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Cardona-Villa R, Uribe-Garcia S, Calvo-Betancur VD, Cantillo JF, Fernández-Caldas E. Efficacy and safety of subcutaneous immunotherapy with a mixture of glutaraldehyde-modified extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae , and Blomia tropicalis. World Allergy Organ J 2022; 15:100692. [PMID: 36119655 PMCID: PMC9467880 DOI: 10.1016/j.waojou.2022.100692] [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: 02/23/2022] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Allergen Immunotherapy (AIT) is an effective treatment of allergic respiratory diseases induced by the inhalation of house dust mite allergens. Objectives To evaluate the efficacy and safety of glutaraldehyde polymerized allergen extracts using a mixture of Dermatophagoides pteronyssinus, D. farinae and Blomia tropicalis in mite allergic individuals residing in Colombia. Methods Two hundred and fifty (250) patients with allergic rhinoconjunctivitis with, or without asthma and sensitized to D. pteronyssinus, D. farinae and B. tropicalis were included. A glutaraldehyde-modified extract containing a mixture of D. pteronyssinus, D. farinae and B. tropicalis was employed, using a cluster up-dosing schedule followed by a monthly maintenance dose. The primary endpoints to evaluate the clinical impact were the Combined Symptom and Medication Scores (CSMS) for allergic rhinitis, the Asthma Control Test (ACT) and the reduction in medication consumption. Results Significant improvement was found after 3 months of treatment regarding CSMS (p < 0.0001) and ACT (p < 0.0001). Additionally, a significant decrease in medication consumption was found after 3 months of treatment (p < 0.0001). Adverse reactions, either local or systemic were mild and no severe reactions related to the vaccines were observed. Conclusion After 12 months of allergen immunotherapy, glutaraldehyde-modified mixture of D. pteronyssinus, D. farinae and B. tropicalis proved to be safe and effective in the treatment of patients with rhinoconjunctivitis with or without asthma due to allergy to mites.
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Affiliation(s)
- Ricardo Cardona-Villa
- Grupo de Alergología Clínica y Experimental (GACE), University of Antioquia, Medellín, Antioquia, Colombia
| | - Susana Uribe-Garcia
- Grupo de Alergología Clínica y Experimental (GACE), University of Antioquia, Medellín, Antioquia, Colombia
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Castro-Almarales RL, Ronquillo-Díaz M, Álvarez-Castelló M, Rodríguez-Canosa J, González-León M, Enríquez-Domínguez I, Navarro-Viltre BI, Mateo-Morejón M, Oliva-Díaz Y, Ramírez-González W, Cox L, Labrada-Rosado A. Subcutaneous allergen immunotherapy for asthma: A randomized, double-blind, placebo-controlled study with a standardized Blomia tropicalis vaccine. World Allergy Organ J 2020; 13:100098. [PMID: 32308779 PMCID: PMC7155230 DOI: 10.1016/j.waojou.2020.100098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sensitization to Blomia tropicalis (Bt) is very frequent in the tropics, and particularly in Cuba, being a significant cause of allergic asthma. Allergen immunotherapy (AIT) with Bt can be a therapeutic option, however, placebo-controlled clinical trials have not been reported. OBJECTIVE To assess the therapeutic effect and safety of AIT for asthma using a standardized allergen vaccine of B. tropicalis by subcutaneous route, in allergic asthmatic patients exposed and sensitized to this mite species. METHODS A double-blind, placebo-controlled Phase II trial was conducted in 35 adults (18 with treatment and 17 with placebo), with mild to moderate asthma, predominantly sensitized to Bt. AIT was administered subcutaneously in increasing doses from 4 to 6000 Biological Units using a locally manufactured standardized extract (BIOCEN, Cuba). Patient assessment was performed using symptom-medication score (SMS), peak expiratory flow and skin reactivity relative to Histamine as measured by skin prick test (SPT). RESULTS The 12-month treatment achieved a significant (p < 0.001) decrease of SMS. Symptom score showed only 41% (CI: 26-61) of placebo values, whereas medication was 34.5% (22.4%-63.3%). Treatment was regarded clinically effective in 67% of patients (OR 32; 95%CI: 17 to 102). The effect size on symptoms and medication was higher than has been reported with equivalent allergen dosages of D. pteronyssinus and D. siboney in Cuban asthmatic patients. Skin reactivity to Bt was also significantly reduced (p = 0.0001), increasing 148-fold the allergen threshold to elicit a positive skin test. This desensitization effect was specific to Bt and did not modify the reactivity to Dermatophagoides. The change of specific skin reactivity was significantly (p < 0.05) correlated to clinical improvement. All adverse events were local with a frequency of 2.4% of injections. CONCLUSIONS Subcutaneous AIT with Blomia tropicalis was effective and safe in asthmatic adults exposed and sensitized to this mite species in a tropical environment. TRIAL REGISTRATION Cuban Public Registry of Clinical Trials: RPCEC00000026 (WHO International Clinical Trial Registry Platform ICTRP).
