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Chen D, Fu Q, Lin J, Hu C, Huang N, Chang KX, Sun B, Liu Z. Gene synthesizing, expression and immunogenicity characterization of recombinant translation elongation factor 2 from Dermatophagoides farinae. Mol Med Rep 2019; 20:5324-5334. [PMID: 31702815 PMCID: PMC6854542 DOI: 10.3892/mmr.2019.10786] [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: 01/07/2018] [Accepted: 09/04/2019] [Indexed: 11/06/2022] Open
Abstract
House dust mite (HDM) hypersensitivity increasingly affects millions of individuals worldwide. Although numerous major allergens produced by HDM species have been characterized, some of the less potent allergens remain to be studied. The present study aimed to obtain the recombinant allergen of Translation Elongation Factor 2 (TEF 2) from the HDM Dermatophagoides farinae by synthesizing, and then expressing the recombinant TEF 2 to identify its immunogenicity. In the present study, the D. farinae TEF 2 (Der f TEF 2) was synthesized, expressed and purified. The molecular characteristics of Der f TEF 2 were analyzed using bioinformatics approaches. The recombinant protein was purified via affinity chromatography, and the allergenicity was assessed using immunoblotting, ELISAs and skin prick tests. The gene for TEF 2 consists of 2,535 bp and encodes an 844‑amino acid protein. A positive response to recombinant Der f TEF 2 was detected in 16.2% of 37 patients with HDM allergies using skin prick tests. In addition, the immunoblotting indicated that the protein showed a high ability to bind serum IgE from patients allergic to HDMs, and that the recombinant TEF 2 was highly immunogenic. Bioinformatics analysis predicted 17 peptides as B cell epitopes (amino acids 29‑35, 55‑64, 92‑99, 173‑200, 259‑272, 311‑318, 360‑365, 388‑395, 422‑428, 496‑502, 512‑518, 567‑572, 580‑586, 602‑617, 785‑790, 811‑817 and 827‑836) and 14 peptides as T cell epitopes (amino acids 1‑15, 65‑79, 120‑134, 144‑159, 236‑250, 275‑289, 404‑418, 426‑440, 463‑477, 510‑524, 644‑658, 684‑698, 716‑730 and 816‑830). The software DNAStar predicted the secondary structure of TEF 2, and showed that 27 α‑helices and five β‑sheets were found in the protein. In conclusion, the present study cloned and expressed the Der f TEF 2 gene, and the recombinant protein exhibited immunogenicity, providing a theoretical bases, and references, for the diagnosis and treatment of allergic disease.
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Affiliation(s)
- Desheng Chen
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen Key Laboratory of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
| | - Qinghui Fu
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen Key Laboratory of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
| | - Jianli Lin
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen Key Laboratory of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
| | - Chengshen Hu
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen Key Laboratory of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
| | - Nana Huang
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen Key Laboratory of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
| | - Ke Xin Chang
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen Key Laboratory of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
| | - Baoqing Sun
- Department of Allergy, Affiliated Luohu Hospital of Shenzhen University, Shenzhen Luohu Hospital Group, Shenzhen, Guangdong 518000, P.R. China
| | - Zhigang Liu
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen Key Laboratory of Allergy and Immunology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
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Smits W, Inglefield JT, Letz K, Lee R, Craig TJ. Improved Immunotherapy with a Rapid Allergen Vaccination Schedule: A Study of 137 Patients. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130308201116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Kevin Letz
- From the Allergy and Asthma Center, Fort Wayne, Ind
| | - Robert Lee
- Indiana University School of Medicine, Indianapolis
| | - Timothy J. Craig
- Department of Pulmonary Allergy and Critical Care Medicine, Pennsylvania State University College of Medicine, Hershey
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Datta A, Moitra S, Hazra I, Mondal S, Das PK, Singh MK, Chaudhuri S, Bhattacharya D, Tripathi SK, Chaudhuri S. Specific allergen immunotherapy attenuates allergic airway inflammation in a rat model of Alstonia scholaris pollen induced airway allergy. Int Immunopharmacol 2015; 30:111-120. [PMID: 26667977 DOI: 10.1016/j.intimp.2015.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/25/2022]
Abstract
Pollen grains are well established to be an important cause of respiratory allergy. Current pharmacologic therapies for allergic asthma do not cure the disease. Allergen specific immunotherapy is the only treatment method which re-directs the immune system away from allergic response leading to a long lasting effect. The mechanism by which immunotherapy achieves this goal is an area of active research world-wide. The present experimental study was designed to develop an experimental model of allergic lung inflammation based on a relevant human allergen, Alstonia scholaris pollen, and to establish the immunological and cellular features of specific allergen immunotherapy using this same pollen extract. Our results revealed that Alstonia scholaris pollen sensitization and challenge causes eosinophilic airway inflammation with mucin hypersecretion. This is associated with increased total IgE, increased expression of FcɛRI on lung mast cells and increased levels of IL-4, IL-5 & IL-13 as confirmed by ELISA, in-situ immunofluorescence and FACS assay. Allergen specific immunotherapy reduced airway inflammation and also decreased total IgE level, FcɛRI expression, IL-4, IL-5 & IL-13 levels. It was further noted that the reduction of these levels was more by intra-nasal route than by intra-peritoneal route. Thus we present a novel animal model of Alstonia scholaris pollen allergic disease and specific allergen immunotherapy which will pave the way towards the development of better treatment modalities.
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Affiliation(s)
- Ankur Datta
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India; Department of Clinical & Experimental Pharmacology, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Saibal Moitra
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Iman Hazra
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Somnath Mondal
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India; Department of Clinical & Experimental Pharmacology, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Prasanta Kumar Das
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Manoj Kumar Singh
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Suhnrita Chaudhuri
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Debanjan Bhattacharya
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Santanu Kumar Tripathi
- Department of Clinical & Experimental Pharmacology, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India
| | - Swapna Chaudhuri
- Department of Laboratory Medicine, School of Tropical Medicine, 108 C. R. Avenue, Kolkata 700073, West Bengal, India.
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Aryan Z, Compalati E, Comapalati E, Canonica GW, Rezaei N. Allergen-specific immunotherapy in asthmatic children: from the basis to clinical applications. Expert Rev Vaccines 2013; 12:639-59. [PMID: 23750794 DOI: 10.1586/erv.13.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Atopic asthma in childhood with the tendency to persist into adult life is an important issue in pediatrics. Allergen-specific immunotherapy (SIT) is the only curative treatment option for these children, being directed to the causes of the disease. The Th2 phenotype is a predominant immunological pattern in atopic asthma and SIT leads to apoptosis/anergy of T cells and induces immune-regulatory responses and immune deviation towards Th1. Many factors can affect the safety and efficacy of SIT, such as pattern of sensitization, allergy vaccine (allergen extracts, adjuvants and conjugated molecules), route of administration (subcutaneous or sublingual) and different treatment schedules. Overall, asthma symptoms and medication scores usually decrease following a SIT course and the most common observed side effects are restricted to local swelling, erythema and pruritus. Compared with conventional pharmacotherapy, SIT may be more cost effective, providing a benefit after discontinuation and a steroid-sparing effect. In addition, it can prevent new sensitizations in monosensitized asthmatic children. Microbial supplements such as probiotics, immunomodulatory substances like anti-IgE/leukotrienes, antibodies and newer allergen preparations such as recombinant forms have been tested to improve the efficacy and safety of SIT with inconclusive results. In conclusion, SIT provides an appropriate solution for childhood asthma that should be employed more often in clinical practice. Further studies are awaited to improve current knowledge regarding the mechanisms behind SIT and determine the most appropriate materials and schedule of immunotherapy for children with asthma.
