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Santaolalla M, Arias-Irigoyen J, Soler JM, Duque JM, Escudero R, Pérez-Formoso JL, Lobera T, Rueda M, Alias C, Hermida H, Vela C, Begoña L, Vazquez A, Madariaga B. Efficacy and safety of subcutaneous immunotherapy with polymerized allergen mixtures in polyallergic patients - ARES observational study. Expert Rev Clin Immunol 2024:1-12. [PMID: 38934292 DOI: 10.1080/1744666x.2024.2373886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Administration of allergen mixtures of many components comprises the most common approach for American allergists regarding the management of polyallergic patients. European allergists, however, are more reluctant to this type of treatment due to the potential drawbacks of mixing extracts. RESEARCH DESIGN AND METHODS To assess the efficacy and safety of subcutaneous immunotherapy (SCIT) with polymerized allergen mixtures without dilutional effect in polyallergic patients.This observational, prospective, multicenter study included patients (between 5 and 60 years) with respiratory allergic diseases that had been prescribed with SCIT with mixtures of two pollen or mite extracts. Changes in Symptoms and Medication Score (SMS) and in rhinitis quality of life questionnaire (RQLQ), subjective clinical improvement, treatment satisfaction and tolerability were assessed after the 1-year treatment. RESULTS A total of 115 patients were included in the assessment. Mean global SMS decreased from 3.5 (SD = 1.1) to 1.6 (SD = 1.2) points, with a mean absolute reduction of 1.6 (SD = 1.3) points in the RQLQ score (p < 0.001, Wilcoxon test). General subjective clinical improvements and a good treatment satisfaction and tolerability were observed. CONCLUSION SCIT with polymerized allergen mixtures from either pollen or mite extracts proved to be an effective and safe treatment option for polyallergic patients suffering from allergic respiratory diseases.
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Affiliation(s)
| | | | - Jose Miguel Soler
- Allergy and Clinical Immunology Unit, ALLERCEN, Barcelona, Catalonia, Spain
| | | | - Rosario Escudero
- Allergy department, Fundación Hospital Calahorra, Calahorra, La Rioja, Spain
| | | | - Teófilo Lobera
- Allergy department, CAR San Millán, Logroño, La Rioja, Spain
| | - María Rueda
- Allergy department, Hospital Quirónsalud Barcelona, Barcelona, Catalonia, Spain
| | - César Alias
- Allergy unit, Centre Assitencial Baix Llobregat, Cornellà de Llobregat, Catalonia, Spain
| | - Helena Hermida
- Allergy unit, Policlínica Augusta, Badalona, Catalonia, Spain
| | - Catalina Vela
- Allergy unit, Logroño Promosalud, Logroño, La Rioja, Spain
| | - Leire Begoña
- Medical Department, ROXALL Medicina España S.A, Zamudio, Basque Country, Spain
| | - Alexander Vazquez
- Medical Department, ROXALL Medicina España S.A, Zamudio, Basque Country, Spain
| | - Begoña Madariaga
- Medical Department, ROXALL Medicina España S.A, Zamudio, Basque Country, Spain
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2
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Ojeda P, Barjau MC, Subiza J, Moreno A, Ojeda I, Solano E, Alonso A, Caballero R, Del Pozo S, Gómez-Perosanz M, Sánchez-Trincado JL, Benito-Villalvilla C, Angelina A, Soria I, Reche PA, Palomares O, Subiza JL, Casanovas M. Grass pollen allergoids conjugated with mannan for subcutaneous and sublingual immunotherapy: a dose-finding study. Front Immunol 2024; 15:1431351. [PMID: 38989287 PMCID: PMC11233432 DOI: 10.3389/fimmu.2024.1431351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
Background Polymerized allergoids conjugated with mannan represent a novel approach of allergen immunotherapy targeting dendritic cells. In this study, we aimed to determine the optimal dose of mannan-allergoid conjugates derived from grass pollen (Phleum pratense and Dactylis glomerata) administered via either the subcutaneous or sublingual route. Methods A randomized, double-blind, placebo-controlled trial with a double-dummy design was conducted, involving 162 participants across 12 centers in Spain. Subjects were randomly allocated to one of nine different treatment groups, each receiving either placebo or active treatment at doses of 500, 1,000, 3,000, or 5,000 mTU/mL over four months. Each participant received five subcutaneous (SC) doses of 0.5 mL each, every 30 days, and a daily sublingual (SL) dose of 0.2 mL. Participants who received active treatment through SC, received placebo through SL. Participants who received active treatment through SL, received placebo SC. One Group, as control, received bot SC and SL