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Key Words
- AIT, Allergen immunotherapy
- ALK, Denmark-based pharmaceutical company
- BIOCEN, National Center of Bioproducts
- BU, Biological Units
- BU/mL, Biological units per milliliter
- Blo t, Mayor allegen of Blomia tropicalis
- Blomia tropicalis
- Bt, Blomia tropicalis or B. tropicalis
- CECMED, Center for State Control of Drugs, Equipment and Medical Devices
- Ch10, Allergen specific reactivity calculated relative to the Histamine HC 10 mg/mL
- Clinical trial
- Dp or D, pteronyssinus: Dermatophagoides pteronyssinus
- Ds or D, siboney: Dermatophagoides siboney
- HDM SCIT, Immunotherpy Subcutaneous with allergens of House Dust Mite
- HDM, House Dust Mite
- OCI, Overall clinical improvement
- PEF, Peak Expiratory Flow
- SM, Symptom and Medication
- SMD, Standard Mean Difference
- Standardized allergen extract
- Subcutaneous immunotherapy
- VALERGEN-BT, Standardized allergen extract of Blomia tropicalis
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Affiliation(s)
- Raúl Lázaro Castro-Almarales
- Second Degree Specialist in Allergy and Integral General Medicine, Master in Transmissible Diseases, Auxiliary Professor, “General Calixto García” University Hospital, Havana University of Medical Science. Auxiliary Researcher, National Center of Bioproducts, Bejucal, Mayabeque, Cuba
| | - Mercedes Ronquillo-Díaz
- Second Degree Specialist in Allergy, Master in Occupational Health, Auxiliary Professor, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - Mirta Álvarez-Castelló
- Second Degree Specialist in Allergy, Auxiliary Professor and Researcher, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - José Rodríguez-Canosa
- Second Degree Specialist in Allergy, Master in Transmissible Diseases, Auxiliary Professor, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - Mayda González-León
- Second Degree Specialist in Integral General Medicine, Master in Natural and Traditional Medicine, Teaching Polyclinic “Pedro Fonseca Álvarez”, Havana, Cuba
| | - Irene Enríquez-Domínguez
- First Degree Specialist in Allergy and Integral General Medicine, Master in Child Integral Care, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana, Cuba
| | | | - Maytee Mateo-Morejón
- Master in Biotechnology, National Center of Bioproducts, Allergens Department, Bejucal, Mayabeque, Cuba
| | - Yunia Oliva-Díaz
- National Center of Bioproducts, Allergen Department, Bejucal, Mayabeque, Cuba
| | - Wendy Ramírez-González
- Master in Biochemistry, National Center of Bioproducts, Allergens Department, Bejucal, Mayabeque, Cuba
| | - Linda Cox
- Allergy & Asthma Center, Fort Lauderdale, Florida, USA
| | - Alexis Labrada-Rosado
- Full Researcher, Research and Development Director, National Center of Bioproducts, Bejucal, Mayabeque, Cuba
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Fazlollahi MR, Najmi M, Fallahnezhad M, Sabetkish N, Kazemnejad A, Bidad K, Shokouhi Shoormasti R, Mahloujirad M, Pourpak Z, Moin M. Paediatric asthma prevalence: The first national population-based survey in Iran. CLINICAL RESPIRATORY JOURNAL 2019; 13:14-22. [PMID: 30472812 DOI: 10.1111/crj.12975] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/26/2018] [Accepted: 11/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The actual prevalence of paediatric asthma as a worldwide chronic disease has been surveyed in developed countries. However, no sufficient survey has been conducted in most of the eastern developing countries. Herein, we took measures to evaluate the prevalence of paediatric asthma in Iran. METHODS In this national cross-sectional study, the prevalence of asthma symptoms was estimated throughout the country using a randomized multistage stratified cluster sampling method in 16 410 and 16 850 individuals aged 6-7 and 13-14 years, respectively. A validated questionnaire including core questions of the International Study of Asthma and Allergies