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Affiliation(s)
- Zahra Aryan
- Molecular Immunology Research Center, Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Spertini F, Reymond C, Leimgruber A. Allergen-specific immunotherapy of allergy and asthma: current and future trends. Expert Rev Respir Med 2012; 3:37-51. [PMID: 20477281 DOI: 10.1586/17476348.3.1.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Allergen-specific immunotherapy is the only immunomodulatory and etiological therapy of allergy and asthma. Conventional specific immunotherapy (SIT) with whole-allergen extract is antigen specific, effective on multiple organs, efficient on asthma in defined conditions, provides long-lasting protection and is cost effective. Moreover, SIT is able to prevent the course of rhinitis to asthma. SIT has its drawbacks: the long duration of treatment, the unsatisfactory standardization of allergen extracts and a questionable safety level. Novel approaches are aimed at drastically reducing adverse anaphylactic events, shortening the duration of therapy and improving its efficacy. Novel promising approaches have based their formulation on a limited set of recombinant allergens or chimeric molecules as well as on hypoallergenic allergen fragments or peptides. The simultaneous use of adjuvants with immunomodulatory properties may contribute to improve both the safety and efficacy of allergen-SIT of allergy and asthma.
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Affiliation(s)
- François Spertini
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Taher YA, Henricks PA, van Oosterhout AJ. Allergen-specific subcutaneous immunotherapy in allergic asthma: immunologic mechanisms and improvement. Libyan J Med 2010; 5:10.3402/ljm.v5i0.5303. [PMID: 21483568 PMCID: PMC3071166 DOI: 10.3402/ljm.v5i0.5303] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 05/21/2010] [Indexed: 12/22/2022] Open
Abstract
Allergic asthma is a disease characterized by persistent allergen-driven airway inflammation, remodeling, and airway hyperresponsiveness. CD4(+) T-cells, especially T-helper type 2 cells, play a critical role in orchestrating the disease process through the release of the cytokines IL-4, IL-5, and IL-13. Allergen-specific immunotherapy (SIT) is currently the only treatment with a long-term effect via modifying the natural course of allergy by interfering with the underlying immunological mechanisms. However, although SIT is effective in allergic rhinitis and insect venom allergy, in allergic asthma it seldom results in complete alleviation of the symptoms. Improvement of SIT is needed to enhance its efficacy in asthmatic patients. Herein, the immunoregulatory mechanisms underlying the beneficial effects of SIT are discussed with the ultimate aim to improve its treatment efficacy.
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Affiliation(s)
- Yousef A. Taher
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Al-Fateh Medical University, Tripoli, Libya
| | - Paul A.J. Henricks
- Department of Pharmacology and Pathophysiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Antoon J.M. van Oosterhout
- Laboratory of Allergology and Pulmonary Diseases, University Medical Center Groningen, Groningen University, Groningen, The Netherlands
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Abstract
That regulatory T cells (Tregs) have a crucial role in controlling allergic diseases such as asthma is now undisputed. The cytokines most commonly implicated in Treg-mediated suppression of allergic asthma are transforming growth factor-beta (TGF-beta) and interleukin (IL)-10). In addition to naturally occurring Tregs, adaptive Tregs, induced in response to foreign antigens, have been shown in recent studies. The concept of inducible/adaptive Tregs (iTregs) has considerable significance in preventing asthma if generated early enough in life. This is because cytokines such as IL-4 and IL-6 inhibit Foxp3 induction in naive CD4+ T cells and therefore de novo generation of Tregs can be expected to be less efficient when it is concomitant with effector cell development in response to an allergen. However, if iTregs can be induced, the process of infectious tolerance would facilitate expansion of the iTreg pool as suggested in the recent literature. It is tempting to speculate that there is a window of opportunity in early life in the context of a relatively immature immune system that is permissive for the generation of iTregs specific to a spectrum of allergens that would regulate asthma for lifelong. The focus of this review is the relevance of nTregs and iTregs in controlling asthma from early life into adulthood, the mechanisms underlying Treg function, and the prospects for using our current concepts to harness the full potential of Tregs to limit disease development and progression.
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Tsai TC, Lu JH, Chen SJ, Tang RB. Clinical efficacy of house dust mite-specific immunotherapy in asthmatic children. Pediatr Neonatol 2010; 51:14-8. [PMID: 20225533 DOI: 10.1016/s1875-9572(10)60004-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Immunotherapy has been widely used in the treatment of allergic diseases. We evaluated the clinical efficacy of specific immunotherapy with extracts of Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) in children with asthma. METHODS All 40 children had moderate-to-severe asthma and positive allergen tests for Dp and Df. All required daily medication. They were randomly assigned to two groups: Half of them received immunotherapy with subcutaneous injections of Dp and Df extracts, while the other half were not given immunotherapy. Participants were followed up for more than 6 months. RESULTS Children in both groups had apparent improvements in medication use and symptoms after 6 months. The mean medication scores declined from 3.6 +/- 1.14 to 1.7 +/- 0.66 in the immunotherapy group (p < 0.01) and from 3.35 +/- 0.87 to 2.4 +/- 1.09 in the control group (p < 0.01). There was a significant difference between the two groups (mean difference 0.95; p < 0.01). The symptom score improved in the immunotherapy group from 2.65 +/- 0.98 to 1.20 +/- 1.00 (p < 0.01) and in the control group from 2.55 +/- 0.99 to 1.40 +/- 0.88 (p < 0.01), with a significant difference between the two groups (mean difference 0.3; p < 0.01). The number of office visits in the immunotherapy group was greater than that of the controls, but the frequencies of emergency room visits and hospitalization decreased. CONCLUSION Our study showed that specific immunotherapy with Dp and Df was beneficial for asthmatic children.
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Affiliation(s)
- Tzu-Chun Tsai
- Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Watanabe J, Tanabe S. The Production of Hypoallergenic Wheat Flour for Wheat-Allergic Patients. ACTA ACUST UNITED AC 2009. [DOI: 10.1201/9781420028836.ch20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy. Clin Psychol Rev 2009; 29:483-95. [DOI: 10.1016/j.cpr.2009.05.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 05/29/2009] [Accepted: 05/30/2009] [Indexed: 01/07/2023]
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Jankovicova B, Rosnerova S, Slovakova M, Zverinova Z, Hubalek M, Hernychova L, Rehulka P, Viovy JL, Bilkova Z. Epitope mapping of allergen ovalbumin using biofunctionalized magnetic beads packed in microfluidic channels. J Chromatogr A 2008; 1206:64-71. [DOI: 10.1016/j.chroma.2008.07.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 07/18/2008] [Accepted: 07/23/2008] [Indexed: 10/21/2022]
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Taher YA, van Esch BCAM, Hofman GA, Henricks PAJ, van Oosterhout AJM. 1alpha,25-dihydroxyvitamin D3 potentiates the beneficial effects of allergen immunotherapy in a mouse model of allergic asthma: role for IL-10 and TGF-beta. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2008; 180:5211-21. [PMID: 18390702 DOI: 10.4049/jimmunol.180.8.5211] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
1alpha,25-Dihydroxyvitamin D(3) (1,25(OH)(2)D(3)), a potent inhibitor of NF-kappaB expression, can prevent the maturation of dendritic cells in vitro leading to tolerogenic dendritic cells with increased potential to induce regulatory T cells. Herein, we investigated whether the combination of allergen immunotherapy with 1,25(OH)(2)D(3) potentiates the suppressive effects of immunotherapy and whether the immunoregulatory cytokines IL-10 and TGF-beta are involved in the effector phase. OVA-sensitized and challenged BALB/c mice displayed airway hyperresponsiveness (AHR) and increased serum OVA-specific IgE levels, bronchoalveolar lavage eosinophilia, and Th2 cytokine levels. In this model, the dose response of allergen immunotherapy 10 days before OVA inhalation challenge shows strong suppression of asthma manifestations at 1 mg of OVA, but partial suppression of bronchoalveolar lavage eosinophilia, IgE up-regulation, and no reduction of AHR at 100 microg. Interestingly, coadministration of 10 ng of 1,25(OH)(2)D(3) with 100 microg of OVA immunotherapy significantly inhibited AHR and potentiated the reduction of serum OVA-specific IgE levels, airway eosinophilia, and Th2-related cytokines concomitant with increased IL-10 levels in lung tissues and TGF-beta and OVA-specific IgA levels in serum. Similar effects on suboptimal immunotherapy were observed by inhibition of the NF-kappaB pathway using the selective IkappaB kinase 2 inhibitor PS-1145. The suppressive effects of this combined immunotherapy were partially reversed by treatment with mAb to either IL-10R or TGF-beta before OVA inhalation challenge but completely abrogated when both Abs were given. These data demonstrate that 1,25(OH)(2)D(3) potentiates the efficacy of immunotherapy and that the regulatory cytokines IL-10 and TGF-beta play a crucial role in the effector phase of this mouse model.
