was effective in predicting ΔMSS-24 (%) in both patients with only rhinitis and with concomitant asthma. PRIS assessment can represent a useful tool to individuate potential responders before SLIT prescription.
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Affiliation(s)
- Ilaria Mormile
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (I.M.); (F.D.C.); (F.D.R.); (A.d.P.); (F.W.R.)
| | - Francescopaolo Granata
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology, and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy;
| | - Aikaterini Detoraki
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology, and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy;
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Francesca Della Casa
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (I.M.); (F.D.C.); (F.D.R.); (A.d.P.); (F.W.R.)
| | - Felicia De Rosa
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (I.M.); (F.D.C.); (F.D.R.); (A.d.P.); (F.W.R.)
| | - Antonio Romano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, University of Naples Federico II, 80131 Naples, Italy;
| | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (I.M.); (F.D.C.); (F.D.R.); (A.d.P.); (F.W.R.)
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, 80131 Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (I.M.); (F.D.C.); (F.D.R.); (A.d.P.); (F.W.R.)
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, 80131 Naples, Italy
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3
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Allergen immunotherapy for pediatric asthma: current evidence and knowledge gaps. Curr Opin Allergy Clin Immunol 2021; 20:162-167. [PMID: 31972602 DOI: 10.1097/aci.0000000000000618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The introduction of high-quality and standardized extracts for immunotherapy has renewed the interest in the treatment of pediatric allergic asthma that represents a high-prevalence disease. RECENT FINDINGS In addition to clinical trials, several systematic reviews and metaanalyses were published, confirming overall the clinical efficacy of allergen immunotherapy in pediatric asthma. In addition, new data on the preventive effect of the treatment on asthma onset were published. Despite this, many intriguing questions emerged, in parallel to the development of knowledge. SUMMARY Allergen immunotherapy is overall effective for the treatment of asthma in children, but a class-effect should not be claimed, rather the efficacy of each single product. According to the recent findings, the challenge for the future research will be to clarify: when to start immunotherapy in children, which are (if they exist) the predictive biomarkers for efficacy in the single individual, the magnitude of the preventive effect and the optimal duration of the treatment.
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Dorofeeva Y, Shilovskiy I, Tulaeva I, Focke‐Tejkl M, Flicker S, Kudlay D, Khaitov M, Karsonova A, Riabova K, Karaulov A, Khanferyan R, Pickl WF, Wekerle T, Valenta R. Past, present, and future of allergen immunotherapy vaccines. Allergy 2021; 76:131-149. [PMID: 32249442 PMCID: PMC7818275 DOI: 10.1111/all.14300] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/25/2020] [Accepted: 03/15/2020] [Indexed: 12/21/2022]
Abstract
Allergen-specific immunotherapy (AIT) is an allergen-specific form of treatment for patients suffering from immunoglobulin E (IgE)-associated allergy; the most common and important immunologically mediated hypersensitivity disease. AIT is based on the administration of the disease-causing allergen with the goal to induce a protective immunity consisting of allergen-specific blocking IgG antibodies and alterations of the cellular immune response so that the patient can tolerate allergen contact. Major advantages of AIT over all other existing treatments for allergy are that AIT induces a long-lasting protection and prevents the progression of disease to severe manifestations. AIT is cost effective because it uses the patient´s own immune system for protection and potentially can be used as a preventive treatment. However, broad application of AIT is limited by mainly technical issues such as the quality of allergen preparations and the risk of inducing side effects which results in extremely cumbersome treatment schedules reducing patient´s compliance. In this article we review progress in AIT made from its beginning and provide an overview of the state of the art, the needs for further development, and possible technical solutions available through molecular allergology. Finally, we consider visions for AIT development towards prophylactic application.
