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Zoratti E, Wood R, Pomés A, Da Silva Antunes R, Altman MC, Benson B, Wheatley LM, Cho K, Calatroni A, Little FF, Pongracic J, Makhija M, Khurana Hershey GK, Sherenian MG, Rivera-Spoljaric K, Stokes JR, Gill MA, Gruchalla RS, Chambliss J, Liu AH, Kattan M, Busse PJ, Bacharier LB, Sheehan W, Kim H, Glesner J, Gergen PJ, Togias A, Baucom JL, Visness CM, Sette A, Busse WW, Jackson DJ. A pediatric randomized, controlled trial of German cockroach subcutaneous immunotherapy. J Allergy Clin Immunol 2024:S0091-6749(24)00455-X. [PMID: 38718950 DOI: 10.1016/j.jaci.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/28/2024] [Accepted: 04/23/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Cockroach allergy contributes to morbidity among urban children with asthma. Few trials address the effect of subcutaneous immunotherapy (SCIT) with cockroach allergen among these at-risk children. OBJECTIVES We sought to determine whether nasal allergen challenge (NAC) responses to cockroach allergen would improve following 1 year of SCIT. METHODS Urban children with asthma, who were cockroach-sensitized and reactive on NAC, participated in a year-long randomized double-blind placebo-controlled SCIT trial using German cockroach extract. The primary endpoint was the change in mean Total Nasal Symptom Score (TNSS) during NAC after 12 months of SCIT. Changes in nasal transcriptomic responses during NAC, skin prick test wheal size, serum allergen-specific antibody production, and T-cell responses to cockroach allergen were assessed. RESULTS Changes in mean NAC TNSS did not differ between SCIT-assigned (n = 28) versus placebo-assigned (n = 29) participants (P = .63). Nasal transcriptomic responses correlated with TNSS, but a treatment effect was not observed. Cockroach serum-specific IgE decreased to a similar extent in both groups, while decreased cockroach skin prick test wheal size was greater among SCIT participants (P = .04). A 200-fold increase in cockroach serum-specific IgG4 was observed among subjects receiving SCIT (P < .001) but was unchanged in the placebo group. T-cell IL-4 responses following cockroach allergen stimulation decreased to a greater extent among SCIT versus placebo (P = .002), while no effect was observed for IL-10 or IFN-γ. CONCLUSIONS A year of SCIT failed to alter NAC TNSS and nasal transcriptome responses to cockroach allergen challenge despite systemic effects on allergen-specific skin tests, induction of serum-specific IgG4 serum production and down-modulation of allergen-stimulated T-cell responses.
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Affiliation(s)
- Edward Zoratti
- Division of Allergy and Immunology, Department of Medicine, Henry Ford Health, Detroit, Mich.
| | - Robert Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | | | | | - Lisa M Wheatley
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | - Kate Cho
- Rho, Inc, Federal Research Operations, Durham, NC
| | | | - Frederic F Little
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - J Pongracic
- Department of Pediatrics, Anne and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Melanie Makhija
- Department of Pediatrics, Anne and Robert H. Lurie Children's Hospital, Chicago, Ill
| | | | | | | | - Jeffrey R Stokes
- Department of Pediatrics, St Louis Children's Hospital, St Louis, Mo
| | - Michelle A Gill
- Department of Pediatrics, St Louis Children's Hospital, St Louis, Mo
| | - Rebecca S Gruchalla
- Department of Pediatrics, University of Texas Southwest Medical Center, Dallas, Tex
| | - Jeffrey Chambliss
- Department of Pediatrics, University of Texas Southwest Medical Center, Dallas, Tex
| | - Andrew H Liu
- Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colo
| | - Meyer Kattan
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Paula J Busse
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Children's Hospital at Vanderbilt University, Nashville, Tenn
| | - William Sheehan
- Department of Pediatrics, Children's National Hospital, Washington, DC
| | - Haejin Kim
- Division of Allergy and Immunology, Department of Medicine, