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Yu J, Zhong N, Luo Q, Liu Y, Yi H, Ye J, Zhang J. Early Efficacy Analysis of Cluster and Conventional Immunotherapy in Patients With Allergic Rhinitis. EAR, NOSE & THROAT JOURNAL 2019; 100:378-385. [PMID: 31547713 DOI: 10.1177/0145561319863370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Specific immunotherapy is an important immune-modifying treatment for patients with allergic rhinitis (AR). We compared the early efficacy and safety of cluster and conventional immunotherapies for patients with AR. METHODS One hundred forty-nine patients with persistent AR were enrolled in a randomized and open-label trial and were divided into the following 4 groups: 60 children treated conventionally, 33 children treated using the cluster schedule, 23 adults treated conventionally, and 33 adults treated using the cluster schedule. Patients in the cluster groups reached the maintenance dose within 6 weeks, while those receiving conventional therapy reached the maintenance dose within 14 weeks. Symptom scores and skin prick test scores (SPTs) were used to evaluate clinical efficacy and adverse reactions. RESULTS After buildup phase of treatment, symptom scores, and SPTs were significantly lower than those prior to treatment in each group (P < .05). No significant differences were found in the efficacy of nasal symptoms scores among four groups (P > .05).However, the efficacy of SPTs using conventional schedule was higher than cluster schedule in children groups (group A and B, 57.7 vs 30.2%, P = .001). Besides, the efficacy of SPTs in adults was higher than children when using the cluster treatment (group D and B, 53.0 vs 30.2%, P = .008). No severe adverse reaction occurred. CONCLUSIONS Conventional and cluster immunotherapy schedules have similar efficacies, which do not vary with age; both schedules are safe and reliable. Also, SPT facilitate evaluation of clinical efficacy.
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Affiliation(s)
- Jieqing Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Nongping Zhong
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qing Luo
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yuanhua Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Huarong Yi
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Jing Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Jian Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
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Ricketti PA, Alandijani S, Lin CH, Casale TB. Investigational new drugs for allergic rhinitis. Expert Opin Investig Drugs 2017; 26:279-292. [DOI: 10.1080/13543784.2017.1290079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Peter A. Ricketti
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Sultan Alandijani
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Chen Hsing Lin
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
| | - Thomas B. Casale
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Division of Allergy and Immunology, Tampa, FL, USA
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Perez‐Witzke D, Miranda‐García MA, Suárez N, Becerra R, Duque K, Porras V, Fuenmayor J, Montano RF. CTLA4Fcε, a novel soluble fusion protein that binds B7 molecules and the IgE receptors, and reduces human in vitro soluble CD23 production and lymphocyte proliferation. Immunology 2016; 148:40-55. [PMID: 26801967 PMCID: PMC4819142 DOI: 10.1111/imm.12586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/18/2015] [Accepted: 01/19/2016] [Indexed: 12/31/2022] Open
Abstract
Immunoglobulin E-mediated allergy and certain autoimmune diseases are characterized by the presence of a T helper type 2 (Th2) immune response and allergen-specific or self-reactive IgE. Soluble CD23 (sCD23) is a B-cell factor that fosters IgE class-switching and synthesis, suggesting that sCD23 may be a therapeutic target for these pathologies. We produced a recombinant protein, CTLA4Fcε, by fusing the ectodomain of the immunoregulatory molecule cytotoxic T-lymphocyte antigen 4 (CTLA-4) with a fragment of the IgE H-chain constant region. In SDS-PAGE/inmunoblot analyses, CTLA4Fcε appeared as a 70,000 MW polypeptide that forms homodimers. Flow cytometry showed that CTLA4Fcε binds to IgE receptors FcεRI and FcεRII/CD23, as well as to CTLA-4 counter-receptors CD80 and CD86. Binding of CTLA4Fcε to FcεRII/CD23 appeared stronger than that of IgE. Since the cells used to study CD23 binding express CD80 and CD86, simultaneous binding of CTLA4Fcε to CD23 and CD80/CD86 seems to occur and would explain this difference. As measured by a human CD23-specific ELISA, CTLA4Fcε - but not IgE - induced a concentration-dependent reduction of sCD23 in culture supernatants of RPMI-8866 cells. Our results suggest that the simultaneous binding of CTLA4Fcɛ to CD23-CD80/CD86 may cause the formation of multi-molecular complexes that are either internalized or pose a steric hindrance to enzymatic proteolysis, so blocking sCD23 generation. CTLA4Fcε caused a concentration-dependent reduction of lymphocyte proliferation in human peripheral blood mononuclear cell samples stimulated in vitro with concanavalin A. The ability to bind IgE receptors on effector cells, to regulate the production of sCD23 and to inhibit lymphocyte proliferation suggests that CTLA4Fcɛ has immunomodulatory properties on human Th2 responses.