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Affiliation(s)
- Yulia Dorofeeva
- Division of ImmunopathologyDepartment of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Igor Shilovskiy
- National Research Center, Institute of immunology, FMBA of RussiaMoscowRussian Federation
| | - Inna Tulaeva
- Division of ImmunopathologyDepartment of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
- Department of Clinical Immunology and AllergyLaboratory of ImmunopathologySechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Margarete Focke‐Tejkl
- Division of ImmunopathologyDepartment of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Sabine Flicker
- Division of ImmunopathologyDepartment of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Dmitriy Kudlay
- National Research Center, Institute of immunology, FMBA of RussiaMoscowRussian Federation
| | - Musa Khaitov
- National Research Center, Institute of immunology, FMBA of RussiaMoscowRussian Federation
| | - Antonina Karsonova
- Department of Clinical Immunology and AllergyLaboratory of ImmunopathologySechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Ksenja Riabova
- Department of Clinical Immunology and AllergyLaboratory of ImmunopathologySechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Alexander Karaulov
- Department of Clinical Immunology and AllergyLaboratory of ImmunopathologySechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Roman Khanferyan
- Department of Immunology and AllergyRussian People’s Friendship UniversityMoscowRussian Federation
| | - Winfried F. Pickl
- Institute of ImmunologyCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Thomas Wekerle
- Section of Transplantation ImmunologyDepartment of SurgeryMedical University of ViennaViennaAustria
| | - Rudolf Valenta
- Division of ImmunopathologyDepartment of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
- National Research Center, Institute of immunology, FMBA of RussiaMoscowRussian Federation
- Department of Clinical Immunology and AllergyLaboratory of ImmunopathologySechenov First Moscow State Medical UniversityMoscowRussian Federation
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Casas ML, Esteban Á, González-Muñoz M, Labrador-Horrillo M, Pascal M, Teniente-Serra A. Proyecto VALIDA: Validation of ALlergy In vitro Diagnostics Assays (Herramientas y recomendaciones para la valoración de las pruebas in vitro en el diagnóstico de la alergia). ADVANCES IN LABORATORY MEDICINE 2020; 1:20200022. [PMCID: PMC10197503 DOI: 10.1515/almed-2020-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 08/29/2023]
Abstract
En la evaluación del paciente con sospecha de alergia las pruebas de detección y cuantificación de la inmunoglobulina E (IgE) específica in vitro se usan de manera habitual en los laboratorios clínicos para ayudar en el diagnóstico de la alergia. Actualmente existen diferentes alternativas comerciales para realizar estos ensayos, pero los resultados obtenidos por cada uno de ellos pueden variar, lo que condiciona el diagnóstico y el tratamiento que se le proporcionará al paciente. Con el fin de dar respuesta a los retos planteados por las diferencias entre las distintas técnicas para la determinación in vitro de la IgE específica, un grupo de expertos ha recogido en un documento una serie de recomendaciones sobre las implicaciones que puede tener el uso de una determinada técnica in vitro y el impacto en el manejo del paciente alérgico que suponen las diferencias entre las distintas técnicas. La lectura y el análisis de este documento de consenso ayudarán a entender las implicaciones que tiene el cambio de método de diagnóstico in vitro en el manejo del paciente con alergia, en su calidad de vida y en los costes socioeconómicos asociados a la enfermedad.
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Affiliation(s)
- María L. Casas
- Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, España
- Servicio de Análisis Clínicos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Ángel Esteban
- Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, España
- Servicio de Análisis Clínicos, Hospital General Universitario de Alicante, Alicante, España
| | - Miguel González-Muñoz
- Sociedad Española de Inmunología (SEI), Barcelona, España
- Servicio de Inmunología, Hospital Universitario La Paz, Madrid, España
| | - Moisés Labrador-Horrillo
- Sociedad Española de Alergología e Inmunología Clínica (SEAIC), Madrid, España
- Servicio de Alergología, Hospital Universitari Vall d’Hebron, Barcelona, España
| | - Mariona Pascal
- Servicio de Alergología, Hospital Universitari Vall d’Hebron, Barcelona, España
- Servicio de Inmunología, CDB, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, España
- Red de Investigación ARADyAL, Instituto Carlos III, Madrid, España
| | - Aina Teniente-Serra
- Sociedad Española de Inmunología (SEI), Barcelona, España
- Servicio de Inmunología, LCMN, Hospital Universitari Germans Trias i Pujol, Badalona, España
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Casas ML, Esteban Á, González-Muñoz M, Labrador-Horrillo M, Pascal M, Teniente-Serra A. VALIDA project: Validation of allergy in vitro diagnostics assays (Tools and recommendations for the assessment of in vitro tests in the diagnosis of allergy). ADVANCES IN LABORATORY MEDICINE 2020; 1:20200051. [PMID: 37360620 PMCID: PMC10197418 DOI: 10.1515/almed-2020-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 06/28/2023]
Abstract
In vitro allergen-specific immunoglobulin E (IgE) detection and quantification tests are routinely performed in clinical laboratories to diagnose patients with a suspected allergy. Numerous commercial assays are available to test for allergies, but the results can vary widely, thereby influencing both diagnosis and treatment. Given the challenges posed by differences in the various assays for in vitro determination of specific IgE, a group of experts has compiled in a document a series of recommendations on the implications that the use of a certain in vitro technique may have and the impact on the management of the allergic patient that the differences between the various techniques represent. The reading and analysis of this consensus document will help to understand the implications of the change of in vitro diagnostic method in the management of the patient with allergy, in the quality of life and in the socioeconomic costs associated with the disease.