in Childhood (ISAAC) was applied between November 2015 and February 2016. RESULTS The total prevalence of asthma was 10.9% (n = 3624) (95% confidence interval [CI]: 10.6%-11.2%) which was significantly higher among 13- to 14-year olds compared to a younger age group (12.4% vs. 9.4%, P < 0.001), males versus females (12.1% vs. 9.8%, P < 0.001) and residents of urban compared to rural areas (P = 0.003). The prevalence of severe asthma was 3.9%, being significantly more prevalent in higher age groups and male individuals (P < 0.001). A significant relationship was found between asthma and passive smoking in both 6- to 7- and 13- to 14-year olds (P < 0.001). CONCLUSIONS The prevalence of asthma and severe asthma in the paediatric population of Iran was similar to other developing countries. It is recommended to pay special attention to urban regions, male individuals and higher age groups for better controlling of asthma. Nevertheless, further national surveys are necessary to determine the trend of paediatric asthma in Iran.
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Affiliation(s)
- Mohammad Reza Fazlollahi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Najmi
- Center of Non-communicable Diseases Management, Deputy for health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mojtaba Fallahnezhad
- Razi Science Researchers Institute, Tehran, Iran.,Health Department of Zanjan, University of Medical Sciences, Zanjan, Iran
| | - Nastaran Sabetkish
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Katayoon Bidad
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Mahloujirad
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Pourpak
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Moin
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ardura-Garcia C, Garner P, Cooper PJ. Is childhood wheeze and asthma in Latin America associated with poor hygiene and infection? A systematic review. BMJ Open Respir Res 2018. [PMID: 29531744 PMCID: PMC5844372 DOI: 10.1136/bmjresp-2017-000249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction High asthma prevalence in Latin-American cities is thought to be caused by poor hygiene and infections. This contradicts the widely accepted 'hygiene hypothesis' for asthma aetiology. Methods Systematic review of observational studies evaluating the association between poor hygiene exposures or infections and asthma/wheeze among Latin-American children aged 4-16 years. MEDLINE, EMBASE, LILACS and CINAHL electronic databases were searched following a predefined strategy to 18 December 2017. We quantified outcomes measured and reported, assessed risk of bias and tabulated the results. Results Forty-five studies included: 6 cohort, 30 cross-sectional and 9 case-control studies. 26 cross-sectional studies were school-based surveys (14 of over 3000 children), whereas 5 case-control studies were hospital/health centre-based. Exposures measured and reported varied substantially between studies, and current wheeze was the most common outcome reported. Data showed selective reporting based on statistical significance (P value <0.05): 17/45 studies did not clearly describe the number of exposures measured and 15/45 studies reported on less than 50% of the exposures measured. Most exposures studied did not show an association with wheeze or asthma, except for a generally increased risk associated with acute respiratory infections in early life. Contradictory associations were observed frequently between different studies. Conclusion Selective reporting is common in observational studies exploring the association between environmental exposures and risk of wheeze/asthma. This, together with the use of different study outcomes (wheeze/asthma) associated with possibly distinct causal mechanisms, complicates inferences about the role of poor hygiene exposures and childhood infections in explaining asthma prevalence in Latin-American children.