placebo. The primary efficacy outcome was the improvement in titrated nasal provocation tests (NPT) at the end of the study compared to baseline. Secondary outcomes included specific antibody (IgG4, IgE) and cellular (IL-10 producing and regulatory T cell) responses. All adverse events and side reactions were recorded and assessed. Results Post-treatment, the active groups showed improvements in NPT ranging from 33% to 53%, with the highest doses showing the greatest improvements regardless of the administration route. In comparison, the placebo group showed a 12% improvement. Significant differences over placebo were observed at doses of 3,000 mTU/mL (p=0.049 for SL, p=0.015 for SC) and 5,000 mTU/mL (p=0.011 for SL, p=0.015 for SC). A dose-dependent increase in IgG4 was observed following SC administration, and an increase in IL-10 producing cells for both routes of administration. No serious systemic or local adverse reactions were recorded, and no adrenaline was required. Conclusion Grass pollen immunotherapy with mannan-allergoid conjugates was found to be safe and efficacious in achieving the primary outcome, whether administered via the subcutaneous or sublingual routes, at doses of 3,000 and 5,000 mTU/mL. Clinical trial registration https://www.clinicaltrialsregister.eu/ctr-search (EudraCT), identifier 2014-005471-88; https://www.clinicaltrials.gov, identifier NCT02654223.
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Affiliation(s)
- Pedro Ojeda
- Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain
| | | | | | | | - Isabel Ojeda
- Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain
| | - Emilio Solano
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Sandra Del Pozo
- Inmunotek, Alcalá de Henares, Spain
- Department of Medicine and Medical Specialities, Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, Spain
| | - Marta Gómez-Perosanz
- Inmunotek, Alcalá de Henares, Spain
- Department of Immunology & O2, School of Medicine, University Complutense of Madrid, Madrid, Spain
| | | | - Cristina Benito-Villalvilla
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
| | - Alba Angelina
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
| | | | - Pedro A Reche
- Department of Immunology & O2, School of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
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Nieto A, Mazón Á, Nieto M, Ibáñez E, Jang D, Calaforra S, Alba P, Pérez‐Francés C, Llusar R, Montoro J, de Mateo A, Alamar R, El‐Qutob D, Fernández J, Moral L, Toral T, Antón M, Andreu C, Ferrer Á, Flores I, Cerdá N, del Pozo S, Caballero R, Subiza JL, Casanovas M. First-in-human phase 2 trial with mite allergoids coupled to mannan in subcutaneous and sublingual immunotherapy. Allergy 2022; 77:3096-3107. [PMID: 35570712 PMCID: PMC9796063 DOI: 10.1111/all.15374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/31/2022] [Accepted: 04/20/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Polymerized allergens conjugated to non-oxidized mannan (PM-allergoids) are novel vaccines targeting dendritic cells (DCs). Previous experimental data indicate that PM-allergoids are readily taken up by DCs and induce Treg cells. This first-in-human study was aimed to evaluate safety and to find the optimal dose of house dust mite PM-allergoid (PM-HDM) administered subcutaneously (SC) or sublingually (SL). METHODS In a randomized, double-blind, double-dummy, placebo-controlled trial, 196 subjects received placebo or PM-HDM at 500, 1000, 3000, or 5000 mannan-conjugated therapeutic units (mTU)/mL in 9-arm groups for 4 months. All subjects received 5 SC doses (0.5 ml each) every 30 days plus 0.2 ml SL daily. The primary efficacy outcome was the improvement of titrated nasal provocation tests (NPT) with D. pteronyssinus at baseline and at the end of the study. All adverse events and reactions were recorded and assessed. Secondary outcomes were the combination of symptom and medication scores (CSMS) and serological markers. RESULTS No moderate or severe adverse reactions were reported. Subjects improving the NPT after treatment ranged from 45% to 62% in active SC, 44% to 61% in active SL and 16% in placebo groups. Statistical differences between placebo and active groups were all significant above 500 mTU, being the highest with 3000 mTU SL (p = 0.004) and 5000 mTU SC (p = 0.011). CSMS improvement over placebo reached 70% (p < 0.001) in active 3000 mTU SC and 40% (p = 0.015) in 5000 mTU SL groups. CONCLUSIONS PM-HDM immunotherapy was safe and successful in achieving primary and secondary clinical outcomes in SC and SL at either 3000 or 5000 mTU/ml.