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Affiliation(s)
- Yousef A Taher
- Department of Pharmacology and Pathophysiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Kim KW, Kim EA, Kwon BC, Kim ES, Song TW, Sohn MH, Kim KE. Comparison of allergic indices in monosensitized and polysensitized patients with childhood asthma. J Korean Med Sci 2006; 21:1012-6. [PMID: 17179678 PMCID: PMC2721920 DOI: 10.3346/jkms.2006.21.6.1012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Monosensitization differs both immunologically and clinically from polysensitization, and specific immunotherapy is more effective in patients sensitized only to a single pollen than in multiple-pollen sensitized patients. To further examine the differences between monosensitized and polysensitized allergies, allergic indices were examined in 68 monosensitized and 62 polysensitized patients with childhood asthma. Measurements included symptom scores, eosinophil counts, skin prick tests, serum total and specific IgE levels, and IL-10 levels, and were used to compare allergic indices between the two groups. Patients were followed for 18 months following immunotherapy to examine the effectiveness of the treatment. Symptom scores and total IgE levels were significantly higher in the polysensitized group than those in the monosensitized group (p<0.05). The levels of skin test response decreased significantly in both groups following immunotherapy. In the monosensitized group, symptom scores and specific IgE levels were significantly reduced after immunotherapy (p<0.05). In the polysensitized group, symptom scores were reduced after immunotherapy (p<0.05), but the degree of reduction was less than that of the monosensitized group (p<0.05). Moreover, in the polysensitized group, specific IgE levels after immunotherapy did not differ from that before immunotherapy. Serum IL-10 levels were not significantly increased after immunotherapy in either group. In conclusion, polysensitized patients tend to show higher allergic indices and immunotherapy might be less effective for these patients.
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Affiliation(s)
- Kyung Won Kim
- Department of Pediatrics and Institute of Allergy, Biomolecule Secretion Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ah Kim
- Department of Pediatrics and Institute of Allergy, Biomolecule Secretion Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Chul Kwon
- Department of Pediatrics and Institute of Allergy, Biomolecule Secretion Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Soo Kim
- Department of Pediatrics and Institute of Allergy, Biomolecule Secretion Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Won Song
- Department of Pediatrics and Institute of Allergy, Biomolecule Secretion Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics and Institute of Allergy, Biomolecule Secretion Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics and Institute of Allergy, Biomolecule Secretion Research Center, Yonsei University College of Medicine, Seoul, Korea
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Nagaya H, Maren S, Nagaya N. Allergy immunotherapy as an early intervention in patients with child-onset atopic asthma. Int Arch Allergy Immunol 2005; 139:9-15. [PMID: 16272821 DOI: 10.1159/000089517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 08/24/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with bronchial asthma an effective treatment is required at early stages of the disease to prevent irreversible structural changes of the airways. The objective of this study was to evaluate the beneficial effects of our routine immunotherapy as an early intervention on FEV1 in patients with child-onset atopic asthma. METHODS Beneficial effects of successful immunotherapy on FEV1 were analyzed retrospectively in 43 unselected patients who received our routine standard subcutaneous immunotherapy with periodic FEV1 measurements and became asymptomatic. RESULTS Although there was no significant correlation between the duration of asthma symptoms prior to immunotherapy and the changes in FEV1 before and after immunotherapy in 43 unselected patients, there was a significant inverse correlation between these two parameters in 23 patients whose asthma duration was less than 20 years. As the FEV1 increased after immunotherapy in all 14 patients whose asthma duration was less than 5 years, the 43 patients were divided into a group 1 including these 14 patients and a group 2 including 29 patients whose asthma duration was more than 5 years. The FEV1 decreased in 7 of the 29 asymptomatic patients in group 2. There was no difference in the initial FEV1 between the two groups, but the final FEV1 and the mean of the average increase in FEV1 per year by immunotherapy were significantly higher in group 1 than in group 2. CONCLUSIONS Immunotherapy should be started as early as possible at the youngest age in order to increase a beneficial effect of successful immunotherapy on FEV1 improvement.
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Gardner LM, Thien FC, Douglass JA, Rolland JM, O'Hehir RE. Induction of T 'regulatory' cells by standardized house dust mite immunotherapy: an increase in CD4+ CD25+ interleukin-10+ T cells expressing peripheral tissue trafficking markers. Clin Exp Allergy 2004; 34:1209-19. [PMID: 15298560 DOI: 10.1111/j.1365-2222.2004.02009.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Clinically effective subcutaneous allergen-specific immunotherapy (SIT) is associated with altered circulating T cell cytokine production and altered local cytokine responses with increased IL-10 following allergen challenge in target organs. OBJECTIVE This study aimed to elucidate mechanisms for these T cell changes, by examining surface expression of markers for peripheral tissue trafficking on circulating cytokine-positive T cells following standardized house dust mite- (HDM-) SIT. METHODS A randomized conventional HDM immunotherapy study was performed on a panel of 12 HDM-allergic subjects. Nine subjects received treatment with conventional HDM immunotherapy using a standardized extract and three subjects were treated by standard pharmacotherapy alone. Symptom and medication scores and allergen-induced cutaneous late-phase responses were assessed before and 9 months after institution of therapy. Before and at 3 and 9 months of SIT, peripheral blood mononuclear cells were cultured for 14 days with HDM extract and CD4+ and CD8+ T cell expression of CD62L, CD49d and CCR5 and production of IL-10, IFN-gamma and IL-4 were analysed by flow cytometry. Allergen-specific T cell proliferation was assessed by 3H-thymidine incorporation. RESULTS At 9 months, all SIT-treated patients showed reduced symptom scores and late-phase cutaneous responses to HDM compared with baseline levels. The proportions of CD4+ T cells which were IL-10+ were increased (P < 0.01), and the proportions of CD4+ and CD8+ T cells which were IL-4+ decreased (P < 0.05) compared with baseline. CD4+ and CD8+ T cell IFN-gamma production, expression of surface markers for peripheral tissue trafficking and allergen-specific proliferation remained unchanged during SIT treatment. However, increased proportions of CD4+CD62L(-), CD4+CD49d(hi), CD4+CCR5+ T cells expressing IL-10 were detected at 9 months of SIT compared with baseline (P < 0.05). IL-10 staining co-localized with CD4+CD25+ T cells. CONCLUSION Clinically effective subcutaneous immunotherapy with a standardized HDM Dermatophagoides pteronyssinus preparation results in decreased numbers of IL-4+ T cells and expansion of CD4+IL-10+ T cells expressing a peripheral tissue trafficking phenotype. The co-localization of IL-10+ staining to CD4+CD25+ T cells is consistent with the induction of a T regulatory cell population by SIT.
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Affiliation(s)
- L M Gardner
- Department of Pathology and Immunology, Monash University, Melbourne, Victoria, Australia
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Harvey SM, Laurie S, Hilton K, Khan DA. Safety of rush immunotherapy to multiple aeroallergens in an adult population. Ann Allergy Asthma Immunol 2004; 92:414-9. [PMID: 15104192 DOI: 10.1016/s1081-1206(10)61776-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rush immunotherapy has many potential benefits but a higher incidence of systemic reactions compared with traditional immunotherapy. The safety of rush immunotherapy to multiple aeroallergens has not been widely studied. OBJECTIVE To examine the safety of rush immunotherapy to multiple aeroallergens in a primarily adult population and to identify risk factors for systemic reactions. METHODS A retrospective review of 65 patients who received rush immunotherapy to multiple aeroallergens in a university-based allergy practice was conducted. All patients were premedicated with prednisone, cetirizine, ranitidine, and zafirlukast or montelukast. Percutaneous skin testing was performed, major allergen content was analyzed in every fourth patient's immunotherapy extract, and systemic reactions were graded. RESULTS Systemic reactions were observed in 25 patients (38%). All systemic reactions occurred with the final 3 doses of the protocol. Most (72%) occurred after the final dose of the protocol. Nineteen (76%) of the reactions were mild, 5 (20%) were moderate, and 1 (4%) was severe. Systemic reactions were associated with a higher degree of skin test sensitivity and the presence of weed or dog allergen in the extract (vaccine). CONCLUSIONS Rush immunotherapy is associated with a relatively high incidence of systemic reactions, but most reactions are mild and easily treated. The degree of skin sensitivity to the allergens administered and the presence of dog or weed allergen in the extract may be predictors for the development of systemic reactions.
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Affiliation(s)
- Shelly M Harvey
- Pediatric Allergy/Immunology Associates, P.A., Dallas, Texas, USA
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Affiliation(s)
- Yvonne M Coyle
- Division of General Internal Medicine, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9103, USA.
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Roberts G, Hurley C, Lack G. Development of a quality-of-life assessment for the allergic child or teenager with multisystem allergic disease. J Allergy Clin Immunol 2003; 111:491-7. [PMID: 12642827 DOI: 10.1067/mai.2003.138] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) questionnaires currently being used to evaluate allergic disease are organ-specific. They therefore fail to take account of the systemic aspects of allergic disease. OBJECTIVE To develop and validate a pediatric HRQOL questionnaire for allergic disease (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ) that encapsulates problems related to the eyes, ears, nose, lungs, skin, emotions, and everyday activities. METHODS In the development phase, 77 subjects (6 to 16 years of age), with seasonal or perennial allergic problems, were asked how much they were bothered by each different area of HRQOL impairment. The highest scoring areas were used to construct the PADQLQ. In the validation phase of the study, 36 subjects (8 to 16 years of age) with seasonal allergic rhinoconjunctivitis, seasonal allergic asthma, and/or cutaneous manifestations of grass pollen allergy were assessed before and during the pollen season. RESULTS The PADQLQ contains 26 questions. In addition to standard symptoms (eg, rhinitis), it incorporates multiorgan symptoms that are usually overlooked (eg, hearing problems). The PADQLQ demonstrated good cross-sectional and longitudinal validity, showing a high degree of correlation with symptom scores and quality of life as measured by a visual analogue scale and two-organ specific questionnaires. The PADQLQ showed good within-subject reliability and a small minimal important difference (0.33; 95% CI, 0.11 to 0.54 on a 7-point scale). CONCLUSIONS The PADQLQ has good cross-sectional and longitudinal validity, making it a potentially useful outcome measure in the evaluation of systemic treatments such as antihistamine medications and immunotherapy in children with multisystem allergic disease.
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Affiliation(s)
- Graham Roberts
- Pediatric Allergy, Asthma, and Immunology, Imperial College School of Medicine at St Mary's, London, United Kingdom
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Pifferi M, Baldini G, Marrazzini G, Baldini M, Ragazzo V, Pietrobelli A, Boner AL. Benefits of immunotherapy with a standardized Dermatophagoides pteronyssinus extract in asthmatic children: a three-year prospective study. Allergy 2002; 57:785-90. [PMID: 12169173 DOI: 10.1034/j.1398-9995.2002.23498.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although widely practiced for over 80 years, the role of specific immunotherapy (SIT) in pediatric asthma treatment is still controversial. We assessed the effects of a 3-year period of subcutaneous administration of a standardized preparation of Dermatophagoides pteronyssinus (D pt) on the respiratory health in a group of asthmatic children monosensitized to house dust mite (HDM). METHODS A randomized clinical trial was performed after 1-year run-in period. Fifteen children receiving SIT for HDM and 14 controls (four drop-outs), matched for age, allergen sensitization, asthma severity, lung function, and non-specific bronchial reactivity (BHR), were studied during the 3-year treatment period. During the whole trial, respiratory symptoms, pharmacological and respiratory function parameters were regularly evaluated. Skin prick tests and methacholine challenge were performed at the beginning and end of the study. RESULTS In the SIT group significant improvement in asthmatic symptoms and marked reduction in drug intake was observed. The SIT group also showed a significant decrease in non-specific bronchial BHR. No new sensitivity occurred during the study period in the SIT group only. No major local or systemic side-effects were reported during the study. CONCLUSIONS Our results confirm that SIT is effective in asthmatic children sensitive to mites. It is associated with a decrease in BHR and it may prevent the development of new sensitizations in monosensitized subjects.
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Affiliation(s)
- M Pifferi
- Departments of Pediatrics, University of Pisa, Italy
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Watanabe J, Tanabe S, Watanabe M, Kasai T, Sonoyama K. Consumption of hypoallergenic flour prevents gluten-induced airway inflammation in Brown Norway rats. Biosci Biotechnol Biochem 2001; 65:1729-35. [PMID: 11577710 DOI: 10.1271/bbb.65.1729] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Brown Norway rats were immunized with gluten, and then fed a diet containing hypoallergenic flour or an amino acid mixture. The rats were then made to inhale a solubilized gluten to induce gluten-specific bronchial asthma. The antibody levels in the serum of rats were measured by ELISA, and cell counts were done on cytospin preparations of bronchoalveolar lavage fluid. Body weight was decreased after allergen challenge in rats fed the amino acid mixture but not in rats fed the hypoallergenic flour. Antibody levels in the serum were significantly lower in rats fed hypoallergenic flour than in those fed the amino acid mixture. Differential cell counts in the bronchoalveolar lavage fluid showed that the numbers of eosinophils, lymphocytes, and neutrophils were significantly lower in rats fed the hypoallergenic flour than in those fed the amino acid mixture. These results suggest that hypoallergenic flour actively suppresses the allergic reactions, probably by inducing oral tolerance.
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Affiliation(s)
- J Watanabe
- Graduate School of Agriculture, Hokkaido University, Sapporo, Japan.
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Abstract
LEARNING OBJECTIVES To understand the principles of asthma management in patients of different ages, and to outline major avoidance measures, classes of medications available, and indications for immunotherapy (IT). DATA SOURCES MEDLINE and major textbooks of allergy and immunology. CONCLUSIONS There has been an understanding of asthma as a chronic inflammatory disease for many decades but recent information about mediators and cytokines has led to new therapies and better understanding of the effects of IT and other preventive measures. The best treatment for any individual patient depends upon many factors and is a decision to be made between the patient and the physician. It seems that the best response to IT occurs in those who are highly sensitive to unavoidable allergens, and who experienced a late-phase asthmatic response to the allergen initially. New data suggest that IT should be considered early, as it may prevent progression of asthma to more severe, less reversible disease. The best therapy results in the ablation of airway early- and late-phase reactivity.
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Affiliation(s)
- B B Wray
- Allergy-Immunology Section, Medical College of Georgia, Augusta 30912-3790, USA.
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Abstract
Many open studies investigating the effects of innovative treatments for steroid-dependent asthma demonstrate some benefit. This is also true of the majority of placebo arms in placebo-controlled trials. This suggests that children with difficult asthma benefit from the high level of input that is typically provided in clinical trials, with or without additional medication. Such intensive management of patients, with the emphasis on establishing the diagnosis, improving adherence, and identifying provoking factors, is the key to optimizing asthma control for these children. For patients with genuinely severe asthma, despite high doses of conventional treatment, a greater understanding of the pathological basis of persistent symptoms is needed. Identification of different pathological subtypes of severe asthma should allow for more rational prescribing of asthma therapy, as well as the design of further trials of potential steroid-sparing treatments.
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Affiliation(s)
- D N Payne
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
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Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. American Thoracic Society. Am J Respir Crit Care Med 2000; 162:2341-51. [PMID: 11112161 DOI: 10.1164/ajrccm.162.6.ats9-00] [Citation(s) in RCA: 707] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Akçakaya N, Hassanzadeh A, Camcioğlu Y, Cokuğraş H. Local and systemic reactions during immunotherapy with adsorbed extracts of house dust mite in children. Ann Allergy Asthma Immunol 2000; 85:317-21. [PMID: 11061476 DOI: 10.1016/s1081-1206(10)62536-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We retrospectively evaluated the incidence of local and systemic reactions to injections of adsorbed extracts of house dust mites (Dermatophagoides pteronyssinus and Dermatophagoides farinae) applied according to a conventional schedule in children. METHOD Eighty-eight patients aged 6 to 15 years, suffering from allergic asthma or asthma together with rhinitis, at various stages of treatment with immunotherapy from January 1989 to November 1997 were included. RESULTS Out of 5,760 injections, 5,542 (96.21%) were not associated with a reaction, 206 injections (3.57%) caused local reactions (144, <20 mm in diameter; 62, >20 mm), and systemic reactions were seen after 12 injections (0.2%). Twelve patients experienced 12 systemic reactions. Of these, 7 patients (58.3%) experienced no local reactions prior to a systemic reaction. Eleven males and one female had systemic reactions. Most of both local and systemic reactions occurred within less than 30 minutes after the injection. CONCLUSIONS Our study supports the safety of immunotherapy with house dust mites in children. The majority of reactions were local. Although five of 12 patients who experienced systemic reactions had local reactions prior to a systemic reaction, in general the presence of local reactions was not helpful in predicting which patients would develop systemic reactions. Males and patients with asthma together with rhinitis appeared to be at greater risk for systemic reactions.
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Affiliation(s)
- N Akçakaya
- Department of Pediatrics, Cerrahpaşa Medical Faculty, University of Istanbul, Turkey
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26
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ADVERSE EFFECTS OF ALLERGEN IMMUNOTHERAPY. Radiol Clin North Am 2000. [DOI: 10.1016/s0033-8389(22)00108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Moss MH, Bush RK. PATIENT SELECTION AND ADMINISTRATION OF AEROALLERGEN VACCINES. Immunol Allergy Clin North Am 2000. [DOI: 10.1016/s0889-8561(05)70165-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moss MH, Bush RK. PATIENT SELECTION AND ADMINISTRATION OF AEROALLERGEN VACCINES. Radiol Clin North Am 2000. [DOI: 10.1016/s0033-8389(22)00106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ross RN, Nelson HS, Finegold I. Effectiveness of specific immunotherapy in the treatment of asthma: a meta-analysis of prospective, randomized, double-blind, placebo-controlled studies. Clin Ther 2000; 22:329-41. [PMID: 10963287 DOI: 10.1016/s0149-2918(00)80037-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite decades of positive experience with specific immunotherapy (SIT) in the treatment of asthma, outcomes associated with SIT have not been evaluated. OBJECTIVE This meta-analysis was conducted to compare the effects of SIT plus medical treatment with those of SIT without medical treatment in patients with asthma. METHODS All studies of SIT in patients with asthma published in English between the years 1966 and 1998 were identified through a MEDLINE search. All prospective, randomized, double-blind, placebo-controlled studies of SIT identified by the search were included in the meta-analysis. One author (R.N.R.) extracted data from these studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS Data were extracted from 24 identified studies of the clinical effectiveness of SIT in the treatment of asthma, involving 962 asthmatic patients with documented allergy. Immunotherapy was judged effective in 17 (71%) of the 24 studies, ineffective in 4 (17%), and equivocal in 3 (12%) (chi2 = 15.25, df = 2, P = 0.0005). Symptoms of asthma were more likely to improve in patients who received SIT than in patients who received placebo (OR 2.76, 95% CI 2.22 to 3.42). Results also favored the immunotherapy group for improvement in pulmonary function (OR 2.87, 95% CI 1.82 to 4.52), protection against bronchial challenge (OR 1.81, 95% CI 1.32 to 2.49), and reduced need for medications (OR 2.00, 95% CI 1.46 to 2.72). CONCLUSION The findings of this meta-analysis support the conclusion that SIT is effective in a population of patients with allergen-triggered asthma.
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Affiliation(s)
- R N Ross
- Medical/Science Analytics, Brookline, Massachusetts 02445, USA
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Janssen EM, van Oosterhout AJ, van Rensen AJ, van Eden W, Nijkamp FP, Wauben MH. Modulation of Th2 responses by peptide analogues in a murine model of allergic asthma: amelioration or deterioration of the disease process depends on the Th1 or Th2 skewing characteristics of the therapeutic peptide. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2000; 164:580-8. [PMID: 10623798 DOI: 10.4049/jimmunol.164.2.580] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Allergen-specific CD4+ Th2 cells play an important role in the immunological processes of allergic asthma. Previously we have shown that, by using the immunodominant epitope OVA323-339, peptide immunotherapy in a murine model of OVA induced allergic asthma, stimulated OVA-specific Th2 cells, and deteriorated airway hyperresponsiveness and eosinophilia. In the present study, we defined four modulatory peptide analogues of OVA323-339 with comparable MHC class II binding affinity. These peptide analogues were used for immunotherapy by s.c. injection in OVA-sensitized mice before OVA challenge. Compared with vehicle-treated mice, treatment with the Th2-skewing wild-type peptide and a Th2-skewing partial agonistic peptide (335N-A) dramatically increased airway eosinophilia upon OVA challenge. In contrast, treatment with a Th1-skewing peptide analogue (336E-A) resulted in a significant decrease in airway eosinophilia and OVA-specific IL-4 and IL-5 production. Our data show for the first time that a Th1-skewing peptide analogue of a dominant allergen epitope can modulate allergen-specific Th2 effector cells in an allergic response in vivo. Furthermore, these data suggest that the use of Th1-skewing peptides instead of wild-type peptide may improve peptide immunotherapy and may contribute to the development of a successful and safe immunotherapy for allergic patients.
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Affiliation(s)
- E M Janssen
- Institute of Infectious Diseases, Department of Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Maguire P, Nicodemus C, Robinson D, Aaronson D, Umetsu DT. The safety and efficacy of ALLERVAX CAT in cat allergic patients. Clin Immunol 1999; 93:222-31. [PMID: 10600332 DOI: 10.1006/clim.1999.4795] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Conventional immunotherapy for cat allergy is effective in reducing cat allergy symptoms in many patients, but this type of immunotherapy can cause severe reactions, including anaphylaxis, and often requires years of injections for successful desensitization. To improve the efficacy of immunotherapy for cat allergic patients, synthetic cat allergen peptides (ALLERVAX CAT) were generated, based on analysis of the immunodominant T cell epitopes of cat allergen. These peptides lack the tertiary structure of native Fel d1 and possess a significantly reduced capacity to bind to Fel d1-specific IgE. Using these peptides, we performed a multicenter, randomized, double-blind, placebo-controlled study of 133 cat allergic patients chronically exposed to cats or who had failed previous conventional cat immunotherapy. We evaluated the safety of ALLERVAX CAT treatment and determined whether ALLERVAX CAT treatment improved tolerance to cat allergen, as measured by symptom analysis and pulmonary function testing. Three of the ALLERVAX CAT-treated patients required systemic epinephrine for adverse reactions, but the frequency of all adverse reactions in both groups was not statistically different from that of the placebo group. The majority of adverse events were "late" events, most commonly associated with respiratory symptoms, and these events declined with successive injections. ALLERVAX CAT given at a dose of 750 microg/dose improved pulmonary function in patients with reduced baseline FEV1, and global evaluation of the subjects' ability to tolerate cats improved significantly in the actively treated groups relative to placebo. Thus, although therapy with ALLERVAX CAT is associated with some adverse events in patients with severe cat sensitivity, such therapy is an effective approach for the management of cat allergy, since it improves tolerance to cats and improves pulmonary function in cat allergic patients with reduced FEV1.
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Affiliation(s)
- P Maguire
- Department of Pediatrics, Stanford University, Stanford, California 94305, USA
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Kobayashi C, Nigi H, Saito S, Ide T, Taniguchi Y, Inouye S, Sakaguchi M. IgE reactivity and cross-reactivity of Japanese monkeys (Macaca fuscata) to Japanese cedar (Cryptomeria japonica) and cypress (Chamaecyparis obtusa) pollen allergens. Clin Exp Allergy 1999; 29:856-61. [PMID: 10336604 DOI: 10.1046/j.1365-2222.1999.00581.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The natural occurrence of Japanese cedar (Cryptomeria japonica, CJ) pollinosis has been reported in Japanese monkeys (Macaca fuscata). However, the reactivity to Japanese cypress (Chamaecyparis obtusa, CO) pollen allergens in these monkeys has not yet been reported. OBJECTIVES The present study was designed to investigate the reactivity to CO pollen allergens in monkeys sensitized to CJ pollen allergens. METHODS Serum samples from 40 monkeys naturally sensitized to CJ pollen allergens were collected from four troops. We measured the specific IgE to CO pollen allergens and examined the reactivity to the allergens by intradermal test. Cross-reactivity between CJ and CO pollen allergens was examined by ELISA inhibition method. Furthermore, we examined the sensitivity to the allergens by histamine release assay from leucocytes. RESULTS All 40 monkeys had specific IgE to crude and purified major allergens (Cha o 1) of CO pollen. The monkeys showed a positive reaction to CO pollen allergens in the intradermal test. Allergenic cross-reactivity between Cha o 1 and Cry j 1 (a major allergen in CJ pollen) was also observed. Specific histamine release to both the major allergens was noted in two monkeys with CJ pollinosis. CONCLUSION Japanese monkeys sensitized to Japanese cedar pollen allergens also demonstrate reactivity to Japanese cypress pollen allergens.
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Affiliation(s)
- C Kobayashi
- Division of Wild Animal Medicine, Nippon Veterinary and Animal Science University, Tokyo, Japan
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Mungan D, Misirligil Z, Gürbüz L. Comparison of the efficacy of subcutaneous and sublingual immunotherapy in mite-sensitive patients with rhinitis and asthma--a placebo controlled study. Ann Allergy Asthma Immunol 1999; 82:485-90. [PMID: 10353581 DOI: 10.1016/s1081-1206(10)62726-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The efficacy of therapy with sublingual allergen extracts is unproven. OBJECTIVE To evaluate the clinical and immunologic outcome of sublingual immunotherapy and to compare the results with subcutaneous immunotherapy and placebo in 36 patients with rhinitis and asthma due to mite allergy. METHOD Thirty-six patients with rhinitis and asthma due to mite allergy were randomly divided into three groups in order to receive subcutaneous injections with allergenic extracts, sublingual drops with solutions of purified standardized allergen preparations, or sublingual placebo for a period of 1 year. Assessment of clinical and immunologic efficacy included symptom and medication scores, methacholine provocation tests, skin prick tests, and specific IgE and IgG4 antibody concentrations. RESULTS Subcutaneous immunotherapy for both rhinitis and asthma was clinically effective. Patients treated with sublingual immunotherapy had decreased rhinitis symptoms (P < .01) but no change in asthma scores. Medication scores significantly decreased in both actively treated groups (P < .01) at the first year compared with baseline. When skin prick tests were evaluated, the subcutaneously treated group had a significant decrease in the wheal diameter of D. pteronyssinus (P < .01), D. farinae (P < .05), and histamine (P < .05) while other two groups showed no difference. There was no significant change in methacholine PC20 values in all groups at the end of the first year when compared with baseline. No change in D. pteronyssinus and D. farinae specific IgE levels were observed; however, specific IgG4 concentrations were significantly higher than baseline both in sublingual and subcutaneous immunotherapy groups (P < .05) after 1 year immunotherapy. No significant difference was obtained in any of these parameters in the placebo group. CONCLUSION Sublingual immunotherapy may be effective in patients with allergic rhinitis. Further, we believe it is a potential therapy for allergic asthmatic patients. The clinical usefulness of this form of immunotherapy (when administered to larger study groups for a longer time) and the mechanisms underlying its immunologic effect deserve additional studies.
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Affiliation(s)
- D Mungan
- Department of Allergic Diseases, Faculty of Medicine, Ankara University, Turkey
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Donahue JG, Greineder DK, Connor-Lacke L, Canning CF, Platt R. Utilization and cost of immunotherapy for allergic asthma and rhinitis. Ann Allergy Asthma Immunol 1999; 82:339-47. [PMID: 10227332 DOI: 10.1016/s1081-1206(10)63282-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Allergic rhinitis and asthma are important sources of morbidity among adults and children. Although immunotherapy is sometimes used to treat these conditions, there is little information on its use, adherence, or cost in the general population. OBJECTIVE We sought to characterize the recipients of immunotherapy for allergic rhinitis and/or asthma with respect to their immunotherapy and utilization of health care services. METHODS A combination of automated and manually extracted data was used to identify HMO members with diagnoses of allergic rhinitis or asthma who were treated with immunotherapy. Costs associated with immunotherapy and related care were examined by linear regression. Proportional hazards and Kaplan-Meier plots were used to evaluate duration of therapy. RESULTS Of the 122,196 persons with a diagnosis of asthma or rhinitis, 2,667 were also treated with immunotherapy. Eligibility criteria were satisfied by 603 individuals who had 28,266 encounters for immunotherapy (median 48). Most patients (>80) were treated with multiple allergens; ragweed was the most common single allergen administered. Thirty-three percent of patients with sufficient observation time completed the intended course of 61 immunotherapy treatments. Females and younger patients had shorter durations of immunotherapy. The most common reason for discontinuation of therapy was patient's decision (54%). Immunotherapy costs were related most strongly to costs for care of rhinitis and asthma. Prescription drugs accounted for more than 50% of the non-immunotherapy costs; hospitalizations accounted for less than 20%. CONCLUSIONS Approximately 2% of HMO members with an asthma or rhinitis diagnosis received immunotherapy. Although screened to optimize compliance, most patients did not complete immunotherapy. Costs of non-immunotherapy care were higher for individuals who completed immunotherapy which is consistent with more severe disease in this group.