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Affiliation(s)
- Daniel Perez‐Witzke
- Laboratorio de Patología Celular y MolecularCentro de Medicina ExperimentalInstituto Venezolano de Investigaciones CientíficasCaracasVenezuela
| | - María Auxiliadora Miranda‐García
- Laboratorio de Patología Celular y MolecularCentro de Medicina ExperimentalInstituto Venezolano de Investigaciones CientíficasCaracasVenezuela
- Present address: Department of Paediatric Rheumatology and ImmunologyUniversity Hospital MuensterMuensterGermany
| | - Nuris Suárez
- Laboratorio de Patología Celular y MolecularCentro de Medicina ExperimentalInstituto Venezolano de Investigaciones CientíficasCaracasVenezuela
| | - Raquel Becerra
- Laboratorio de Patología Celular y MolecularCentro de Medicina ExperimentalInstituto Venezolano de Investigaciones CientíficasCaracasVenezuela
- Present address: Molecular Neurobiology LaboratoryBiomedicine Research Institute of Buenos AiresCONICET‐Partner Institute of Max Planck SocietyBuenos AiresArgentina
| | - Kharelys Duque
- Laboratorio de Patología Celular y MolecularCentro de Medicina ExperimentalInstituto Venezolano de Investigaciones CientíficasCaracasVenezuela
| | - Verónica Porras
- Laboratorio de Patología Celular y MolecularCentro de Medicina ExperimentalInstituto Venezolano de Investigaciones CientíficasCaracasVenezuela
| | - Jaheli Fuenmayor
- Laboratorio de Patología Celular y MolecularCentro de Medicina ExperimentalInstituto Venezolano de Investigaciones CientíficasCaracasVenezuela
| | - Ramon Fernando Montano
- Laboratorio de Patología Celular y MolecularCentro de Medicina ExperimentalInstituto Venezolano de Investigaciones CientíficasCaracasVenezuela
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Caminati M, Dama AR, Djuric I, Montagni M, Schiappoli M, Ridolo E, Senna G, Canonica GW. Incidence and risk factors for subcutaneous immunotherapy anaphylaxis: the optimization of safety. Expert Rev Clin Immunol 2014; 11:233-45. [PMID: 25484197 DOI: 10.1586/1744666x.2015.988143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fatal reactions related to subcutaneous allergen immunotherapy are rare: one event in 2.5 million injections has been reported in the USA and none in Europe. The prevalence of very severe systemic reactions (systemic adverse events [SAEs]) is one in 1 million injections. Though the serious events rate is decreasing and the majority of SAEs (∼0.2% per injection) are moderate and reversible, they still represent a major concern. Uncontrolled asthma, long-term therapy with β-blockers and high degree of allergen sensitivity are generally considered risk factors. The relevance of other conditions, like previous local reactions, the use of extracts conjugated with adjuvants and accelerated build-up schedules is controversial, as well as the role of preventative strategies. A careful risk assessment of patients and optimal administration procedures may significantly decrease the risk of SAEs. However, more uniform safety data are required and an accurate safety profile should be provided for every allergen product.
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Affiliation(s)
- Marco Caminati
- Allergy Unit, Verona University and General Hospital, Verona, Italy
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Feng S, Xu Y, Ma R, Sun Y, Luo X, Li H. Cluster subcutaneous allergen specific immunotherapy for the treatment of allergic rhinitis: a systematic review and meta-analysis. PLoS One 2014; 9:e86529. [PMID: 24489740 PMCID: PMC3904879 DOI: 10.1371/journal.pone.0086529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/10/2013] [Indexed: 11/19/2022] Open
Abstract
Background Although allergen specific immunotherapy (SIT) represents the only immune- modifying and curative option available for patients with allergic rhinitis (AR), the optimal schedule for specific subcutaneous immunotherapy (SCIT) is still unknown. The objective of this study is to systematically assess the efficacy and safety of cluster SCIT for patients with AR. Methods By searching PubMed, EMBASE and the Cochrane clinical trials database from 1980 through May 10th, 2013, we collected and analyzed the randomized controlled trials (RCTs) of cluster SCIT to assess its efficacy and safety. Results Eight trials involving 567 participants were included in this systematic review. Our meta-analysis showed that cluster SCIT have similar effect in reduction of both rhinitis symptoms and the requirement for anti-allergic medication compared with conventional SCIT, but when comparing cluster SCIT with placebo, no statistic significance were found in reduction of symptom scores or medication scores. Some caution is required in this interpretation as there was significant heterogeneity between studies. Data relating to Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) in 3 included studies were analyzed, which consistently point to the efficacy of cluster SCIT in improving quality of life compared to placebo. To assess the safety of cluster SCIT, meta-analysis showed that no differences existed in the incidence of either local adverse reaction or systemic adverse reaction between the cluster group and control group. Conclusion Based on the current limited evidence, we still could not conclude affirmatively that cluster SCIT was a safe and efficacious option for the treatment of AR patients. Further large-scale, well-designed RCTs on this topic are still needed.