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Affiliation(s)
- Antonio Nieto
- Unit of Pediatric Allergy and PneumologyHospital Universitari i Politècnic la FeValenciaSpain
| | - Ángel Mazón
- Unit of Pediatric Allergy and PneumologyHospital Universitari i Politècnic la FeValenciaSpain
| | - María Nieto
- Unit of Pediatric Allergy and PneumologyHospital Universitari i Politècnic la FeValenciaSpain
| | - Ethel Ibáñez
- Department of AllergyHospital Universitari i Politècnic la FeValenciaSpain
| | - Dah‐Tay Jang
- Unit of Pediatric Allergy and PneumologyHospital Universitari i Politècnic la FeValenciaSpain
| | | | - Pilar Alba
- Allergy ServiceHospital ManisesValenciaSpain
| | | | - Ruth Llusar
- Allergy ServiceUniversity Hospital Doctor PesetValenciaSpain
| | - Javier Montoro
- Allergy ServiceUniversity Hospital Arnau de VilanovaValenciaSpain
| | | | | | - David El‐Qutob
- Allergy ServiceUniversity Hospital de la PlanaCastellónSpain
| | - Javier Fernández
- Allergy ServiceHospital General Universitario Dr. Balmis, ISABIALAlicanteSpain
| | - Luis Moral
- Pediatric Allergy and Respiratory UnitHospital Universitario Dr. Balmis, ISABIALAlicanteSpain
| | - Teresa Toral
- Pediatric Allergy and Respiratory UnitHospital Universitario Dr. Balmis, ISABIALAlicanteSpain
| | - Mónica Antón
- Allergy ServiceUniversity Hospital VinalopóElche, AlicanteSpain
| | - Carmen Andreu
- Allergy ServiceHospital Vega BajaOrihuela, AlicanteSpain
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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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Heldner A, Alessandrini F, Russkamp D, Heine S, Schnautz B, Chaker A, Mwange J, Carreno Velazquez TL, Heath MD, Skinner MA, Kramer MF, Zissler UM, Schmidt‐Weber CB, Blank S. Immunological effects of adjuvanted low-dose allergoid allergen-specific immunotherapy in experimental murine house dust mite allergy. Allergy 2022; 77:907-919. [PMID: 34287971 DOI: 10.1111/all.15012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/28/2021] [Accepted: 06/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Native allergen extracts or chemically modified allergoids are routinely used to induce allergen tolerance in allergen-specific immunotherapy (AIT), although mechanistic side-by-side studies are rare. It is paramount to balance optimal dose and allergenicity to achieve efficacy warranting safety. AIT safety and efficacy could be addressed by allergen dose reduction and/or use of allergoids and immunostimulatory adjuvants, respectively. In this study, immunological effects of experimental house dust mite (HDM) AIT were investigated applying high-dose HDM extract and low-dose HDM allergoids with and without the adjuvants microcrystalline tyrosine (MCT) and monophosphoryl lipid A (MPL) in a murine model of HDM allergy. METHODS Cellular, humoral, and clinical effects of the different AIT strategies were assessed applying a new experimental AIT model of murine allergic asthma based on physiological, adjuvant-free intranasal sensitization followed by subcutaneous AIT. RESULTS While low-dose allergoid and high-dose extract AIT demonstrated comparable potency to suppress allergic airway inflammation and Th2-type cytokine secretion of lung-resident lymphocytes and draining lymph node cells, low-dose allergoid AIT was less effective in inducing a potentially protective IgG1 response. Combining low-dose allergoid AIT with MCT or MCT and dose-adjusted MPL promoted Th1-inducing mechanisms and robust B-cell activation counterbalancing the allergic Th2 immune response. CONCLUSION Low allergen doses induce cellular and humoral mechanisms counteracting Th2-driven inflammation by using allergoids and dose-adjusted adjuvants. In light of safety and efficacy improvement, future therapeutic approaches may use low-dose allergoid strategies to drive cellular tolerance and adjuvants to modulate humoral responses.