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Affiliation(s)
- J G Donahue
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bousquet J, Lockey R, Malling HJ, Alvarez-Cuesta E, Canonica GW, Chapman MD, Creticos PJ, Dayer JM, Durham SR, Demoly P, Goldstein RJ, Ishikawa T, Ito K, Kraft D, Lambert PH, Løwenstein H, Müller U, Norman PS, Reisman RE, Valenta R, Valovirta E, Yssel H. Allergen immunotherapy: therapeutic vaccines for allergic diseases. World Health Organization. American academy of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998; 81:401-5. [PMID: 9860031 DOI: 10.1016/s1081-1206(10)63136-5] [Citation(s) in RCA: 164] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Asero R. Effects of birch pollen-specific immunotherapy on apple allergy in birch pollen-hypersensitive patients. Clin Exp Allergy 1998; 28:1368-73. [PMID: 9824409 DOI: 10.1046/j.1365-2222.1998.00399.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most patients with birch pollen allergy report oral allergy symptoms after eating fresh apples and other vegetable foods. Major birch pollen and apple allergens, Bet v 1 and Mal d 1, are highly homologous; as a consequence, pollen-specific immunotherapy (SIT) might be expected to improve apple hypersensitivity. OBJECTIVE To evaluate the clinical and immunological effects of birch pollen SIT on oral allergy syndrome (OAS) induced by apples. METHODS A prospective study carried out in 49 birch pollen-sensitive patients with apple-induced OAS who received injection immunotherapy for 12, 24, or 36 months. Twenty-six patients not submitted to SIT and followed up for 12-48 months were used as controls. Both SPT and open oral challenges with fresh golden delicious apple were performed, as well as specific IgE measurements, before and after SIT. RESULTS Forty-one patients (84%) vs no control (0%) reported a significant reduction (50-95%) or a total disappearance (100%) of OAS symptoms after SIT (P < 0. 001). Similar responses were observed in patients treated for 12, 24, or 36 months. SIT also induced a marked reduction in skin reactivity against fresh apple in 43 patients (88%). The effect of SIT was inversely related with baseline skin reactivity: 50% and 8% patients with a weakly or strongly positive baseline apple skin prick tests (SPT), respectively, did not report changes in OAS severity after SIT (P < 0.01). In contrast, baseline birch pollen-specific or apple-specific IgE antibodies levels did not influence SIT effectiveness on OAS. SIT induced a marked decrease in birch pollen-specific IgE levels (P < 0.001), whereas apple-specific IgE showed an unexpected variability (reduction in 21%, no change in 43%, increase in 38%). No control subject reported a reduction in OAS severity or showed a decrease in skin reactivity at follow-up (P < 0.001). CONCLUSIONS SIT with birch pollen extracts effectively reduces clinical apple sensitivity and skin reactivity in most cases after only 1 year of treatment; these effects are not paralleled by a similar reduction in apple-specific IgE. These findings suggest a decrease in activability of effector cells as the mechanism underlying clinical benefit.
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Affiliation(s)
- R Asero
- Ambulatorio di Allergologia, Ospedale Caduti Bollatesi, Bollate, Italy
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Van Oosterhout AJ, Van Esch B, Hofman G, Hofstra CL, Van Ark I, Nijkamp FP, Kapsenberg ML, Savelkoul HF, Weller FR. Allergen immunotherapy inhibits airway eosinophilia and hyperresponsiveness associated with decreased IL-4 production by lymphocytes in a murine model of allergic asthma. Am J Respir Cell Mol Biol 1998; 19:622-8. [PMID: 9761759 DOI: 10.1165/ajrcmb.19.4.3112m] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In the present study, we investigated whether allergen immunotherapy is effective in a murine model with immunologic and pathophysiologic features reminiscent of allergic asthma. Ovalbumin-sensitized mice received increasing (1 microgram to 1 mg) subcutaneous doses of ovalbumin twice a week for 8 wk according to a semirush immunotherapy protocol as used in allergic patients. During immunotherapy, an initial rise in serum levels of ovalbumin-specific antibodies (immunoglobulin [Ig]G1, IgE, IgG2a) occurred, after which IgE levels decreased sharply concomitant with an increase in IgG2a levels. The increase in IgG2a levels, with the decline in IgE levels, suggests that during immunotherapy interferon-gamma production is increased or interleukin (IL)-4 production is decreased. After immunotherapy, inhalation challenge of the mice with ovalbumin revealed almost complete inhibition (98%, P < 0.01) of eosinophil infiltration into bronchoalveolar lavage and airway hyperresponsiveness (100% at 320 microgram/kg methacholine, P < 0.05) compared with sham-treated animals. In addition, IL-4 production of thoracic lymph node cells stimulated with ovalbumin in vitro was largely reduced (60%, P < 0.05) after immunotherapy. Thus, effective immunotherapy in this animal model appears to be due to modulation of antigen-specific T cells. Similar effects on airway symptoms and IL-4 production can be obtained within 1 wk by three injections of the highest dose of ovalbumin (1 mg). This animal model will be used as a preclinical model to improve allergen immunotherapy and to gain more insight into the mechanisms involved.
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Affiliation(s)
- A J Van Oosterhout
- Department of Pharmacology and Pathophysiology, Utrecht University, Utrecht, The Netherlands.
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Sone T, Morikubo K, Miyahara M, Komiyama N, Shimizu K, Tsunoo H, Kino K. T Cell Epitopes in Japanese Cedar ( Cryptomeria japonica) Pollen Allergens: Choice of Major T Cell Epitopes in Cry j 1 and Cry j 2 Toward Design of the Peptide-Based Immunotherapeutics for the Management of Japanese Cedar Pollinosis. THE JOURNAL OF IMMUNOLOGY 1998. [DOI: 10.4049/jimmunol.161.1.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Japanese cedar pollinosis is caused by exposure to Japanese cedar (Cryptomeria japonica) pollen, of which two components, Cry j 1 and Cry j 2, are believed to be the major allergens. T cell lines specific to either Cry j 1 or rCry j 2 were reactive to various portions of each panel of overlapping peptides derived from Cry j 1 or Cry j 2. Two peptides, p211–225 and p108–120, from among six major T cell epitopes identified in Cry j 1 sequence, and three peptides, p182–200, p344–355, and p66–80, from among five in Cry j 2, were chosen to design an artificial polypeptide (named Cry-consensus) based on a difference among the types of the restriction molecules capable of presenting these peptides. After construction of a DNA encoding these peptides in order, Cry-consensus was expressed in Escherichia coli. Five of six T cell epitopes, except for Cry j 2 p344–355, in Cry-consensus were recognized by the T cell clones specific to each peptide. PBMC from allergic patients induced higher proliferation under stimulation from Cry-consensus than individual peptides. Eighty-eight percent of the PBMC (15 of 17) showed proliferation under the Cry-consensus stimulation. Thus, several major T cell epitopes from Cry j 1 and Cry j 2 can be chosen in the design of peptide-based immunotherapeutics for the management of Japanese cedar pollinosis in subjects having various types of HLA class II molecules.
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Affiliation(s)
- Toshio Sone
- Department of Pharmaceutical Research, Meiji Institute of Health Science, Odawara, Kanagawa, Japan
| | - Keiko Morikubo
- Department of Pharmaceutical Research, Meiji Institute of Health Science, Odawara, Kanagawa, Japan
| | - Michinori Miyahara
- Department of Pharmaceutical Research, Meiji Institute of Health Science, Odawara, Kanagawa, Japan
| | - Naoki Komiyama
- Department of Pharmaceutical Research, Meiji Institute of Health Science, Odawara, Kanagawa, Japan
| | - Kimiko Shimizu
- Department of Pharmaceutical Research, Meiji Institute of Health Science, Odawara, Kanagawa, Japan
| | - Hajime Tsunoo
- Department of Pharmaceutical Research, Meiji Institute of Health Science, Odawara, Kanagawa, Japan
| | - Kohsuke Kino
- Department of Pharmaceutical Research, Meiji Institute of Health Science, Odawara, Kanagawa, Japan
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Abstract
The risk and safety of specific immunotherapy (SIT) has been the subject of many well-designed studies since it was introduced. Most authors consider SIT an efficient and safe mode of treatment despite the occurrence of life-threatening anaphylactic reactions. They emphasize the importance of a proper selection of patients as well as the requirement for highly qualified physicians to provide the treatment. Another problem associated with the safety of SIT is the potential enhancement of the synthesis of immune complexes after the treatment. SIT causes a decrease in allergen-specific IgE which is slower in circulating immune complexes than in the serum. No data are available to show that SIT induces immune-complex diseases, in either the immunologic or the clinical sense. As far as anaphylactic reactions are concerned, new alternative methods different from the conventional parenteral mode of delivery seem to be safe. Our increased understanding of the altered functions of the immune system justifies the assumption that the more specific the method of SIT administration, the more effective and safe it is.
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Affiliation(s)
- B Rogala
- Department and Clinic of Internal and Allergic Diseases, Silesian School of Medicine, Zabrze, Poland
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Affiliation(s)
- M L Kowalski
- Department of Clinical Immunology and Allergy, Medical University of Lódź, Poland
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Affiliation(s)
- J A Douglass
- Department of Allergy and Clinical Immunology, Alfred Hospital, Prahran, Victoria, Australia
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Affiliation(s)
- F Bonifazi
- Allergy Respiratory Unit, Regional Hospital, Ancona, Italy
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Olaguibel JM, Tabar AI, García Figueroa BE, Cortés C. Immunotherapy with standardized extract of Dermatophagoides pteronyssinus in bronchial asthma: a dose-titration study. Allergy 1997; 52:168-78. [PMID: 9105521 DOI: 10.1111/j.1398-9995.1997.tb00971.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
According to the maximum tolerated dose (MTD) achieved, we assessed the changes in clinical and laboratory parameters, induced by specific immunotherapy (SIT), in a group of 43 asthmatic patients sensitized to Dermatophagoides pteronyssinus, over a period of 18 months. A standardized extract (100 Bu/ml; 40 micrograms/ml of Der p 1; 20 micrograms/ml of Der p 2) was used. The patients were divided into two groups: the high-dose immunotherapy (HDI) group (MTD > or = 4 micrograms Der p I) and the conventional immunotherapy (CI) group (MTD < 4 micrograms Der p 1). Changes in clinical severity index, medication, and symptom scores; in cutaneous and conjunctival reactivity; and in the levels of specific IgE, IgG, IgG1, and IgG4 to D. pteronyssinus (Der p 1 and Der p 2) were measured (ELISA monoclonal antibodies). Safety was monitored according to the EAACI guidelines. The range of the MTD was 0.8-16 micrograms of Der p 1. Ninety percent of the patients tolerated a dose of 3.2 micrograms, but only 18% of the patients reached a maintenance dose of 16 micrograms. The medians of the accumulated dose were 197 micrograms of Der p 1 for the HDI group, and 50 micrograms for the CI group. Conjunctival and cutaneous reactivity was significantly lowered (P < 0.001) after SIT, as were the clinical severity score and medication score in both groups, without significant differences between the groups, except for cutaneous reactivity. Levels of specific IgE decreased significantly (P < 0.01) in both groups, again without significant differences between the groups. The range of the increase in medians of specific IgG, IgG1, and IgG4 was 4.4-120-fold for the HDI group and 3-24-fold for the CI group (P < 0.01). The increase in the levels of Der p 1 and Der p 2 IgG4 were correlated to the changes in cutaneous and conjunctival reactivity (P < 0.01). These results show that a maintenance dose of 3.2 micrograms Der p 1 (8 BU) can induce pronounced clinical and immunologic changes with an excellent safety profile.
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Affiliation(s)
- J M Olaguibel
- Sección de Alergología, Hospital Virgen del Camino, Pamplona, Spain
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Adkinson NF, Eggleston PA, Eney D, Goldstein EO, Schuberth KC, Bacon JR, Hamilton RG, Weiss ME, Arshad H, Meinert CL, Tonascia J, Wheeler B. A controlled trial of immunotherapy for asthma in allergic children. N Engl J Med 1997; 336:324-31. [PMID: 9011784 DOI: 10.1056/nejm199701303360502] [Citation(s) in RCA: 209] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Injections of allergens are widely prescribed for patients with asthma, but little is known about the effectiveness of immunotherapy. METHODS We conducted a double-blind, placebo-controlled trial of multiple-allergen immunotherapy in 121 allergic children with moderate-to-severe, perennial asthma. The children, who required daily medication for their asthma, were randomly assigned to receive subcutaneous injections of either a mixture of up to seven aeroallergen extracts or a placebo. Maintenance injections were continued for 18 months or longer. Medications were adjusted every two to three weeks on the basis of peak flow rates and symptoms. The principal outcome was the daily medication score. Bronchial sensitivity to methacholine (the concentration provoking a 20 percent decrease in the forced expiratory volume in one second [PC20]) was measured twice yearly. RESULTS The median medication score declined from 5.4 to 4.9 in the immunotherapy group (P<0.001) and from 5.2 to 5.0 in the placebo group (P<0.001), but there was no significant difference between the groups (P>0.6). The number of days on which oral corticosteroids were used was similar in the two groups. Partial or complete remission of asthma occurred in 31 percent of the immunotherapy group and in 28 percent of the placebo group (P>0.5). There was no difference between the groups in the use of medical care, symptoms, or peak flow rates. The median PC20 increased significantly in both groups, but again with no difference between the two groups. CONCLUSIONS Immunotherapy with injections of allergens for over two years was of no discernible benefit in allergic children with perennial asthma who were receiving appropriate medical treatment.
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Affiliation(s)
- N F Adkinson
- Asthma and Allergy Center and the Department of Medicine, Johns Hopkins University School of Medicine, MD, USA
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Koning H, Baert MR, Oranje AP, Savelkoul HF, Neijens HJ. Development of immune functions related to allergic mechanisms in young children. Pediatr Res 1996; 40:363-75. [PMID: 8865270 DOI: 10.1203/00006450-199609000-00001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The newborn immune system differs quantitatively and functionally from that of adults. Development of the immune system has important implications for childhood diseases. The immaturity of the immune system in the first years of life may contribute to failure of tolerance induction and in the development of allergic disease. T cell function is diminished, especially the capacity to produce cytokines; production of interferon (IFN)-gamma, and IL-4 is strongly reduced. IFN-gamma has been found to be even lower in cord blood of newborns with a family history of atopy. Differences in other cell types (natural killer cells, antigen-presenting cells, and B cells) could also play a role in the development of allergic disease. Current data suggest that irregularities in IgE synthesis, helper T cell subsets (Th1, Th2, CD45RA, and CD45RO), cytokines (IL-4, IFN-gamma), and possibly other cell types may play a role in the development of allergy in childhood. Moreover, the role of cell surface molecules, like co-stimulatory molecules (CD28, CD40L), activation markers (CD25), and adhesion molecules (LFA-1/ICAM-1, VLA-4/ VCAM-1) is also discussed. These variables are modulated by genetic (relevant loci are identified on chromosome 5q, 11q, and 14) and environmental forces (allergen exposure, viral infections, and smoke). The low sensitivity of current predictive factors for the development of allergic diseases, such as cord blood IgE levels, improves in combination with family history and by measurement of in vitro responses of lymphocytes and skin reactivity to allergens. New therapeutic approaches are being considered on the basis of our current understanding of the immunopathology of allergic disease, for instance cytokine therapy and vaccination with tolerizing doses of allergen or peptides.
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Affiliation(s)
- H Koning
- Department of Paediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands
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Mohapatra SS, Mohapatra S. APPLICATION OF MOLECULAR BIOLOGY FOR DIAGNOSIS AND TREATMENT OF ALLERGIC DISEASES. Radiol Clin North Am 1996. [DOI: 10.1016/s0033-8389(22)00231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mohapatra SS, Mohapatra S. APPLICATION OF MOLECULAR BIOLOGY FOR DIAGNOSIS AND TREATMENT OF ALLERGIC DISEASES. Immunol Allergy Clin North Am 1996. [DOI: 10.1016/s0889-8561(05)70262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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