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Affiliation(s)
| | - Paul Garner
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Philip J Cooper
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's, University of London, London, UK
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Fernandes SDSC, Andrade CRD, Alvim CG, Camargos PAM, Ibiapina CDC. Epidemiological trends of allergic diseases in adolescents. J Bras Pneumol 2018; 43:368-372. [PMID: 29160383 PMCID: PMC5790655 DOI: 10.1590/s1806-37562016000000255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 05/04/2017] [Indexed: 01/07/2023] Open
Abstract
Objective: To assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in adolescents in the city of Belo Horizonte, Brazil, in 2012 by administering the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as to compare the observed prevalences with those found in studies performed 10 years earlier and employing the same methodology used here. Methods: This was a cross-sectional study conducted between May and December of 2012 and involving adolescents in the 13- to 14-year age bracket. Participants were randomly selected from among adolescents studying at public schools in Belo Horizonte and completed the ISAAC questionnaire. Proportions were calculated in order to assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in the sample as a whole, and the chi-square goodness-of-fit test was used in order to compare the prevalences observed in 2012 with those found in 2002. Results: The prevalences of symptoms of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in 2012 were 19.8%, 35.3%, and 16.3%, respectively, being significantly higher than those found in 2002 (asthma, p = 0.006; allergic rhinitis, p < 0.01; and allergic rhinoconjunctivitis, p = 0.002). Conclusions: The prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis among adolescents in 2012 were found to be high, having increased in comparison with those found 10 years earlier, despite efforts in prevention, diagnosis, and treatment.
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Affiliation(s)
| | - Cláudia Ribeiro de Andrade
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Cristina Gonçalves Alvim
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | | | - Cássio da Cunha Ibiapina
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
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Repercussions of preterm birth on symptoms of asthma, allergic diseases and pulmonary function, 6-14 years later. Allergol Immunopathol (Madr) 2016; 44:489-496. [PMID: 27756492 DOI: 10.1016/j.aller.2016.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/29/2016] [Accepted: 04/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prevalence of allergic diseases and impaired pulmonary function may be high in children born prematurely. This study aimed to assess pulmonary function and prevalence of asthma, atopic diseases and allergic sensitisation in these patients. METHODS A cross-sectional study was conducted with children aged 6-14 years who were born prematurely with birth weight <2000g from January 2008 to May 2011. Exclusion criteria were: major malformations, or acute respiratory disorders. The International Study of Asthma and Allergies in Childhood questionnaire was applied followed by allergic skin prick test and spirometry. RESULTS The study included 84 children aged 9.3±2.3 years born at mean gestational age of 31.8±2.4 weeks. The prevalence of current asthma was 25%, more severe asthma was 15.5%; rhinitis was 38.1%; flexural eczema was 8.3%; and a positive skin-prick test was 69.6%. Frequencies of children with values <80% of predicted were: FVC (8.3%), FEV1 (22.6%), and FEV1/FVC ratio (16.7%). Prevalence of children with FEF25-75% <70% of the predicted value was 32.4%, positive bronchodilator response was observed in 20.5% of cases, and altered pulmonary function in 42.9%. Factors associated with altered pulmonary function were oxygen dependency at 28 days of life (OR: 4.213, p=0.021), the presence of wheezing in childhood (OR: 5.979, p=0.014) and infant's height (OR: 0.945, p=0.005). CONCLUSIONS There was a high prevalence of severe asthma, allergic sensitisation, and altered pulmonary function among children and adolescents born prematurely. Bronchopulmonary dysplasia and a history of wheezing were risk factors for altered pulmonary function.