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Affiliation(s)
- María L. Casas
- Clinical Analysis Service, Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain
- Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Ángel Esteban
- Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
- Clinical Analysis Service, University General Hospital of Alicante, Alicante, Spain
| | - Miguel González-Muñoz
- Immunology Service, La Paz University Hospital, Madrid, Spain
- Spanish Society of Immunology (SEI), Barcelona, Spain
| | - Moisés Labrador-Horrillo
- Allergology Service, Vall d’Hebron University Hospital, Barcelona, Spain
- Spanish Society of Allergology and Clinical Immunology (SEAIC), Madrid, Spain
| | - Mariona Pascal
- Spanish Society of Immunology (SEI), Barcelona, Spain
- Spanish Society of Allergology and Clinical Immunology (SEAIC), Madrid, Spain
- Immunology Service, CBD, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- ARADyAL Research Network, Carlos III Institute, Madrid, Spain
| | - Aina Teniente-Serra
- Spanish Society of Immunology (SEI), Barcelona, Spain
- Immunology Service, LCMN, Germans Trias i Pujol University Hospital, Badalona, Spain
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Tomazic PV, Lang-Loidolt D. Current and emerging pharmacotherapy for pediatric allergic rhinitis. Expert Opin Pharmacother 2020; 22:849-855. [PMID: 32808819 DOI: 10.1080/14656566.2020.1808622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) is a global health problem in adults as well as the younger population, continuously increasing and posing a significant problem for patients, health care systems and economies. For the younger population, some aspects differ from treatment of adults, namely, prevention, compliance and adherence. AREAS COVERED This narrative review summarizes all the pharmacotherapeutic options with special focus on the pediatric population. Moreover, it elucidates prevention strategies as well as future developments of AR treatment. Currently, symptomatic therapy in the form of steroids and antihistamines is applied topically and systemically where steroids need to be administered with caution and for a very short term. The only disease-modifying and causal treatment is allergen immunotherapy administered sublingually and subcutaneously. Future and current novel therapeutic options are human monoclonal antibodies. EXPERT OPINION The greatest potential for future developments currently lie in allergen immunotherapy and here in different routes of administration and modification of (recombinant) allergens as well as immune-modulating adjuvants and nanoparticles. Secondly, monoclonal antibodies are promising molecules blocking and/or interfering with up- and downstream immune mechanisms. Another important aspect lies in prevention of allergic sensitization and disease progression through both AIT and biologics which is particularly true for the pediatric population.
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Affiliation(s)
- Peter Valentin Tomazic
- Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Doris Lang-Loidolt
- Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
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Barker N, Thevasagayam R, Ugonna K, Kirkby J. Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management. Front Pediatr 2020; 8:379. [PMID: 32766182 PMCID: PMC7378385 DOI: 10.3389/fped.2020.00379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
Dysfunctional breathing (DB) is an overarching term describing deviations in the normal biomechanical patterns of breathing which have a significant impact on quality of life, performance and functioning. Whilst it occurs in both children and adults, this article focuses specifically on children. DB can be viewed as having two components; breathing pattern disorder (BPD) and inducible laryngeal obstruction (ILO). They can be considered in isolation, however, are intricately related and often co-exist. When both are suspected, we propose both BPD and ILO be investigated within an all-encompassing multi-disciplinary dysfunctional breathing clinic. The MDT clinic can diagnose DB through expert history taking and a choice of appropriate tests/examinations which may include spirometry, breathing pattern analysis, exercise testing and laryngoscopic examination. Use of the proposed algorithm presented in this article will aid decision making regarding choosing the most appropriate tests and understanding the diagnostic implications of these tests. The most common symptoms of DB are shortness of breath and chest discomfort, often during exercise. Patients with DB typically present with normal spirometry and an altered breathing pattern at rest which is amplified during exercise. In pediatric ILO, abnormalities of the upper airway such as cobblestoning are commonly seen followed by abnormal activity of the upper airway structures provoked by exercise. This may be associated with a varying degree of stridor. The symptoms, however, are often misdiagnosed as asthma and the picture can be further complicated by the common co-presentation of DB and asthma. Associated conditions such as asthma, extra-esophageal reflux, rhinitis, and allergy must be treated appropriately and well controlled before any directed therapy for DB can be started if therapy is to be successful. DB in pediatrics is commonly treated with a course of non-pharmaceutical therapy. The therapy is provided by an experienced physiotherapist, speech and language therapist or psychologist depending on the dominant features of the DB presentation (i.e., BPD or ILO in combination or in isolation) and some patients will benefit from input from more than one of these disciplines. An individualized treatment program based on expert assessment and personalized goals will result in a return to normal function with reoccurrence being rare.
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Affiliation(s)
- Nicki Barker
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Ravi Thevasagayam
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Kelechi Ugonna
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Jane Kirkby
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
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