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Batard T, Taillé C, Guilleminault L, Bozek A, Floch VBL, Pfaar O, Canonica WG, Akdis C, Shamji MH, Mascarell L. Allergen Immunotherapy for the Prevention and Treatment of Asthma. Clin Exp Allergy 2024. [PMID: 39363801 DOI: 10.1111/cea.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 10/05/2024]
Abstract
Allergic asthma is the predominant phenotype among asthmatics. Although conventional pharmacotherapy is a central component in the management of asthma, it does not enable control of asthma symptoms in all patients. In recent decades, some uncontrolled asthmatic patients, especially those with allergic asthma, have benefited from biological therapies. However, biologics do not address all the unmet needs left by conventional pharmacotherapy. Furthermore, it is noteworthy that neither conventional pharmacotherapy nor biological therapies have disease-modifying properties. In this context, allergen immunotherapy (AIT) represents an indispensable component of the therapeutic arsenal against allergic asthma, due to its disease-modifying immunological effects. In this review article, funded by an AIT manufacturer, we find clinical trials support AIT as the only treatment option able both to improve allergic asthma symptoms and to prevent the onset and worsening of the condition. For patients with severe asthma or other safety concerns, the combination of AIT and biologics offers very promising new treatment modalities for the management of allergic asthma. Trial Registration: clinicaltrials.gov identifier: NCT06027073.
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Affiliation(s)
- Thierry Batard
- Innovation & Science Department, Stallergenes Greer, Antony, France
| | - Camille Taillé
- Service de Pneumologie et Centre de référence pour les maladies respiratoires rares, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France
- CRISALIS F-CRIN Network, Paris, France
| | - Laurent Guilleminault
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, University Toulouse III, Toulouse, France
- Department of Respiratory Medicine, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
- CRISALIS/FCRIN, Toulouse, France
| | - Andrzej Bozek
- Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, Katowice, Poland
| | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Walter G Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
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2
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Bogacz-Piaseczyńska A, Bożek A, Krupka-Olek M, Kawczyk-Krupka A, Zalejska-Fiolka J, Canonica GW. Dupilumab and House Dust Mite Immunotherapy in Patients with Atopic Dermatitis: A Preliminary Study. Vaccines (Basel) 2024; 12:1046. [PMID: 39340076 PMCID: PMC11435717 DOI: 10.3390/vaccines12091046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 09/04/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Severe atopic dermatitis (AD) is a complex disease requiring systemic treatment. This study aimed to assess the effectiveness of combined therapy consisting of dupilumab and sublingual dust mite allergen immunotherapy (SLIT-HDM) in patients with severe AD and HDM allergies. METHODS Patients diagnosed with severe AD were included in this randomised, placebo-controlled, double-blind 12-month trial; they received SLIT for HDMs and/or dupilumab for 12 months and were compared with patients on cyclosporine. The primary outcomes for the treatment arms were changes in the Eczema Area and Severity Index (EASI), body surface area (%BSA), and Investigator Global Assessment (IsGA) over 12 months. The secondary outcomes were the proportion of patients who achieved IsGA success and reduced medication scores. RESULTS Significant improvements were observed in all analysed groups after 12 months of therapy based on the EASI, %BSA, and IsGA. However, the most substantial changes were observed in the groups treated with dupilumab or a combination of SLIT-HDM and dupilumab. Additionally, the proportion of patients who achieved an IsGA reduction was significantly greater in the group receiving combination therapy than in the other groups (9/14 [64% of the group receiving SLIT-HDM] vs. 11/14 [73% of the group receiving dupilumab] vs. 15/17 [88% of the group receiving dupilumab and SLIT-HDM] vs. 7/13 [53% of the group receiving cyclosporine]) (p < 0.05). CONCLUSIONS In patients with severe AD and HDM allergies, combination treatment with dupilumab and allergen immunotherapy for HDMs may increase the therapeutic benefit over treatment with these methods separately.
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Affiliation(s)
- Agnieszka Bogacz-Piaseczyńska
- Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, 40-055 Katowice, Poland; (A.B.-P.)
| | - Andrzej Bożek
- Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, 40-055 Katowice, Poland; (A.B.-P.)
| | - Magdalena Krupka-Olek
- Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, 40-055 Katowice, Poland; (A.B.-P.)
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland;
| | - Jolanta Zalejska-Fiolka
- Department of Biochemistry, Faculty of Medical Science, Zabrze Medical University of Silesia, 40-055 Katowice, Poland;
| | - Giorgio Walter Canonica
- Head Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital, Humanitas University, 20089 Milano, Italy;
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Huber P, Becker S, Gröger M. [Pitfalls in the diagnosis of house dust mite allergy]. HNO 2024; 72:619-625. [PMID: 38358481 DOI: 10.1007/s00106-024-01425-y] [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] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
House dust mite (HDM) is the most significant indoor allergen, responsible for not only many cases of rhinoconjunctivitis but also for many cases of bronchial asthma, rendering it of considerable socioeconomic relevance. Besides symptomatic treatment and avoidance measures, allergen immunotherapy (AIT) is crucial, as the only causal, disease-modifying therapeutic approach. However, high diagnostic certainty is essential for initiating AIT. The challenge in making a correct diagnosis lies in interpreting the demonstrated HDM sensitization regarding its clinical relevance (clinically silent sensitization vs. allergy). While the risk of allergy increases with the level of IgE titers against HDM extract, Der p 1, or Der p 2, as well as with the breadth of the molecular sensitization profile against HDM components (Der p 1, Der p 2, Der p 23), no threshold can be defined for the presence of allergy, nor can sensitization to a specific component be confidently considered allergy inducing. It should be noted that at least in Southern Bavaria, the prevalence of Der p 23 sensitization is too low to be considered a major allergen, and Der p 23 is not able to molecularly differentiate all HDM sensitizations when added to the two major allergens Der p 1 and Der p 2. Evidently, HDM possesses a diverse profile of allergens, with some relevant ones possibly yet to be described. Unfortunately, patient history does not provide a sufficient assessment of the clinical relevance of a demonstrated HDM sensitization, necessitating allergen provocation testing before initiating AIT with HDM, despite the relatively large effort involved.
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Affiliation(s)
- P Huber
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - S Becker
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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4
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Oezguen N, Rider NL, Dowlin M, Singh I. Identifying Region-Specific Allergy Sensitization Clusters to Optimize Diagnosis and Reduce Costs. J Pediatr 2024; 270:113999. [PMID: 38431194 DOI: 10.1016/j.jpeds.2024.113999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To delineate quantitatively the allergen sensitization patterns in a large pediatric cohort and inform the selection of a region-specific panel of allergen tests for timely and cost-effective in vitro atopy screening. STUDY DESIGN IgE levels for specific allergens from patients in the Texas Children's Health System were analyzed retrospectively. Statistical and network analyses were conducted to reveal sensitization patterns. RESULTS Network analysis of 114 distinct allergens among 12 065 patients identified 2 main groups of allergens: environmental and food. Approximately 67.5% of patients were sensitized to environmental allergens, 47.2% to food allergens, and 7.3% to at least 1 allergen from both groups. We identified a novel panel of 13 allergens that could detect sensitization in 95% of patients, whereas panels of 7 allergens within each category effectively identified sensitization in 95% of patients with specific sensitivities. This data-driven approach is estimated to reduce overall testing costs by 52%. In agreement with literature, we observed correlations among allergens within specific categories, such as pollen, shellfish, nuts, and dairy allergens. CONCLUSIONS This study provides insights into allergen sensitization patterns informing an algorithmic testing approach tailored for primary care settings. The use of a region and population-specific test panel can efficiently identify atopy, leading to more targeted testing. This strategy has the potential to refine laboratory testing, reduce costs, and improve the appropriateness of referrals to allergy specialists, ultimately enhancing diagnostic accuracy and resource allocation.
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Affiliation(s)
- Numan Oezguen
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX; Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Nicholas L Rider
- Department of Health Systems & Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Allergy-Immunology, The Carilion Clinic, Roanoke, VA
| | - Michael Dowlin
- Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Ila Singh
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX; Department of Pathology, Texas Children's Hospital, Houston, TX.
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Creticos PS, Gunaydin FE, Nolte H, Damask C, Durham SR. Allergen Immunotherapy: The Evidence Supporting the Efficacy and Safety of Subcutaneous Immunotherapy and Sublingual Forms of Immunotherapy for Allergic Rhinitis/Conjunctivitis and Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1415-1427. [PMID: 38685477 DOI: 10.1016/j.jaip.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
Allergen immunotherapy (AIT) is a recognized key therapeutic modality for the treatment of allergic respiratory disease. Definitive studies have provided evidence-based data to demonstrate its effectiveness in allergic rhinitis and asthma due to the inhalation of proteinaceous allergic substances from specific seasonal pollens, dust mites, animal allergens, and certain mold spores. Over the ensuing decades, laboratory investigations have provided objective evidence to demonstrate immunologic changes, including production of protective IgG antibody, suppression of IgE antibody, upregulation of regulatory T cells, and induction of a state of immune tolerance to the offending allergen(s). Tangential to this work were carefully designed clinical studies that defined allergen dose and duration of treatment, established the importance of preparing extracts with standardized allergens (or well-defined extracts) based on major protein moieties, and used allergen provocation models to demonstrate efficacy superior to placebo. In the United States, the use of subcutaneous immunotherapy extracts for AIT was grandfathered in by the Food and Drug Administration based on expert literature review. In contrast, sublingual tablet immunotherapy underwent formal clinical development programs (phase I-III clinical trials) that provided the necessary clinical evidence for safety and efficacy that led to regulatory agency approvals for the treatment of allergic rhinitis in properly characterized patients with allergy. The allergy specialist's treatment options currently include traditional subcutaneous AIT and specific sublingual tablets approved for grass, ragweed, house dust mites, trees belonging to the birch-homologous group, and Japanese cedar. Tangential to this are sublingual drops that are increasingly being used off-label (albeit not approved by the Food and Drug Administration) in the United States. This article will review the evidence-based literature supporting the use of these forms of AIT, as well as focus on several current controversies and gaps in our knowledge base that have relevance for the appropriate selection of patients for treatment with specific AIT.
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Affiliation(s)
- Peter Socrates Creticos
- Johns Hopkins Division of Allergy & Clinical Immunology, Baltimore, Md; Creticos Research Group, Crownsville, MD.
| | - Fatma E Gunaydin
- Department of Immunology & Allergy, Ordu University Education & Research Hospital, Ordu, Türkiye
| | | | - Cecilia Damask
- Department of Otolaryngology, Central Florida College of Medicine, Orlando, Fla
| | - Stephen R Durham
- Allergy & Clinical Immunology, Division of Respiratory Science, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
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6
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Gurgel RK, Baroody FM, Damask CC, Mims JW, Ishman SL, Baker DP, Contrera KJ, Farid FS, Fornadley JA, Gardner DD, Henry LR, Kim J, Levy JM, Reger CM, Ritz HJ, Stachler RJ, Valdez TA, Reyes J, Dhepyasuwan N. Clinical Practice Guideline: Immunotherapy for Inhalant Allergy. Otolaryngol Head Neck Surg 2024; 170 Suppl 1:S1-S42. [PMID: 38408152 DOI: 10.1002/ohn.648] [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: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence-based recommendations for improved patient care. PURPOSE The purpose of this clinical practice guideline (CPG) is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce the risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The GDG made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitizations, (2) reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre- and co-seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions (LRs) to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The GDG offered the following KASs as options: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta-blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.