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Silva ESD, Pinheiro CS, Quintella CM, Ferreira F, C Pacheco LG, Alcântara-Neves NM. Advances in patent applications related to allergen immunotherapy. Expert Opin Ther Pat 2016; 26:657-68. [PMID: 27011299 DOI: 10.1517/13543776.2016.1170809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Allergies are among the most prevalent chronic diseases worldwide. Allergen-specific immunotherapy is used as an alternative treatment to pharmacotherapy. These immunotherapies are performed with crude extracts, which have disadvantages when compared to the new approaches, among them are recombinant proteins and hypoallergens. This review aims to assess immunotherapy for allergies through patent application analysis spanning recent decades. AREAS COVERED Patents referring to allergen immunotherapies used in allergy treatment. Data were obtained from the Espacenet® website, using the Cooperative Patent Classification (CPC) system. Two-hundred-and-one patent applications were analyzed, taking into consideration their classification by the type of technology and applicant. EXPERT OPINION Allergen-specific immunotherapy represents the only potentially curative therapeutic intervention for the treatment of allergic diseases. The extract-based immunotherapy is being replaced by the use of recombinant allergens, highlighting the hypoallergenic forms, which have low IgE-binding while retaining T-cell reactivity. It is expected that the development of hypoallergens will expand the scope of allergen-specific immunotherapy, especially if associated with alternative systems for expression and delivery systems with future potential. Furthermore, these new developments will likely address the problem of long-term protocols in allergen-specific immunotherapy, thus allowing better patient adherence and compliance.
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Affiliation(s)
- Eduardo Santos da Silva
- a Instituto de Ciências da Saúde - ICS , Universidade Federal da Bahia (UFBA) , Salvador , Bahia , Brazil.,b Programa de Pós-Graduação em Biotecnologia da Rede Nordeste de Biotecnologia (RENORBIO) , Universidade Estadual do Ceará , Fortaleza , Brazil
| | - Carina Silva Pinheiro
- a Instituto de Ciências da Saúde - ICS , Universidade Federal da Bahia (UFBA) , Salvador , Bahia , Brazil
| | | | - Fatima Ferreira
- d Department of Molecular Biology , University of Salzburg , Salzburg , Austria
| | - Luis Gustavo C Pacheco
- a Instituto de Ciências da Saúde - ICS , Universidade Federal da Bahia (UFBA) , Salvador , Bahia , Brazil
| | - Neuza Maria Alcântara-Neves
- a Instituto de Ciências da Saúde - ICS , Universidade Federal da Bahia (UFBA) , Salvador , Bahia , Brazil.,b Programa de Pós-Graduação em Biotecnologia da Rede Nordeste de Biotecnologia (RENORBIO) , Universidade Estadual do Ceará , Fortaleza , Brazil
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Hussein AH, Elawamy W. Quantitation of Blomia tropicalis allergen Blo t 5 in cereal and cereal-based foods consumed in the Nile Delta, Egypt. Am J Trop Med Hyg 2015; 93:194-7. [PMID: 25870423 DOI: 10.4269/ajtmh.14-0837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/11/2015] [Indexed: 11/07/2022] Open
Abstract
The mite Blomia tropicalis has significant prevalence worldwide. Blo t 5 is a major B. tropicalis allergen that has been associated with sensitization and allergic symptoms in many asthmatic patients. Besides house dust, contaminated foodstuffs are an important source of exposure to B. tropicalis allergens. In this study, a double sandwich enzyme-linked immunosorbent assay (ELISA) using mAb 4D4 and biotinylated mAb 4G9 was done to detect Blo t 5 allergen in different types of raw and processed foods, including wheat, corn, rice, bean, wheat and corn flour, cake, and rusk, which were collected from retail stores in the Nile Delta of Egypt. Out of 88 samples, 38 (43.2%) were positive for Blo t 5 allergen with no significant statistical difference in positivity according to food type. In positive samples, the Blo t 5 concentration ranged from 10 ng/g to 790 ng/g. This study showed that Blo t 5 should be considered as an important allergen that presents a risk to the Egyptian population and should become a routine allergen in the skin prick test to improve the management of allergic disease.
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Affiliation(s)
- Atef H Hussein
- Department of Parasitology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Waleed Elawamy
- Department of Parasitology, Benha Faculty of Medicine, Benha University, Benha, Egypt
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