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Affiliation(s)
- Alexander Heldner
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Francesca Alessandrini
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Dennis Russkamp
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Sonja Heine
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Benjamin Schnautz
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Adam Chaker
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
- Department of Otolaryngology, Klinikum rechts der Isar Faculty of Medicine Technical University of Munich Munich Germany
| | | | | | | | | | - Matthias F. Kramer
- Allergy Therapeutic PLC. Worthing UK
- Bencard Allergie GmbH Munich Germany
| | - Ulrich M. Zissler
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Carsten B. Schmidt‐Weber
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
| | - Simon Blank
- Center of Allergy and Environment (ZAUM) Technical University of Munich, Faculty of Medicine and Helmholtz Center Munich German Research Center for Environmental Health Member of the German Center of Lung Research (DZL) Member of the Immunology and Inflammation Initiative of the Helmholtz AssociationMunich Germany
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Allergen Immunotherapy: Current and Future Trends. Cells 2022; 11:cells11020212. [PMID: 35053328 PMCID: PMC8774202 DOI: 10.3390/cells11020212] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 02/06/2023] Open
Abstract
Allergen immunotherapy (AIT) is the sole disease-modifying treatment for allergic rhinitis; it prevents rhinitis from progressing to asthma and lowers medication use. AIT against mites, insect venom, and certain kinds of pollen is effective. The mechanism of action of AIT is based on inducing immunological tolerance characterized by increased IL-10, TGF-β, and IgG4 levels and Treg cell counts. However, AIT requires prolonged schemes of administration and is sometimes associated with adverse reactions. Over the last decade, novel forms of AIT have been developed, focused on better allergen identification, structural modifications to preserve epitopes for B or T cells, post-traductional alteration through chemical processes, and the addition of adjuvants. These modified allergens induce clinical-immunological effects similar to those mentioned above, increasing the tolerance to other related allergens but with fewer side effects. Clinical studies have shown that molecular AIT is efficient in treating grass and birch allergies. This article reviews the possibility of a new AIT to improve the treatment of allergic illness.
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Alba P, Moreno V, Arias-Irigoyen J, Antón M, Parra A, Gómez-Fernández MC, Madariaga B, Martínez A, Begoña L. Safety evaluation of a multiallergen immunotherapy treatment in polyallergic patients. APOLO observational study. Immunotherapy 2020; 12:75-87. [PMID: 31902260 DOI: 10.2217/imt-2019-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: Assessment of safety, tolerability and changes in global clinical impression with an multiallergen immunotherapy treatment without dilutional effect in polyallergic patients. Patients & methods: This observational prospective study included patients with allergic rhinitis-rhinoconjunctivitis with or without asthma between 5 and 60 years old receiving immunotherapy treatment with a mixture of two allergenic sources. All adverse events were recorded. Global clinical impression, tolerability subjective assessment and satisfaction were also assessed. Results: 130 patients were analyzed. Nine clinically relevant local adverse reactions were reported in six patients (4.6%). Six systemic reactions (grades 0-I) occurred in four patients (3.1%). Patients improved significantly in their global clinical impression. Good tolerability subjective assessment and satisfaction values were also observed. Conclusion: This multiallergen immunotherapy treatment without dilutional effect can be considered as a potential therapeutic alternative for polyallergic patients suffering from allergic rhinitis.
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Affiliation(s)
- Pilar Alba
- Hospital de Manises. Allergy Department, Manises, Valencia, Spain
| | | | | | - Mónica Antón
- Department of Allergy, Hospital Universitario del Vinalopó. Elche, Alicante, Spain
| | - Antonio Parra
- Department of Allergy, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Begoña Madariaga
- R&D Department, ROXALL Medicina España S.A., Zamudio, Bizkaia, Spain
| | - Alberto Martínez
- R&D Department, ROXALL Medicina España S.A., Zamudio, Bizkaia, Spain
| | - Leire Begoña
- R&D Department, ROXALL Medicina España S.A., Zamudio, Bizkaia, Spain
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Leung TF. In-season Dosage Adjustment for Pollen Subcutaneous Immunotherapy: The Controversy Continues. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1440-1441. [DOI: 10.1016/j.jaip.2017.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023]
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