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Affiliation(s)
| | - Fuad M Baroody
- The University of Chicago Medicine, Chicago, Illinois, USA
| | | | - James Whit Mims
- Wake Forest Baptist Health, Winston Salem, North Carolina, USA
| | | | - Dole P Baker
- Anderson ENT & Facial Plastics, Anderson, South Carolina, USA
| | | | | | - John A Fornadley
- Associated Otolaryngologists of PA, Inc, Hershey, Pennsylvania, USA
| | | | | | - Jean Kim
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua M Levy
- National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland, USA
| | - Christine M Reger
- Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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7
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Gurgel RK, Baroody FM, Damask CC, Mims JW, Ishman SL, Baker DP, Contrera KJ, Farid FS, Fornadley JA, Gardner DD, Henry LR, Kim J, Levy JM, Reger CM, Ritz HJ, Stachler RJ, Valdez TA, Reyes J, Dhepyasuwan N. Executive Summary of Clinical Practice Guideline on Immunotherapy for Inhalant Allergy. Otolaryngol Head Neck Surg 2024; 170:635-667. [PMID: 38408153 DOI: 10.1002/ohn.650] [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: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence-based recommendations for improved patient care. PURPOSE The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The guideline development group made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The guideline development group made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitization, (2) reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre- and co-seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The guideline development group offered the following KASs as options: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta-blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.
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Affiliation(s)
| | - Fuad M Baroody
- The University of Chicago Medicine, Chicago, Illinois, USA
| | | | - James Whit Mims
- Wake Forest Baptist Health, Winston Salem, North Carolina, USA
| | | | - Dole P Baker
- Anderson ENT & Facial Plastics, Anderson, South Carolina, USA
| | | | | | - John A Fornadley
- Associated Otolaryngologists of PA, Inc., Hershey, Pennsylvania, USA
| | | | | | - Jean Kim
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua M Levy
- National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland, USA
| | - Christine M Reger
- University of Pennsylvania, Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
| | | | | | | | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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8
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Lee HY, Lee SM, Kang SY, Kim K, Kim JH, Ryu G, Min JY, Park KH, Park SY, Sung M, Lee Y, Yang EA, Jee HM, Ha EK, Shin YS, Chung EH, Choi SH, Koh YI, Kim ST, Nahm DH, Park JW, Shim JY, An YM, Han DH, Han MY, Lee YW, Choi JH. KAAACI Guidelines for Allergen Immunotherapy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:725-756. [PMID: 37957792 PMCID: PMC10643862 DOI: 10.4168/aair.2023.15.6.725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/16/2023] [Accepted: 10/07/2023] [Indexed: 11/15/2023]
Abstract
Allergen immunotherapy (AIT) is a causative treatment for various allergic diseases such as allergic rhinitis, allergic asthma, and bee venom allergy that induces tolerance to offending allergens. The need for uniform practice guidelines in AIT is continuously growing because of the increasing discovery of potential candidates for AIT and evolving interest in new therapeutic approaches. This guideline is an updated version of the Korean Academy of Asthma Allergy and Clinical Immunology recommendations for AIT published in 2010. This updated guideline proposes an expert opinion by allergy, pediatrics, and otorhinolaryngology specialists with an extensive literature review. The guideline deals with basic knowledge and methodological aspects of AIT, including mechanisms, clinical efficacy, patient selection, allergens extract selection, schedule and doses, management of adverse reactions, efficacy measurements, and special consideration in pediatrics. The guidelines for sublingual immunotherapy will be covered in detail in a separate article.
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Affiliation(s)
- Hwa Young Lee
- Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sung-Yoon Kang
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyunghoon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
| | - Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Young Min
- Department of Otorhinolaryngology-Head & Neck Surgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - So-Young Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Eun-Ae Yang
- Department of Pediatrics, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young-Il Koh
- Department of Allergy and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seon Tae Kim
- Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dong-Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Won Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Yong Won Lee
- Division of Allergy & Clinical Immunology, Department of Internal Medicine, Center for Health Policy Research, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Korea.
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
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de Kam PJ, Zielen S, Bernstein JA, Berger U, Berger M, Cuevas M, Cypcar D, Fuhr-Horst A, Greisner WA, Jandl M, Laßmann S, Worm M, Matz J, Sher E, Smith C, Steven GC, Mösges R, Shamji MH, DuBuske L, Borghese F, Oluwayi K, Zwingers T, Seybold M, Armfield O, Heath MD, Hewings SJ, Kramer MF, Skinner MA. Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy. Allergy 2023; 78:2756-2766. [PMID: 37366581 DOI: 10.1111/all.15788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND A modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine and monophosphoryl lipid-A as an adjuvant system (Grass MATA MPL [PQ Grass]) is being developed as short-course treatment of grass-pollen allergic rhinitis (SAR) and/or rhinoconjunctivitis. We sought to evaluate the combined symptom and medication score (CSMS) of the optimized cumulative dose of 27,600 standardized units (SU) PQ Grass in a field setting prior to embarking on a pivotal Phase III trial. METHODS In this exploratory, randomized, double-blind, placebo-controlled trial subjects were enrolled across 14 sites (Germany and the United States of America). Six pre-seasonal subcutaneous injections of PQ Grass (using conventional or extended regimens) or placebo were administered to 119 subjects (aged 18-65 years) with moderate-to-severe SAR with or without asthma that was well-controlled. The primary efficacy endpoint was CSMS during peak grass pollen season (GPS). Secondary endpoints included Rhinoconjunctivitis Quality of Life Questionnaire standardized (RQLQ-S) and allergen-specific IgG4 response. RESULTS The mean CSMS compared to placebo was 33.1% (p = .0325) and 39.5% (p = .0112) for the conventional and extended regimens, respectively. An increase in IgG4 was shown for both regimens (p < .01) as well as an improvement in total RQLQ-S for the extended regimen (mean change -0.72, p = .02). Both regimens were well-tolerated. CONCLUSIONS This trial demonstrated a clinically relevant and statistically significant efficacy response to PQ Grass. Unprecedented effect sizes were reached for grass allergy of up to ≈40% compared to placebo for CSMS after only six PQ Grass injections. Both PQ Grass regimens were considered equally safe and well-tolerated. Based on enhanced efficacy profile extended regime will be progressed to the pivotal Phase III trial.
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Affiliation(s)
| | - S Zielen
- Children and Adolescents Department, Allergology, Pulmonology & Cystic Fibrosis, Goethe University, Frankfurt, Germany
| | - J A Bernstein
- Bernstein Clinical Research Center, LLC, Cincinnati, Ohio, USA
| | - U Berger
- Aerobiology and Pollen Research Unit, Department of Oto-Rhino-Laryngology, Medical University Vienna, Vienna, Austria
| | - M Berger
- Department of Otorhinolaryngology, Wiener Gesundheitsverbund, Hospital Hietzing, Vienna, Austria
| | - M Cuevas
- Clinic and Polyclinic of Otorhinolaryngology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - D Cypcar
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | - A Fuhr-Horst
- ENT Research- Institut für klinische Studien, Essen, Germany
| | - W A Greisner
- Bluegrass Allergy Research, Lexington, Kentucky, USA
| | - M Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - S Laßmann
- Studienzentrum Dr. Sabine Laßmann, Saalfeld, Germany
| | - M Worm
- Department of Dermatology and Allergy-Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - J Matz
- Chesapeake Clinical Research, Inc, White Marsh, Maryland, USA
| | - E Sher
- Allergy Partners of New Jersey, Ocean Township, New Jersey, USA
| | - C Smith
- Certified Research Associates, Cortland, New York, USA
| | - G C Steven
- Allergy Asthma & Sinus Center, S.C., Greenfield, Wisconsin, USA
| | - R Mösges
- IMSB (Institute of Computational Biology and Medical Statistics), University at Cologne, Cologne, Germany
- ClinCompetence, Cologne, Germany
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - L DuBuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University Hospital, Washington, DC, USA
| | | | - K Oluwayi
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M Seybold
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M D Heath
- Allergy Therapeutics PLC, Worthing, UK
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Owenier C, Barnowski C, Leineweber M, Yu D, Verhagen M, Distler A. Tolerability and Safety of Sublingual Immunotherapy in Patients with Tree Pollen Allergy in Daily Practice-An Open, Prospective, Non-Interventional Study. J Clin Med 2023; 12:5517. [PMID: 37685584 PMCID: PMC10487851 DOI: 10.3390/jcm12175517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
To investigate the tolerability and safety of two sublingual tree pollen extracts approved in 2018, a non-interventional study (NIS) was performed. This NIS was an 8-month observational study conducted at 84 sites throughout Germany. Study participants received either a sublingual liquid allergen extract of birch pollen (SBPE) or a liquid allergen extract consisting of a mixture of birch, hazel, and alder tree pollen (STPE). Data from 432 patients were analyzed for the occurrence of adverse events and patient compliance. At least one local reaction occurred in 69 (22.2%) patients, whereas systemic reactions were only observed in 27 (6.3%) patients. STPE-treated patients developed systemic reactions more frequently than SBPE-treated patients (SBPE: 9 (4.3%) vs. STPE: 18 (8.0%)). Only one patient developed a systemic grade III reaction. Severe systemic grade IV reactions were not observed. A total of 348 (98.6%) of the patients who completed all visits were satisfied or very satisfied with the sublingual immunotherapy (SLIT), and 322 (71%) patients completed all visits. Both investigated products were well tolerated by the patients and demonstrated a good safety profile. AEs were observed less frequently than in the preceding clinical phase III trial, and no new safety concerns were identified.
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Affiliation(s)
| | | | | | - Donghui Yu
- HAL Allergy BV, 2333 CH Leiden, The Netherlands; (D.Y.); (M.V.)
| | - Marjan Verhagen
- HAL Allergy BV, 2333 CH Leiden, The Netherlands; (D.Y.); (M.V.)
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11
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Incorvaia C, Cavaliere C, Schroeder JW, Leo G, Nicoletta F, Barone A, Ridolo E. Safety and adverse reactions in subcutaneous allergen immunotherapy: a review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023172. [PMID: 37539607 PMCID: PMC10440773 DOI: 10.23750/abm.v94i4.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/14/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is the only treatment which acts on the causes of allergic diseases by modifying their natural history. In the eighties subcutaneous immunotherapy (SCIT) with high biological power allergen extracts caused a number of severe systemic reactions and also fatalities in the UK and the US, resulting in its limitation and in the introduction of other routes of administration. A decisive advance for SCIT safety was understanding that the major cause of mortality was injecting the allergen extract to patients with uncontrolled asthma at the time of injection. AREAS COVERED This awareness resulted in a significant decrease in fatalities, but not in their abolition. In 2019, an increase in SCIT-related mortality was observed, suggesting to continue the research for still unidentified factors favoring severe reactions, such as the administration of a wrong extract or of allergen doses higher than listed, unintentional intravenous administration, and missed dose reduction after protracted interruption. Moreover, in the context of the improving of the safety, the role played in tolerance-promoting by adjuvants such as CpG oligodeoxynucleotides has to be taken into account, as well as the potential preventive effect performed by the monoclonal anti-IgE antibody omalizumab against the exacerbation of severe reactions during SCIT. CONCLUSION The safety of SCIT is good, but the research to improve it further must continue. In particular, the pathophysiological mechanisms related to AIT for inhalants and for Hymenoptera venom should be studied, based on the evident diversity demonstrated by the complete absence of fatal reactions to Hymenoptera venom immunotherapy from its introduction in comparison with the history of serious and fatal offenses examined in this review.
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Affiliation(s)
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University, Rome, Italy.
| | - Jan W Schroeder
- Allergy and Immunology polispecialistic medical department. Niguarda Hospital, Milan, Italy.
| | - Gualtiero Leo
- High Specialization in Allergy and Asthma. Department of Childhood and Developmental Medicine, Fatebenefratelli and Sacco Hospital, Milan, Italy.
| | - Francesca Nicoletta
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy.
| | - Alessandro Barone
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy.
| | - Erminia Ridolo
- University of Parma, Department of Clinical and Experimental Medicine, Parma, Italy. .
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12
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Hellings PW, Lau S, Scadding GK, Bjermer L, Backer V, Chaker AM, Conti DM, De Corso E, Diamant Z, Djukanovic R, Fokkens W, Gevaert P, Gray CL, Han JK, Heaney LG, Hoffmann HJ, Jesenak M, Johansen P, Kumaran MS, McDonald M, Melén E, Mullol J, Reitsma S, Ryan D, Scadding G, Schmid-Grendelmeier P, Teeling T, Odemyr M, Wahn U. EUFOREA summit in Brussels 2023: inspiring the future of allergy & respiratory care. FRONTIERS IN ALLERGY 2023; 4:1236977. [PMID: 37577332 PMCID: PMC10415067 DOI: 10.3389/falgy.2023.1236977] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
In March 2023, the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) organized its bi-annual Summit in Brussels with expert panel members of EUFOREA, representatives of the EUFOREA patient advisory board, and the EUFOREA board and management teams. Its aim was to define the research, educational and advocacy initiatives to be developed by EUFOREA over the next 2 years until the 10th anniversary in 2025. EUFOREA is an international non-for-profit organization forming an alliance of all stakeholders dedicated to reducing the prevalence and burden of chronic allergic and respiratory diseases via research, education, and advocacy. Based on its medical scientific core competency, EUFOREA offers an evidence-supported platform to introduce innovation and education in healthcare leading to optimal patient care, bridging the gap between latest scientific evidence and daily practice. Aligned with the mission of improving health care, the expert panels of asthma, allergic rhinitis (AR), chronic rhinosinusitis (CRS) & European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), allergen immunotherapy (AIT) and paediatrics have proposed and elaborated a variety of activities that correspond to major unmet needs in the allergy and respiratory field. The current report provides a concise overview of the achievements, ambitions, and action plan of EUFOREA for the future, allowing all stakeholders in the allergy and respiratory field to be up-dated and inspired to join forces in Europe and beyond.
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Affiliation(s)
- P. W. Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals, Leuven, Belgium
- Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - S. Lau
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - G. K. Scadding
- Department of Allergy & Rhinology, Royal National ENT Hospital, London, United Kingdom
- Division of Immunity and Infection, University College, London, United Kingdom
| | - L. Bjermer
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
| | - V. Backer
- Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - A. M. Chaker
- Department of Otorhinolaryngology and Center for Allergy and Environment (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - D. M. Conti
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium
| | - E. De Corso
- Otolaryngology Head and Neck Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Z. Diamant
- Department of Respiratory Medicine & 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 Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Dept of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
| | - R. Djukanovic
- NIHR Southampton Biomedical Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - W. Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - P. Gevaert
- Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - C. L. Gray
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa
- Specialist Allergist, Kidsallergy Centre, Cape Town, South Africa
| | - J. K. Han
- Department of Otolaryngology & Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States
| | - L. G. Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, United Kingdom
| | - H. J. Hoffmann
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - M. Jesenak
- Department of Pulmonology and Phthisiology, Department of Pediatrics, Department of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - P. Johansen
- Department of Dermatology, University of Zurich, Zurich, Switzerland
- Allergy Unit, Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - M. S. Kumaran
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M. McDonald
- Mediclinic Sandton, Johannesburg, South Africa
| | - E. Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet and Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - J. Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - S. Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - D. Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- International Primary Care Respiratory Group., Edinburgh, United Kingdom
| | - G. Scadding
- Allergy, Royal Brompton Hospital, London, United Kingdom
| | - P. Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine-Kühne Center for Allergy research and Education CK-CARE, Davos, Switzerland
| | - T. Teeling
- Patient Advisory Board of the European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
| | - M. Odemyr
- Patient Advisory Board of the European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
| | - U. Wahn
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitaetsmedizin, Berlin, Germany
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Abdul Latiff AH, Husain S, Abdullah B, Suppiah P, Tan V, Ing Ping T, Woo K, Yap YY, Bachert C, J Schunemann H, Bedbrook A, Czarlewski W, Bousquet J. ARIA Care Pathways 2019: Next-Generation Allergic Rhinitis Care and Allergen Immunotherapy in Malaysia. J Pers Med 2023; 13:jpm13050835. [PMID: 37241005 DOI: 10.3390/jpm13050835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
An increase in the prevalence of allergic rhinitis (AR) worldwide presents a significant burden to the health care system. An initiative was started in Europe designated as Allergic Rhinitis and Its Impact on Asthma (ARIA) to develop internationally applicable guidelines by utilising an evidence-based approach to address this crucial issue. The efforts are directed at empowerment of patients for self-management, the use of digital mobile technology to complement and personalise treatment, and establishment of real-life integrated care pathways (ICPs). This guideline includes aspects of patients' and health care providers' management and covers the main areas of treatment for AR. The model provides better real-life health care than the previous traditional models. This review summarises the ARIA next-generation guideline in the context of the Malaysian health care system.
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Affiliation(s)
- Amir Hamzah Abdul Latiff
- Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Jalan Bukit Pantai, Taman Bukit Pantai, Kuala Lumpur 59100, Malaysia
| | - Salina Husain
- Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Palaniappan Suppiah
- Otorhinolaryngology, Gleneagles Hospital Penang, 1, Jalan Pangkor, George Town 10050, Malaysia
| | - Vincent Tan
- Otorhinolaryngology, KPJ Klang Specialist Hospital, Persiaran Rajawali, Bandar Baru Klang, Klang 41150, Malaysia
| | - Tang Ing Ping
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine & Health Sciences, University Malaysia Sarawak, Kota Samarahan 94300, Malaysia
| | - Kent Woo
- Allergy & Immunology Clinic, Gleneagles Hospital Kuala Lumpur, Jalan Ampang, Kampung Berembang, Kuala Lumpur 50450, Malaysia
| | - Yoke-Yeow Yap
- Otorhinolaryngology, KPJ Johor Specialist Hospital, 39B Jalan Abdul Samad, Johor Bahru 80100, Malaysia
| | - Claus Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Münster, 48149 Münster, Germany
- International Airway Research Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
- Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, 9000 Ghent, Belgium
| | - Holger J Schunemann
- Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | | | - Wienczyslawa Czarlewski
- ARIA & MASK-air, 34090 Montpellier, France
- Medical Consulting Czarlewski, 92300 Levallois, France
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 12203 Berlin, Germany
- University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
- Inserm Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
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14
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Šošić L, Paolucci M, Flory S, Jebbawi F, Kündig TM, Johansen P. Allergen immunotherapy: progress and future outlook. Expert Rev Clin Immunol 2023:1-25. [PMID: 37122076 DOI: 10.1080/1744666x.2023.2209319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Allergy, the immunological hypersensitivity to innocuous environmental compounds, is a global health problem. The disease triggers, allergens, are mostly proteins contained in various natural sources such as plant pollen, animal dander, dust mites, foods, fungi and insect venoms. Allergies can manifest with a wide range of symptoms in various organs, and be anything from just tedious to life-threatening. A majority of all allergy patients are self-treated with symptom-relieving medicines, while allergen immunotherapy (AIT) is the only causative treatment option. AREAS COVERED This review will aim to give an overview of the state-of-the-art allergy management, including the use of new biologics and the application of biomarkers, and a special emphasis and discussion on current research trends in the field of AIT. EXPERT OPINION Conventional AIT has proven effective, but the years-long treatment compromises patient compliance. Moreover, AIT is typically not offered in food allergy. Hence, there is a need for new, effective and safe AIT methods. Novel routes of administration (e.g. oral and intralymphatic), hypoallergenic AIT products and more effective adjuvants holds great promise. Most recently, the development of allergen-specific monoclonal antibodies for passive immunotherapy may also allow treatment of patients currently not treated or treatable.
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Affiliation(s)
- Lara Šošić
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Marta Paolucci
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Stephan Flory
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Fadi Jebbawi
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Thomas M Kündig
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Pål Johansen
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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15
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Wang W, Wang X, Wang H, Wang X. Evaluation of Safety, Efficacy, and Compliance of Intralymphatic Immunotherapy for Allergic Rhinoconjunctivitis: A Systematic Review and Meta-Analysis. Int Arch Allergy Immunol 2023; 184:754-766. [PMID: 37105134 DOI: 10.1159/000529025] [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: 07/24/2022] [Accepted: 12/13/2022] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Intralymphatic immunotherapy (ILIT) is an emerging type of allergen immunotherapy with fewer injections and shorter course for allergic rhinoconjunctivitis (ARC). The efficacy and safety have not been confirmed by informative and powerful evidence yet. METHODS A systematic review and meta-analysis were conducted through electronic searching with PubMed, Web of Science, Embase, Scopus, and China National Knowledge Infrastructure (CNKI). The safety (incidence of adverse events [AEs]), compliance (percent of patients completing treatment), and clinical efficacy of ILIT were evaluated. Clinical efficacy could be assessed by improvement of subjective symptom and rescue medication use or the nasal tolerance to specific allergen. This study is registered with PROSPERO (CRD42022353562). RESULTS 12 randomized controlled trials (RCTs) comparing ILIT with placebo and 3 trials (2 RCTs and one case-control study) comparing ILIT and SCIT were included in this review. Totally, 582 patients diagnosed as AR or ARC were enrolled. Almost all the AEs were mild-to-moderate reactions except 2 patients developed anaphylactic reactions at the intralymphatic injection dose 5,000 SQ-U in one study. ILIT got higher incidence of local AEs than placebo, but their incidence of systemic AEs was similar. ILIT was safer than SCIT (p < 0.05). Almost all the patients could complete ILIT treatment, and the most common reason for discontinuation of ILIT was AEs. The compliance of patients receiving ILIT seemed higher than patients receiving SCIT. ILIT could significantly ameliorate subjective allergic symptoms, especially for seasonal ARC, and increase nasal tolerance, similar to SCIT. CONCLUSION ILIT was a safe and effective treatment for ARC and could achieve comparable clinical improvement with SCIT with shorter duration and higher compliance. Moreover, ILIT was safer than SCIT.
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Affiliation(s)
- Wenping Wang
- Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China,
| | - Xiaoyan Wang
- Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Hongtian Wang
- Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Xueyan Wang
- Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
- Center of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
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16
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Adlany YK, Šošić L, Senti G, Lang CC, Wüthrich B, Kündig TM, Johansen P. Quality of life in allergic rhinitis patients treated with intralymphatic immunotherapy (ILIT): A 19-year follow-up. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:43-50. [PMID: 37780115 PMCID: PMC10509981 DOI: 10.1016/j.jacig.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 10/03/2023]
Abstract
Background In 2002-2005, we conducted a phase I/II clinical trial where a new allergy immunotherapy (AIT) route was introduced: intralymphatic immunotherapy (ILIT). Ultrasound guidance allowed injection of allergen directly into inguinal lymph nodes. Grass pollen-allergic patients received 3 injections with 1-month intervals. The short ILIT was more patient-friendly, required lower dosing, and was comparable with SCIT regarding short-term efficacy, which was used as a reference. Objective Nineteen years after ILIT, the same patients were followed up to assess the long-term effect on quality of life and efficacy of the treatment. Methods Patients who received ILIT and SCIT in 2002-2005 and an additional group of patients, who completed SCIT in 2015-2018, were recruited. All participants received a trial-specific in-house questionnaire and a standardized Rhinoconjunctivitis Quality of Life Questionnaire. Data were recorded off- (February 2021) and on- (May-June 2021) season. Descriptive statistics were applied. Results Of 58 and 54 patients who originally received ILIT or SCIT, 25 (43%) and 29 (54%) patients, respectively, returned the questionnaires for analysis. Four (16%) and 3 (11%) of the ILIT and SCIT patients, respectively, developed complete protection against grass pollen-mediated rhinitis, whereas another 15 (60%) and 20 (69%) expressed satisfaction with the received AIT. In both groups, any persistent symptoms were reported as mild. Medication usage in the ILIT and SCIT groups was comparable. Nineteen (76%) and 23 (79%) patients, respectively, expressed satisfaction with their AIT. Conclusions Grass pollen ILIT leads to long-term significant improvement in rhinitis-associated quality of life 19 years after treatment, and the ILIT quality-of-life effect was not inferior to that of SCIT.
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Affiliation(s)
- Yasmin K. Adlany
- Department of Dermatology, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Lara Šošić
- Department of Dermatology, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Gabriela Senti
- University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Claudia C.V. Lang
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Brunello Wüthrich
- Department of Dermatology, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Thomas M. Kündig
- Department of Dermatology, University of Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Pål Johansen
- Department of Dermatology, University of Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
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17
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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. INDIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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18
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Adaptive discrimination between harmful and harmless antigens in the immune system by predictive coding. iScience 2022; 26:105754. [PMID: 36594030 PMCID: PMC9804113 DOI: 10.1016/j.isci.2022.105754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/08/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
The immune system discriminates between harmful and harmless antigens based on past experiences; however, the underlying mechanism is largely unknown. From the viewpoint of machine learning, the learning system predicts the observation and updates the prediction based on prediction error, a process known as "predictive coding." Here, we modeled the population dynamics of T cells by adopting the concept of predictive coding; conventional and regulatory T cells predict the antigen concentration and excessive immune response, respectively. Their prediction error signals, possibly via cytokines, induce their differentiation to memory T cells. Through numerical simulations, we found that the immune system identifies antigen risks depending on the concentration and input rapidness of the antigen. Further, our model reproduced history-dependent discrimination, as in allergy onset and subsequent therapy. Taken together, this study provided a novel framework to improve our understanding of how the immune system adaptively learns the risks of diverse antigens.
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19
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Vogelberg C, Klimek L, Brüggenjürgen B, Jutel M. Real-world evidence for the long-term effect of allergen immunotherapy: Current status on database-derived European studies. Allergy 2022; 77:3584-3592. [PMID: 36074052 PMCID: PMC10087412 DOI: 10.1111/all.15506] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 01/28/2023]
Abstract
Randomized controlled trials (RCTs) are the gold-standard for benefit-risk assessments during drug approval processes. Real-word data (RWD) and the resulting real-world evidence (RWE) are becoming increasingly important for assessing the effectiveness of drug products after marketing authorization showing how RCT results are transferred into real life care. The effectiveness of allergen immunotherapy (AIT) has been assessed in several RWE studies based on large prescription databases. We performed a literature search for retrospective cohort assessments of prescription databases in Europe to provide an overview on the methodology, long-term effectiveness outcomes, and adherence to AIT. Thirteen respective publications were selected. AIT was more effective in reducing the progression of allergic rhinitis (AR) compared to a non-AIT control group receiving only symptomatic treatment for AR for up to 6 years. The development and progression of asthma were hampered for most endpoints in patients treated with most preparations compared to the non-AIT group, receiving only anti-asthmatic medication. The results for "time to onset" of asthma were inconsistent. Adherence to AIT decreased during the recommended 3-year treatment period, however, in most studies higher adherence to subcutaneous than to sublingual AIT was shown. The analysis of long-term effectiveness outcomes of the RWE studies based on prescription databases confirms the long-term efficacy of AIT demonstrated in RCTs. Progression of rhinitis and asthma symptoms as well as delayed onset of asthma triggered by different allergens, real life adherence to the treatment shows differences in particular application routes.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Bernd Brüggenjürgen
- Institute for Healthcare Research and Technical Orthopedics, Medical University, Hannover, Germany
| | - Marek Jutel
- All-MED Medical Research Institute, Wrocław, Poland.,Department of Clinical Immunology, Wroclaw Medical University, Wrocław, Poland
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20
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Vogelberg C, Klimek L, Brüggenjürgen B, Jutel M. Real-world evidence for the long-term effect of allergen immunotherapy: Current status on database-derived European studies. Allergy 2022; 77:3584-3592. [PMID: 36074052 PMCID: PMC10087412 DOI: 10.1111/all.15506 10.1111/all.15506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 07/07/2023]
Abstract
Randomized controlled trials (RCTs) are the gold-standard for benefit-risk assessments during drug approval processes. Real-word data (RWD) and the resulting real-world evidence (RWE) are becoming increasingly important for assessing the effectiveness of drug products after marketing authorization showing how RCT results are transferred into real life care. The effectiveness of allergen immunotherapy (AIT) has been assessed in several RWE studies based on large prescription databases. We performed a literature search for retrospective cohort assessments of prescription databases in Europe to provide an overview on the methodology, long-term effectiveness outcomes, and adherence to AIT. Thirteen respective publications were selected. AIT was more effective in reducing the progression of allergic rhinitis (AR) compared to a non-AIT control group receiving only symptomatic treatment for AR for up to 6 years. The development and progression of asthma were hampered for most endpoints in patients treated with most preparations compared to the non-AIT group, receiving only anti-asthmatic medication. The results for "time to onset" of asthma were inconsistent. Adherence to AIT decreased during the recommended 3-year treatment period, however, in most studies higher adherence to subcutaneous than to sublingual AIT was shown. The analysis of long-term effectiveness outcomes of the RWE studies based on prescription databases confirms the long-term efficacy of AIT demonstrated in RCTs. Progression of rhinitis and asthma symptoms as well as delayed onset of asthma triggered by different allergens, real life adherence to the treatment shows differences in particular application routes.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatric Pneumology and AllergologyUniversity Hospital Carl Gustav Carus, Technical University DresdenDresdenGermany
| | - Ludger Klimek
- Center for Rhinology and AllergologyWiesbadenGermany
| | - Bernd Brüggenjürgen
- Institute for Healthcare Research and Technical Orthopedics, Medical UniversityHannoverGermany
| | - Marek Jutel
- All‐MED Medical Research InstituteWrocławPoland
- Department of Clinical ImmunologyWroclaw Medical UniversityWrocławPoland
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21
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Valbert F, Neusser S, Pfaar O, Klimek L, Sperl A, Werfel T, Hamelmann E, Riederer C, Wobbe-Ribinski S, Hillerich V, Neumann A, Wasem J, Biermann-Stallwitz J. Care with allergen immunotherapy for allergic respiratory diseases in Germany-Predictors and deficits. Clin Exp Allergy 2022; 52:1422-1431. [PMID: 35524545 DOI: 10.1111/cea.14172] [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: 12/14/2021] [Revised: 03/27/2022] [Accepted: 04/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Allergen immunotherapy (AIT) represents the only possibility of causal therapy for allergic respiratory diseases. Although the prevailing high prevalence of allergic diseases and restrictions in the daily lives of patients, AIT is offered to a suboptimal number of patients in Germany. METHODS Insured patients with documented allergic respiratory disease of one of the largest statutory health insurances in Germany, 'DAK-Gesundheit', were contacted by postal mail and asked to participate in the study. In case of written consent, primary and secondary data of patients were collected and analysed. Patient characteristics, predictors of being offered AIT, predictors of performing AIT and guideline-compliant care were analysed. RESULTS 2505 subjects were included in the VerSITA study. Allergy to tree pollen and native speaking were identified as predictors, which increase the probability of being offered AIT. The probability was significantly decreased by the characteristics allergic rhinitis only, allergic asthma only, age in years, non-German citizenship, no graduation and lower secondary qualification. Significant positive predictors for an AIT to be actually performed were: Allergy to tree pollen and male sex. Predictors that decrease the likelihood that AIT is performed were: only allergic asthma, current smoker, former smoker, age and non-German citizenship. Furthermore, it was possible to identify characteristics in which guideline-compliant patients differed significantly from the rest of the study population. CONCLUSIONS Based on statutory health insurance data and patient survey data, the VerSITA study provides a broad and in-depth overview of the care situation with regard to AIT in Germany and identifies deficits.
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Affiliation(s)
- Frederik Valbert
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Annette Sperl
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Thomas Werfel
- Clinic for Dermatology, Allergology and Venerology, Hannover Medical School, Hanover, Germany
| | - Eckard Hamelmann
- Department for Pediatrics, Children's Center Bethel, University Bielefeld, Bielefeld, Germany
| | - Cordula Riederer
- Department of Health Services Research, DAK-Gesundheit, Hamburg, Germany
| | | | - Vivienne Hillerich
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Anja Neumann
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Jürgen Wasem
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
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22
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Gutermuth J, Grosber M, Pfaar O, Bergmann KC, Ring J. 111 years of allergen-immunotherapy: A long and successful history of the only available disease-modifier in allergic diseases. Allergol Select 2022; 6:248-258. [PMID: 36457720 PMCID: PMC9707371 DOI: 10.5414/alx02330e] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/06/2022] [Indexed: 09/19/2023] Open
Abstract
The great milestones in medicine almost always have their precursors, which help the great event to break through. So it was with allergen-specific immunotherapy (AIT) and the great work of Noon and Freeman and their world-renowned publication in 1911. In this article, we want to outline AIT's long journey, from early attempts to achieve tolerance to allergens in the environment. Many very different methods were used; from homeopathy to the use of recombinant allergens. Initially, the allergen extracts were given only subcutaneously, but then also through other routes, such as nasal, rectal, intradermal, epicutaneous, in lymph nodes, or oral. It was the great merit of Bill Franklin, whom many of us still experienced as active participants in congresses, to point out that the effect of AIT must be documented not only by clinical observation but in a controlled form including placebo injections. AIT was thus transferred to evidence-based medicine, which we successfully apply today. We would like to express our gratitude to Bill Franklin himself and all others involved in the development of AIT with this summary of 111 years of immunotherapy.
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Affiliation(s)
- Jan Gutermuth
- Department of Dermatology, University Hospital Free University Brussels, Brussels, Belgium
| | - Martine Grosber
- Department of Dermatology, University Hospital Free University Brussels, Brussels, Belgium
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg
| | - Karl Christian Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, and
| | - Johannes Ring
- Department of Dermatology and Allergology Biederstein, Technical University Munich, Munich, Germany
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23
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4/m mit chronischem Schnupfen und Husten. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Development and validation of a tool for the assessment of benefit from treatment of allergic rhinitis in children and adolescents (PBI-AR-K). Allergy Asthma Clin Immunol 2022; 18:95. [PMID: 36284348 PMCID: PMC9598024 DOI: 10.1186/s13223-022-00733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Allergic rhinitis (AR) is frequent in children and adolescents and can severely affect their lives. This article describes the development and validation of a questionnaire to assess treatment needs and benefits in children and adolescents, the PBI-AR-K, in a sample of patients receiving grass pollen sublingual immunotherapy. Patients and methods The PBI-AR-K was developed based on an open survey including children and adolescents and expert consensus between methodologists, patients, and physicians. The PBI-AR-K assesses patient needs before the treatment and perceived benefit during or at the end of a treatment. A weighted benefit score can be calculated ranging from 0 to 4 (4 = highest possible benefit). The validation was conducted in children (5–12 years) and adolescents (13–17 years) receiving sublingual immunotherapy. Subscales were developed based on factor analysis. Psychometric properties of items and scales were assessed with descriptive statistics, internal consistency, and convergent validity. Results The final PBI-AR-K consists of 19 items. For validation, data from 345 patients (mean age 11.1; 60.9% male; n = 223 children; n = 122 adolescents) was analysed. Factor analyses resulted in four subscales for children and three subscales for adolescents. The items with the highest importance ratings were about choice of leisure activities (mean value in children: 3.5) and about being free of AR symptoms (adolescents: 3.3). The weighted PBI-AR-K scores reflected considerable patient-reported benefit (2.08–2.82) in both children and adolescents. Internal consistency of all scales was good or acceptable. In the children’s sample, the global scale and three of four subscales were quite consistently correlated with convergent variables, while the subscale ‘treatment burden’ was significantly correlated only with change in average impairments due to rhinitis symptoms. The adolescents’ sample showed more inconsistent results with only change in rhinitis severity being significantly associate with all subscales. Conclusion The newly developed PBI-AR-K is a reliable and valid questionnaire for use in children; for the use in adolescents, it should be further elaborated.
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25
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Palathumpattu B, Pieper‐Fürst U, Acikel C, Sahin H, Allekotte S, Singh J, Hess M, Sager A, Müller T, Mösges R. Correlation of the combined symptom and medication score with quality of life, symptom severity and symptom control in allergic rhinoconjunctivitis. Clin Transl Allergy 2022; 12:e12191. [PMID: 36225263 PMCID: PMC9533220 DOI: 10.1002/clt2.12191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background The European Academy of Allergy and Clinical Immunology recommended the Combined Symptom and Medication Score (CSMS) as primary endpoint in clinical trials on allergen-specific immunotherapy (AIT) in allergic rhinoconjunctivitis. Here, the correlation between the CSMS and the validated standardised Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ(S)), Rhinitis Control Assessment Test (RCAT) and Visual Analogue Scale (VAS) was analysed. Methods Two prospective, multicentre, non-interventional studies on tree pollen, grass pollen and house dust mite allergic patients were performed. The first study comprised 167 patients receiving AIT (AIT population), and the second included 56 patients treated with symptomatic medication only (control population). For up to two seasons (pollen)/exposure periods (house dust mites), participants documented their symptoms and medication intake in a CSMS diary, including VAS. In addition, the standardised RQLQ(S) and the RCAT were completed during study visits. Results Comparison between CSMS and RQLQ(S) revealed a positive correlation in the AIT population (r = 0.426) and in the control population (r = 0.569). For CSMS and RCAT, a negative correlation with r = -0.409 (AIT) and r = -0.547 (control) was shown. Positive correlation between CSMS and VAS was also demonstrated with r = 0.585 (AIT) and r = 0.563 (control). Conclusion These results support the assumption that the CSMS correlates with quality of life, symptom severity and symptom control on the one hand, while the moderate strength of correlations on the other hand mirrors distinctions of the CSMS compared to the assessments used here.
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Affiliation(s)
- Binoy Palathumpattu
- Institute of Medical Statistics and Computational BiologyFaculty of MedicineUniversity of CologneCologneGermany
| | | | | | | | | | | | - Mark Hess
- ClinCompetence Cologne GmbHCologneGermany
| | | | | | - Ralph Mösges
- Institute of Medical Statistics and Computational BiologyFaculty of MedicineUniversity of CologneCologneGermany
- ClinCompetence Cologne GmbHCologneGermany
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26
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Pfaar O, Ankermann T, Augustin M, Bubel P, Böing S, Brehler R, Eng PA, Fischer PJ, Gerstlauer M, Hamelmann E, Jakob T, Kleine-Tebbe J, Kopp MV, Lau S, Mülleneisen N, Müller C, Nemat K, Pfützner W, Saloga J, Strömer K, Schmid-Grendelmeier P, Schuster A, Sturm GJ, Taube C, Szépfalusi Z, Vogelberg C, Wagenmann M, Wehrmann W, Werfel T, Wöhrl S, Worm M, Wedi B. Guideline on allergen immunotherapy in IgE-mediated allergic diseases: S2K Guideline of the German Society of Allergology and Clinical Immunology (DGAKI), Society of Pediatric Allergology and Environmental Medicine (GPA), Medical Association of German Allergologists (AeDA), Austrian Society of Allergology and Immunology (ÖGAI), Swiss Society for Allergology and Immunology (SSAI), German Dermatological Society (DDG), German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), German Society of Pediatrics and Adolescent Medicine (DGKJ), Society of Pediatric Pulmonology (GPP), German Respiratory Society (DGP), German Professional Association of Otolaryngologists (BVHNO), German Association of Paediatric and Adolescent Care Specialists (BVKJ), Federal Association of Pneumologists, Sleep and Respiratory Physicians (BdP), Professional Association of German Dermatologists (BVDD). Allergol Select 2022; 6:167-232. [PMID: 36178453 PMCID: PMC9513845 DOI: 10.5414/alx02331e] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
Not available.
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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
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg, Hamburg
| | | | - Sebastian Böing
- Specialized Practice in Pneumology, Allergology and Sleep Medicine, Düsseldorf/Meerbusch
| | - Randolf Brehler
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Peter A. Eng
- Section of Pediatric Pulmonology and Allergy Children’s Hospital, Aarau, Switzerland
| | - Peter J. Fischer
- Practice for Pediatric and Adolescent Medicine m.S. Allergology and Pediatric Pneumology, Schwäbisch Gmünd
| | - Michael Gerstlauer
- Paediatric Pulmonology and Allergology, University Medical Center Augsburg, Augsburg
| | - Eckard Hamelmann
- Department of Paediatrics, Children‘s Center Bethel, University Bielefeld, Bielefeld
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center, Justus Liebig University Gießen, Gießen
| | - Jörg Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic & Research Center, Berlin, Germany
| | - Matthias Volkmar Kopp
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Lau
- Charité Universitätsmedizin Berlin, Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin
| | | | - Christoph Müller
- Medical Center – University of Freiburg, Center for Pediatrics, Department of General Pediatrics, Adolescent Medicine and Neonatology, Freiburg
| | - Katja Nemat
- Pediatric Pneumology and Allergology (medical practice), Children’s Center Dresden-Friedrichstadt (Kid), Dresden
- University AllergyCenter Dresden, University Hospital Dresden (UKD), Dresden
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Clinic, Philipps-Universität Marburg, Marburg
| | - Joachim Saloga
- Department of Dermatology, University Medical Center, Johannes Gutenberg-University, Mainz
| | | | | | - Antje Schuster
- Department of Pediatrics, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Gunter Johannes Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen, Germany
| | - Zsolt Szépfalusi
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus Dresden, Technical, University Dresden, Dresden
| | - Martin Wagenmann
- Department of Otorhinolaryngology (HNO-Klinik), Düsseldorf University Hospital (UKD), Düsseldorf
| | | | - Thomas Werfel
- Department of Dermatology & Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Stefan Wöhrl
- Floridsdorf Allergy Center (FAZ), Vienna, Austria
| | - Margitta Worm
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology and Allergy, Berlin
| | - Bettina Wedi
- Department of Dermatology & Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
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Matysiak J, Matuszewska E, Packi K, Klupczyńska-Gabryszak A. Diagnosis of Hymenoptera Venom Allergy: State of the Art, Challenges, and Perspectives. Biomedicines 2022; 10:2170. [PMID: 36140269 PMCID: PMC9496208 DOI: 10.3390/biomedicines10092170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
Hymenoptera venom allergy is the most common cause of anaphylaxis in adults and the second-most frequent in children. The proper diagnosis of this life-threatening allergy remains a challenge. This review focuses on the current knowledge regarding diagnostics of Hymenoptera venom allergy. The paper includes a brief description of the representatives of Hymenoptera order and the composition of their venoms. Then, diagnostic tests for allergy to Hymenoptera venom are described. Common diagnostic problems, especially double positivity in tests for IgE antibodies specific to honeybee and wasp venom, are also discussed. Special attention is paid to the search for new diagnostic capabilities using modern methodologies. Multidimensional molecular analysis offers an opportunity to characterize changes in body fluids associated with Hymenoptera venom allergy and yields a unique insight into the cell status. Despite recent developments in the diagnostics of Hymenoptera venom allergy, new testing methodologies are still needed to answer questions and doubts we have.
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Affiliation(s)
- Joanna Matysiak
- Faculty of Health Sciences, Calisia University-Kalisz, 62-800 Kalisz, Poland
| | - Eliza Matuszewska
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (E.M.); (K.P.); (A.K.-G.)
| | - Kacper Packi
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (E.M.); (K.P.); (A.K.-G.)
- AllerGen, Center of Personalized Medicine, 97-300 Piotrkow Trybunalski, Poland
| | - Agnieszka Klupczyńska-Gabryszak
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (E.M.); (K.P.); (A.K.-G.)