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Affiliation(s)
- Shaoyan Feng
- Allergy and Cancer Center, Otorhinolarygology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Ying Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Renqiang Ma
- Allergy and Cancer Center, Otorhinolarygology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yueqi Sun
- Allergy and Cancer Center, Otorhinolarygology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Luo
- Allergy and Cancer Center, Otorhinolarygology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huabin Li
- Allergy and Cancer Center, Otorhinolarygology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- * E-mail:
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The contribution of allergen-specific IgG to the development of th2-mediated airway inflammation. J Allergy (Cairo) 2012; 2012:236075. [PMID: 23150737 PMCID: PMC3485540 DOI: 10.1155/2012/236075] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/18/2012] [Indexed: 01/01/2023] Open
Abstract
In both human asthmatics and animal models of allergy, allergen-specific IgG can contribute to Th2-mediated allergic inflammation. Mouse models have elucidated an important role for IgG and Fc-gamma receptor (FcγR) signaling on antigen presenting cells (APC) for the induction of airway inflammation. These studies suggest a positive feedback loop between IgG produced by the adaptive B cell response and FcγR signaling on innate immune cells. Studies of IgG and FcγRs in humans with asthma or allergic lung disease have been more controversial. Some reports have identified associations between allergen-specific IgG and severity of allergic responses, while other studies have found associations of IgG subclass IgG4 with allergic tolerance. In this paper, we review the literature to help define the nature of IgG and FcγR signaling on innate immune cells and how it contributes to the development of allergic immune responses.
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Les traitements de l’allergie dans la prise en charge de l’asthme selon l’âge. Arch Pediatr 2012. [DOI: 10.1016/s0929-693x(12)71245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- Cheol-Woo Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
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Weir NA, Levine SJ. Achieving symptom control in patients with moderate asthma. Clin Med Insights Circ Respir Pulm Med 2011; 6:1-11. [PMID: 22259262 PMCID: PMC3256747 DOI: 10.4137/ccrpm.s5100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Disease severity in asthma can be classified as mild, moderate or severe based upon the frequency of symptoms or the severity of airflow obstruction. This review will focus on the treatment of youths greater than 12 years of age and adults with moderate persistent asthma. Moderate asthmatics may have daily symptoms that cause some limitation with normal daily activities and require use of a rescue inhaled short-acting beta(2)-agonist inhaler or experience nocturnal awakenings secondary to asthma that occur more than once per week. Furthermore, spirometry may reveal airflow obstruction with a reduction in FEV(1) to between 60% and 80% of predicted. Although inhaled corticosteroids (ICS) are the primary controller medication used to modify symptoms in moderate asthmatics, additional controller medications, such as inhaled long-acting beta(2)-agonists (LABA), leukotriene receptor antagonists (LTRA) or theophylline, are often needed to obtain optimal disease control. While the addition of an inhaled LABA to an ICS is very effective at improving disease control in moderate asthma, concerns have arisen over the safety of LABAs, in particular the risk of asthma-related death. Therefore, consideration may be given to initially adding a LTRA, rather than a LABA, to ICS when asthma symptoms are not adequately controlled by ICS alone. Furthermore, individualization of medication regimens, treatment of co-morbid conditions, and patient education are crucial to optimizing compliance with therapy, improving disease control, and reducing the risk of exacerbations. Lastly, the development of new asthma treatments, perhaps based upon personalized medicine, may revolutionize the future treatment of moderate asthma.
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Affiliation(s)
- Nargues A. Weir
- The Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA
- The Laboratory of Asthma and Lung Inflammation, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Stewart J. Levine
- The Laboratory of Asthma and Lung Inflammation, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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