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28
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Die allergenspezifische Immuntherapie. ALLERGO JOURNAL 2022. [DOI: 10.1007/s15007-022-5087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Diesner-Treiber S, Voitl P. Chancen und Grenzen der ambulanten Pädiatrie. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Abdullah B, Abdul Latiff AH, Manuel AM, Mohamed Jamli F, Dalip Singh HS, Ismail IH, Jahendran J, Saniasiaya J, Keen Woo KC, Khoo PC, Singh K, Mohammad N, Mohamad S, Husain S, Mösges R. Pharmacological Management of Allergic Rhinitis: A Consensus Statement from the Malaysian Society of Allergy and Immunology. J Asthma Allergy 2022; 15:983-1003. [PMID: 35942430 PMCID: PMC9356736 DOI: 10.2147/jaa.s374346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
The goal of allergic rhinitis (AR) management is to achieve satisfactory symptom control to ensure good quality of life. Most patients with AR are currently treated with pharmacotherapy. However, knowledge gaps on the use of pharmacotherapy still exist among physicians, particularly in the primary care setting, despite the availability of guideline recommendations. Furthermore, it is common for physicians in the secondary care setting to express uncertainty regarding the use of new combination therapies like intranasal corticosteroid plus antihistamine combinations. Inadequate treatment leads to significant reduction of quality of life that affects daily activities at home, work, and school. With these concerns in mind, a practical consensus statement was developed to complement existing guidelines on the rational use of pharmacotherapy in both the primary and secondary care settings.
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Affiliation(s)
- Baharudin Abdullah
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | | | | | | | | | | | | | | | | | - Kuljit Singh
- Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Nurashikin Mohammad
- Department of Internal Medicine, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Sakinah Mohamad
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Salina Husain
- Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ralph Mösges
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
- ClinCompetence Cologne GmbH, Cologne, Germany
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Kanjanawasee D, Tantilipikorn P. LNIT-Local nasal immunotherapy in allergic rhinitis: revisited evidence and perspectives. Curr Opin Allergy Clin Immunol 2022; 22:259-267. [PMID: 35779069 DOI: 10.1097/aci.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Allergen immunotherapy (AIT) is a personalized treatment approach for the allergic airway disease. The most common routes of administration are subcutaneous and sublingual. Local nasal immunotherapy (LNIT) presents another alternative route for allergen desensitization. Nasal mucosa is the first entry site of pathogens and numerous lymphoid organs are located in this area, making LNIT a favorable method for triggering immune tolerance. LNIT has shown promising results in reducing symptoms and medication use in allergic rhinitis patients. Over time, difficulties in dosing adjustments have made this method less popular. Recent advances in intranasal drug delivery systems warrant re-examination of LNIT as a viable option for the treatment of the allergic airway disease. RECENT FINDINGS The scope of the review includes evidences of LNIT in human trials including comparison with placebo and conventional method of immunotherapy. Recent articles regarding the mechanism of LNIT and the challenges of intranasal drug delivery are reviewed. Advances in the LNIT delivery system which have overcome previous limitations demonstrate promising effects. SUMMARY LNIT presents a judicious alternative for noninjection AIT. The evidences from previous clinical trials and the novel improvement of drug delivery system will lead into the future allergen vaccine production.
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Affiliation(s)
- Dichapong Kanjanawasee
- Center of Research Excellence in Allergy and Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University
- Biodesign Innovation Center, Department of Parasitology
| | - Pongsakorn Tantilipikorn
- Center of Research Excellence in Allergy and Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University
- Division of Rhinology and Allergy, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Heine S, Aguilar-Pimentel A, Russkamp D, Alessandrini F, Gailus-Durner V, Fuchs H, Ollert M, Bredehorst R, Ohnmacht C, Zissler UM, Hrabě de Angelis M, Schmidt-Weber CB, Blank S. Thermosensitive PLGA–PEG–PLGA Hydrogel as Depot Matrix for Allergen-Specific Immunotherapy. Pharmaceutics 2022; 14:pharmaceutics14081527. [PMID: 35893787 PMCID: PMC9329805 DOI: 10.3390/pharmaceutics14081527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 12/10/2022] Open
Abstract
Allergen-specific immunotherapy (AIT) is the only currently available curative treatment option for allergic diseases. AIT often includes depot-forming and immunostimulatory adjuvants, to prolong allergen presentation and to improve therapeutic efficacy. The use of aluminium salts in AIT, which are commonly used as depot-forming adjuvants, is controversially discussed, due to health concerns and Th2-promoting activity. Therefore, there is the need for novel delivery systems in AIT with similar therapeutic efficacy compared to classical AIT strategies. In this study, a triblock copolymer (hydrogel) was assessed as a delivery system for AIT in a murine model of allergic asthma. We show that the hydrogel combines the advantages of both depot function and biodegradability at the same time. We further demonstrate the suitability of hydrogel to release different bioactive compounds in vitro and in vivo. AIT delivered with hydrogel reduces key parameters of allergic inflammation, such as inflammatory cell infiltration, mucus hypersecretion, and allergen-specific IgE, in a comparable manner to standard AIT treatment. Additionally, hydrogel-based AIT is superior in inducing allergen-specific IgG antibodies with potentially protective functions. Taken together, hydrogel represents a promising delivery system for AIT that is able to combine therapeutic allergen administration with the prolonged release of immunomodulators at the same time.
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Affiliation(s)
- Sonja Heine
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Munich, Germany; (S.H.); (D.R.); (F.A.); (C.O.); (U.M.Z.); (C.B.S.-W.)
| | - Antonio Aguilar-Pimentel
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany; (A.A.-P.); (V.G.-D.); (H.F.); (M.H.d.A.)
| | - Dennis Russkamp
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Munich, Germany; (S.H.); (D.R.); (F.A.); (C.O.); (U.M.Z.); (C.B.S.-W.)
| | - Francesca Alessandrini
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Munich, Germany; (S.H.); (D.R.); (F.A.); (C.O.); (U.M.Z.); (C.B.S.-W.)
| | - Valerie Gailus-Durner
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany; (A.A.-P.); (V.G.-D.); (H.F.); (M.H.d.A.)
| | - Helmut Fuchs
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany; (A.A.-P.); (V.G.-D.); (H.F.); (M.H.d.A.)
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health (LIH), 4354 Esch-Sur-Alzette, Luxembourg;
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, 5000 Odense, Denmark
| | - Reinhard Bredehorst
- Institute of Biochemistry and Molecular Biology, University of Hamburg, 20146 Hamburg, Germany;
| | - Caspar Ohnmacht
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Munich, Germany; (S.H.); (D.R.); (F.A.); (C.O.); (U.M.Z.); (C.B.S.-W.)
| | - Ulrich M. Zissler
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Munich, Germany; (S.H.); (D.R.); (F.A.); (C.O.); (U.M.Z.); (C.B.S.-W.)
| | - Martin Hrabě de Angelis
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany; (A.A.-P.); (V.G.-D.); (H.F.); (M.H.d.A.)
- Chair of Experimental Genetics, School of Life Science Weihenstephan, Technical University of Munich, 85354 Freising, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
| | - Carsten B. Schmidt-Weber
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Munich, Germany; (S.H.); (D.R.); (F.A.); (C.O.); (U.M.Z.); (C.B.S.-W.)
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Munich, Germany; (S.H.); (D.R.); (F.A.); (C.O.); (U.M.Z.); (C.B.S.-W.)
- Correspondence: ; Tel.: +49-89-318-726-25
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Creticos PS. Subcutaneous allergen immunotherapy in the treatment of allergic respiratory disease. Allergy Asthma Proc 2022; 43:260-266. [PMID: 35818144 DOI: 10.2500/aap.2022.43.220033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Subcutaneous immunotherapy is recognized as a cornerstone in the management of allergic respiratory disease in patients who are properly characterized with allergy and with allergic rhinoconjunctivis and/or well-controlled asthma, and who are willing to adhere to the rigorous treatment program. A key tenet is that it affords the opportunity to effect long-term clinical remission through its disease-modifying properties. Furthermore, it has the potential to prevent the progression of allergic rhinitis to asthma, prevent new allergen sensitivities, and improve a patient's quality of life.
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The Role of Allergen-Specific Immunotherapy in ENT Diseases: A Systematic Review. J Pers Med 2022; 12:jpm12060946. [PMID: 35743730 PMCID: PMC9224998 DOI: 10.3390/jpm12060946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 12/16/2022] Open
Abstract
Previous studies have demonstrated that both subcutaneous (SCIT) and sublingual specific immunotherapy (SLIT) are effective in treating allergic rhinitis (AR). Further studies have evaluated the efficacy of allergen-specific immunotherapy (AIT) on different ear, nose, and throat (ENT) manifestations, in which allergy might have an etiopathogenetic role, such as local allergic rhinitis (LAR), rhinosinusitis (RS), otitis media (OM), and adenotonsillar (AT) disease. Nevertheless, the management of allergy in ENT diseases is still debated. To the best of our knowledge, this is the first systematic review assessing the efficacy of AIT in ENT diseases aside from AR. Literature data confirmed that AIT might be an effective therapeutic option in LAR, although its effect is restricted to studies with short-term follow-up. Furthermore, previous research demonstrated that AIT may improve symptoms and surgical outcomes of chronic rhinosinusitis when used as an adjunctive treatment. Few studies supported the hypothesis that AIT may exert positive therapeutic effects on recurrent upper airway infections as adenotonsillar disease. Finally, some clinical observations suggested that AIT may add some benefits in the management of otitis media with effusion (OME). The results of this systematic review allow us to conclude that the efficacy of AIT in ENT disorders has been only slightly investigated and additional studies are needed.
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Yadav S, Singh S, Mandal P, Tripathi A. Immunotherapies in the treatment of immunoglobulin E‑mediated allergy: Challenges and scope for innovation (Review). Int J Mol Med 2022; 50:95. [PMID: 35616144 DOI: 10.3892/ijmm.2022.5151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
Abstract
Immunoglobulin E (IgE)‑mediated allergy or hypersensitivity reactions are generally defined as an unwanted severe symptomatic immunological reaction that occurs due to shattered or untrained peripheral tolerance of the immune system. Allergen‑specific immunotherapy (AIT) is the only therapeutic strategy that can provide a longer‑lasting symptomatic and clinical break from medications in IgE‑mediated allergy. Immunotherapies against allergic diseases comprise a successive increasing dose of allergen, which helps in developing the immune tolerance against the allergen. AITs exerttheirspecial effectiveness directly or indirectly by modulating the regulator and effector components of the immune system. The number of success stories of AIT is still limited and it canoccasionallyhave a severe treatment‑associated adverse effect on patients. Therefore, the formulation used for AIT should be appropriate and effective. The present review describes the chronological evolution of AIT, and provides a comparative account of the merits and demerits of different AITs by keeping in focus the critical guiding factors, such as sustained allergen tolerance, duration of AIT, probability of mild to severe allergic reactions and dose of allergen required to effectuate an effective AIT. The mechanisms by which regulatory T cells suppress allergen‑specific effector T cells and how loss of natural tolerance against innocuous proteins induces allergy are reviewed. The present review highlights the major AIT bottlenecks and the importantregulatory requirements for standardized AIT formulations. Furthermore, the present reviewcalls attention to the problem of 'polyallergy', which is still a major challenge for AIT and the emerging concept of 'component‑resolved diagnosis' (CRD) to address the issue. Finally, a prospective strategy for upgrading CRD to the next dimension is provided, and a potential technology for delivering thoroughly standardized AIT with minimal risk is discussed.
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Affiliation(s)
- Sarika Yadav
- Systems Toxicology and Health Risk Assessment Group, CSIR‑Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
| | - Saurabh Singh
- Systems Toxicology and Health Risk Assessment Group, CSIR‑Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
| | - Payal Mandal
- Food, Drugs and Chemical Toxicology Group, CSIR‑Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
| | - Anurag Tripathi
- Systems Toxicology and Health Risk Assessment Group, CSIR‑Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
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36
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Rhinitis allergica bei Vorratsmilbenallergie. ALLERGO JOURNAL 2022. [DOI: 10.1007/s15007-022-4986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pfaar O, Hamelmann E, Klimek L, Taube C, Vogelberg C, Wagenmann M, Werfel T, Worm M. Allergen immunotherapy during the COVID-19 pandemic-A survey of the German Society for Allergy and Clinical Immunology. Clin Transl Allergy 2022; 12:e12134. [PMID: 35344300 PMCID: PMC8967257 DOI: 10.1002/clt2.12134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background When the coronavirus pandemic 2019 (COVID‐19) emerged, concerns were also raised regarding the safety of allergen immunotherapy (AIT). The German Society for Allergology and Clinical Immunology (DGAKI) conducted a survey to collect real‐world data on the daily routine of administering subcutaneous AIT (SCIT) and sublingual AIT (SLIT) during the COVID‐19 pandemic. Methods A web‐based retrospective survey using the online platform survio with 26 standardized questions was used to survey physicians treating allergic patients during the pandemic. Results Three hundred and forty‐five physicians who regularly offer and perform AIT in German‐speaking countries responded to the questions. 70.4% of the respondents stated that they regularly initiated and dosed up SCIT for inhalant allergies (41.4% venom‐SCIT, 73.6% SLIT), and 85.2% of the respondents stated that they continued SCIT for inhalant allergies during the maintenance phase in a regular way (59.1% venom‐SCIT, 90.4% SLIT) in healthy patients without current symptoms indicating an infection with COVID‐19. With regard to tolerability, there was no evidence for increased occurrence of adverse events in patients without current symptoms of COVID‐19 infection during the pandemic. Conclusions This retrospective study demonstrated adherence to national and international position papers of AIT during the COVID‐19 pandemic in German‐speaking countries. Besides, the survey has confirmed a good tolerability of AIT for both SCIT and SLIT.
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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
| | - Eckard Hamelmann
- Department of Paediatrics, Children's Center Bethel, University Bielefeld, Bielefeld, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Christian Vogelberg
- Department of Pediatric Pulmonology and Allergy, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Martin Wagenmann
- Department of Otorhinolaryngology (HNO-Klinik), Düsseldorf University Hospital (UKD), Düsseldorf, Germany
| | - Thomas Werfel
- Department of Dermatoloy and Allergy, Medizinische Hochschule Hannover, Hannover, Germany
| | - Margitta Worm
- Division of Allergology and Immunology, Department Dermatology, Venerology and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Bircher AJ, Spoerl D, Scherer Hofmeier K. Wespe statt Biene – Akzidentelle Neusensibilisierung auf Wespengift unter Immuntherapie mit Bienengift. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1660-4731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungWährend einer laufenden Immuntherapie mit Bienengift bei einer auf Bienengift monosensibilisierten Patientin wurde im 3. Jahr irrtümlicherweise eine Erhaltungsdosis Wespengift verabreicht. Es traten keine unmittelbaren Nebenwirkungen auf, hingegen konnte nach einigen Wochen ein Anstieg der initial negativen wespengiftspezifischen IgE- und IgG-Antikörper dokumentiert werden. Es muss somit von einer aktiven Sensibilisierung durch die hohe Einmaldosis Wespengift ausgegangen werden. Die Immuntherapie mit Bienengift konnte nach der empfohlenen Dauer von 5 Jahren vollendet werden. Eine akzidentelle nachweislich aktive Sensibilisierung auf ein Allergen ist sehr selten, dürfte aber einen Verstoß gegen die Pflichten aus dem Behandlungsvertrag darstellen und möglicherweise sogar den Tatbestand der Körperverletzung erfüllen. Die permanente Schädigung kann rechtlich schwerer wiegen als ein einmaliger Dosierungsfehler. Die strikte Anwendung von Leitlinienempfehlungen ist zur Vermeidung von systematischen und menschlichen Fehlern unabdingbar.
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Affiliation(s)
- Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
| | - David Spoerl
- Service d'immunologie et d'allergologie, Département de médecine, Hôpitaux Universitaires de Genève, Genève, Schweiz
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39
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Immunotherapy Update: What Delivery Techniques Are Available? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Heldner A, Alessandrini F, Russkamp D, Heine S, Schnautz B, Chaker A, Mwange J, Carreno Velazquez TL, Heath MD, Skinner MA, Kramer MF, Zissler UM, Schmidt‐Weber CB, Blank S. Immunological effects of adjuvanted low-dose allergoid allergen-specific immunotherapy in experimental murine house dust mite allergy. Allergy 2022; 77:907-919. [PMID: 34287971 DOI: 10.1111/all.15012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/28/2021] [Accepted: 06/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Native allergen extracts or chemically modified allergoids are routinely used to induce allergen tolerance in allergen-specific immunotherapy (AIT), although mechanistic side-by-side studies are rare. It is paramount to balance optimal dose and allergenicity to achieve efficacy warranting safety. AIT safety and efficacy could be addressed by allergen dose reduction and/or use of allergoids and immunostimulatory adjuvants, respectively. In this study, immunological effects of experimental house dust mite (HDM) AIT were investigated applying high-dose HDM extract and low-dose HDM allergoids with and without the adjuvants microcrystalline tyrosine (MCT) and monophosphoryl lipid A (MPL) in a murine model of HDM allergy. METHODS Cellular, humoral, and clinical effects of the different AIT strategies were assessed applying a new experimental AIT model of murine allergic asthma based on physiological, adjuvant-free intranasal sensitization followed by subcutaneous AIT. RESULTS While low-dose allergoid and high-dose extract AIT demonstrated comparable potency to suppress allergic airway inflammation and Th2-type cytokine secretion of lung-resident lymphocytes and draining lymph node cells, low-dose allergoid AIT was less effective in inducing a potentially protective IgG1 response. Combining low-dose allergoid AIT with MCT or MCT and dose-adjusted MPL promoted Th1-inducing mechanisms and robust B-cell activation counterbalancing the allergic Th2 immune response. CONCLUSION Low allergen doses induce cellular and humoral mechanisms counteracting Th2-driven inflammation by using allergoids and dose-adjusted adjuvants. In light of safety and efficacy improvement, future therapeutic approaches may use low-dose allergoid strategies to drive cellular tolerance and adjuvants to modulate humoral responses.
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Affiliation(s)
- Alexander Heldner
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Francesca Alessandrini
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Dennis Russkamp
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Sonja Heine
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Benjamin Schnautz
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Adam Chaker
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
- Department of Otolaryngology, Klinikum rechts der Isar Faculty of Medicine Technical University of Munich Munich Germany
| | | | | | | | | | - Matthias F. Kramer
- Allergy Therapeutic PLC. Worthing UK
- Bencard Allergie GmbH Munich Germany
| | - Ulrich M. Zissler
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Carsten B. Schmidt‐Weber
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Simon Blank
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
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Englhard AS, Holzer M, Eder K, Gellrich D, Gröger M. How reliable is anamnestic data in predicting the clinical relevance of house dust mite sensitization? Eur Arch Otorhinolaryngol 2022; 279:801-810. [PMID: 34019148 PMCID: PMC8794942 DOI: 10.1007/s00405-021-06862-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/30/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE For perennial inhalant allergens such as house dust mite (HDM), the German guideline on allergen-specific immunotherapy explicitly recommends provocation testing. This procedure is time-consuming, expensive, and potentially dangerous for the patient. Recently it has been discussed whether provocation tests are really necessary for diagnosing allergy to Dermatophagoides species. Thus, our study aimed to analyze the concordance between nasal provocation tests with Dermatophagoides species and anamnestic data. METHODS We retrospectively analyzed the concordance between patients' histories including self-reported symptom scores and the results of provocation testing in 471 individuals with proven sensitization to Dermatophagoides species. RESULTS 248 patients had a positive nasal provocation test (NPT) result to Dermatophagoides species and 223 individuals a negative NPT result. Patients allergic to HSM suffered significantly more often from atopic dermatitis (14% vs. 7%, p = 0.046) and more from asthma (20% vs. 19%, p = 0.851). Moreover, individuals with clinically silent sensitization complained less about nasal secretion (37% vs. 45%, p = 0.244) but significantly more about nasal dryness (46% vs. 34%, p = 0.046) whereas rates of nasal airway obstruction, ocular complaints and sleep quality were comparable in both groups. Allergic patients reported more often perennial (34% vs. 30%, p = 0.374) and location-dependent (39% vs. 31%, p = 0.090) symptoms. However, the discrepant prevalence of atopic dermatitis was the only statistically significant difference between both groups. CONCLUSION Despite slight differences between both patient groups, clinical data are not sufficient to distinguish between silent sensitization and clinically relevant allergic rhinitis to HDM. Therefore, nasal provocation testing remains the gold standard for assessing clinical relevance in patients sensitized to Dermatophagoides species.
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Affiliation(s)
- Anna S Englhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany.
| | - Martin Holzer
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Katharina Eder
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Donata Gellrich
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Moritz Gröger
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
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Khachouk R, Pieper-Fürst U, Acikel C, Kolot C, Bilstein A, Mösges R. Effectiveness of Ectoin lozenges on oropharyngeal allergic symptoms. Clin Transl Allergy 2022; 12:e12095. [PMID: 35028129 PMCID: PMC8738077 DOI: 10.1002/clt2.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rawan Khachouk
- Institute of Medical Statistics and Computational Biology Faculty of Medicine University of Cologne Cologne Germany
| | | | | | | | | | - Ralph Mösges
- Institute of Medical Statistics and Computational Biology Faculty of Medicine University of Cologne Cologne Germany.,ClinCompetence Cologne GmbH Cologne Germany
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Allergen Immunotherapy: Current and Future Trends. Cells 2022; 11:cells11020212. [PMID: 35053328 PMCID: PMC8774202 DOI: 10.3390/cells11020212] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 02/06/2023] Open
Abstract
Allergen immunotherapy (AIT) is the sole disease-modifying treatment for allergic rhinitis; it prevents rhinitis from progressing to asthma and lowers medication use. AIT against mites, insect venom, and certain kinds of pollen is effective. The mechanism of action of AIT is based on inducing immunological tolerance characterized by increased IL-10, TGF-β, and IgG4 levels and Treg cell counts. However, AIT requires prolonged schemes of administration and is sometimes associated with adverse reactions. Over the last decade, novel forms of AIT have been developed, focused on better allergen identification, structural modifications to preserve epitopes for B or T cells, post-traductional alteration through chemical processes, and the addition of adjuvants. These modified allergens induce clinical-immunological effects similar to those mentioned above, increasing the tolerance to other related allergens but with fewer side effects. Clinical studies have shown that molecular AIT is efficient in treating grass and birch allergies. This article reviews the possibility of a new AIT to improve the treatment of allergic illness.
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[43/f-Allergic complaints outside the season : Preparation for the medical specialist examination: part 135]. Internist (Berl) 2022; 63:201-206. [PMID: 34982168 DOI: 10.1007/s00108-021-01226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
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Barker CIS, Groeneweg G, Maitland-van der Zee AH, Rieder MJ, Hawcutt DB, Hubbard TJ, Swen JJ, Carleton BC. Pharmacogenomic testing in paediatrics: clinical implementation strategies. Br J Clin Pharmacol 2021; 88:4297-4310. [PMID: 34907575 PMCID: PMC9544158 DOI: 10.1111/bcp.15181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022] Open
Abstract
Pharmacogenomics (PGx) relates to the study of genetic factors determining variability in drug response. Implementing PGx testing in paediatric patients can enhance drug safety, helping to improve drug efficacy or reduce the risk of toxicity. Despite its clinical relevance, the implementation of PGx testing in paediatric practice to date has been variable and limited. As with most paediatric pharmacological studies, there are well‐recognised barriers to obtaining high‐quality PGx evidence, particularly when patient numbers may be small, and off‐label or unlicensed prescribing remains widespread. Furthermore, trials enrolling small numbers of children can rarely, in isolation, provide sufficient PGx evidence to change clinical practice, so extrapolation from larger PGx studies in adult patients, where scientifically sound, is essential. This review paper discusses the relevance of PGx to paediatrics and considers implementation strategies from a child health perspective. Examples are provided from Canada, the Netherlands and the UK, with consideration of the different healthcare systems and their distinct approaches to implementation, followed by future recommendations based on these cumulative experiences. Improving the evidence base demonstrating the clinical utility and cost‐effectiveness of paediatric PGx testing will be critical to drive implementation forwards. International, interdisciplinary collaborations will enhance paediatric data collation, interpretation and evidence curation, while also supporting dedicated paediatric PGx educational initiatives. PGx consortia and paediatric clinical research networks will continue to play a central role in the streamlined development of effective PGx implementation strategies to help optimise paediatric pharmacotherapy.
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Affiliation(s)
- Charlotte I S Barker
- Department of Medical & Molecular Genetics, King's College London, London, UK.,Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gabriella Groeneweg
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Anke H Maitland-van der Zee
- Respiratory Medicine/Pediatric Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael J Rieder
- Departments of Paediatrics, Physiology and Pharmacology and Medicine, Western University, London, Ontario, Canada.,Molecular Medicine Group, Robarts Research Institute, London, Ontario, Canada
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,NIHR Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK
| | - Tim J Hubbard
- Department of Medical & Molecular Genetics, King's College London, London, UK.,Genomics England, London, UK
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Network for Personalized Therapeutics, Leiden, The Netherlands
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Bergmann KC, Berger M, Klimek L, Pfaar O, Werchan B, Werchan M, Zuberbier T. Nonpharmacological measures to prevent allergic symptoms in pollen allergy: A critical review. Allergol Select 2021; 5:349-360. [PMID: 34870079 PMCID: PMC8638355 DOI: 10.5414/alx02294e] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
Allergic rhinoconjunctivitis (hay fever) is the most common chronic disease in all industrialized nations. Therapy consists essentially in the use of anti-allergic and anti-inflammatory drugs, which mostly show a good and quick effect. With allergen-specific immunotherapy, there is also a causal possibility of tolerance induction. There is currently a considerable undersupply, as those affected trivialize the symptoms and often have concerns about long-term drug therapy. There is also great interest in using non-medicinal measures to prevent and/or relieve allergic symptoms on the assumption that these are free from side effects. In this publication, we present non-drug methods for which clinical studies are available in the literature. The methods have varying degrees of effectiveness. An evidence-based comparative assessment between the methods is not possible. There are also hardly any studies in comparison to standard drug therapy. A large number of the interventions consist of allergen reduction, e.g., with air filters, or cleaning of the mucous membranes with nasal irrigation, etc., none of which should be seen as a substitute but as a supplement to drug therapy.
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Affiliation(s)
- Karl-Christian Bergmann
- Charité, Universitätsmedizin Berlin, Clinic for Dermatology, Venereology and Allergy, Berlin, Germany
| | - Markus Berger
- Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Vienna, Austria
| | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg
| | - Barbora Werchan
- German Pollen Information Service Foundation (PID), Berlin, Germany
| | - Matthias Werchan
- German Pollen Information Service Foundation (PID), Berlin, Germany
| | - Torsten Zuberbier
- Charité, Universitätsmedizin Berlin, Clinic for Dermatology, Venereology and Allergy, Berlin, Germany
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New insights in mite immunotherapy - sublingual tablets. Curr Opin Allergy Clin Immunol 2021; 21:602-610. [PMID: 34494616 DOI: 10.1097/aci.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sublingual tablet immunotherapy has been demonstrated to be effective for allergies induced by exposure to grass, ragweed, specific trees (Japanese Cedar; birch homologous tree mix), and house dust mites (HDM). This review provides both an overview of the evidence-based clinical studies that address the use of the HDM SLIT-tablet for the treatment of HDM-induced allergic rhinitis/conjunctivitis and its appropriate use in carefully selected asthmatic patients and provides the clinician with practical management considerations. RECENT FINDINGS Solid evidence-based clinical studies have shown that the HDM SLIT-tablet is both well tolerated in patients with mild-to-moderate asthma and has demonstrated a meaningful improvement in exacerbations, need for rescue medication, quality of life, and asthma control. SUMMARY The HDM SLIT-tablet provides the allergy specialist with a well-tolerated treatment that has established superior safety to subcutaneous injection therapy, which can be administered easily as a sublingual dissolvable tablet, and which provides the opportunity to address one of the more difficult aspects in the management of an inducer of perennial allergic disease - that of persistent airway inflammation and allergic asthma.
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Pfaar O, Agache I, Bonini M, Brough HA, Chivato T, Del Giacco SR, Gawlik R, Gelincik A, Hoffmann‐Sommergruber K, Jutel M, Klimek L, Knol EF, Lauerma A, Ollert M, O’Mahony L, Mortz CG, Palomares O, Riggioni C, Schwarze J, Skypala I, Torres MJ, Untersmayr E, Walusiak‐Skorupa J, Chaker A, Giovannini M, Heffler E, Jensen‐Jarolim E, Quecchia C, Sandoval‐Ruballos M, Sahiner U, Tomić Spirić V, Alvaro‐Lozano M. COVID-19 pandemic and allergen immunotherapy-an EAACI survey. Allergy 2021; 76:3504-3516. [PMID: 33655519 PMCID: PMC8013670 DOI: 10.1111/all.14793] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND As in many fields of medical care, the coronavirus disease 2019 (COVID-19) resulted in an increased uncertainty regarding the safety of allergen immunotherapy (AIT). Therefore, the European Academy of Allergy and Clinical Immunology (EAACI) aimed to analyze the situation in different countries and to systematically collect all information available regarding tolerability and possible amendments in daily practice of sublingual AIT (SLIT), subcutaneous AIT (SCIT) for inhalant allergies and venom AIT. METHODS Under the framework of the EAACI, a panel of experts in the field of AIT coordinated by the Immunotherapy Interest Group set-up a web-based retrospective survey (SurveyMonkey® ) including 27 standardized questions on practical and safety aspects on AIT in worldwide clinical routine. RESULTS 417 respondents providing AIT to their patients in daily routine answered the survey. For patients (without any current symptoms to suspect COVID-19), 60% of the respondents informed of not having initiated SCIT (40% venom AIT, 35% SLIT) whereas for the maintenance phase of AIT, SCIT was performed by 75% of the respondents (74% venom AIT, 89% SLIT). No tolerability concern arises from this preliminary analysis. 16 physicians reported having performed AIT despite (early) symptoms of COVID-19 and/or a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CONCLUSIONS This first international retrospective survey in atopic diseases investigated practical aspects and tolerability of AIT during the COVID-19 pandemic and gave no concerns regarding reduced tolerability under real-life circumstances. However, the data indicate an undertreatment of AIT, which may be temporary, but could have a long-lasting negative impact on the clinical care of allergic patients.
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Lamberti C, Nebbia S, Cirrincione S, Brussino L, Giorgis V, Romito A, Marchese C, Manfredi M, Marengo E, Giuffrida MG, Rolla G, Cavallarin L. Thermal processing of insect allergens and IgE cross-recognition in Italian patients allergic to shrimp, house dust mite and mealworm. Food Res Int 2021; 148:110567. [PMID: 34507722 DOI: 10.1016/j.foodres.2021.110567] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 06/16/2021] [Accepted: 06/28/2021] [Indexed: 12/26/2022]
Abstract
Edible insects are considered as a promising and sustainable alternative protein source for humans, although risk assessments, with particular reference to the allergic potential of insect proteins, are required. Considering that insects are likely to be consumed after processing, it is crucial to assess how processing can influence allergenicity. In our study, we investigated how boiling and frying affect the IgE cross-recognition of proteins from five edible insects (mealworm, buffalo worm, silkworm, cricket and grasshopper). We considered three groups of Italian patients allergic to shrimps and to house dust mites, who had never consumed insects before and two subjects with occupational allergy and food sensitization to mealworm. Our data suggest that thermal processing may change the solubility of proteins, thereby resulting in a protein shift from water-soluble fractions to water-insoluble fractions. Immunoblot and LC-MS/MS analyses have shown that tropomyosin may play an important role as a cross-allergen for house dust mite and shrimp allergic patients, while larval cuticle protein seems to play a major role in the cross-reactivity of patients primarily sensitized to mealworm. On the basis of our results, the effects of processing appear to be protein-, species- and treatment-specific. Therefore, house dust mite, shrimp and mealworm allergic patients should consume insects with caution, even after thermal processing.
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Affiliation(s)
- Cristina Lamberti
- Institute of Sciences of Food Production-CNR, Grugliasco, (TO), Italy.
| | - Stefano Nebbia
- Institute of Sciences of Food Production-CNR, Grugliasco, (TO), Italy.
| | | | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology, The University of Turin & AO Mauriziano "Umberto I", Turin, Italy.
| | - Veronica Giorgis
- Department of Medical Sciences, Allergy and Clinical Immunology, The University of Turin & AO Mauriziano "Umberto I", Turin, Italy
| | | | | | - Marcello Manfredi
- Center for Translational Research on Autoimmune and Allergic Disease - CAAD, The University of Piemonte Orientale, Novara, Italy.
| | - Emilio Marengo
- Center for Translational Research on Autoimmune and Allergic Disease - CAAD, The University of Piemonte Orientale, Novara, Italy.
| | | | - Giovanni Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology, The University of Turin & AO Mauriziano "Umberto I", Turin, Italy.
| | - Laura Cavallarin
- Institute of Sciences of Food Production-CNR, Grugliasco, (TO), Italy.
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Allergisches Asthma bronchiale. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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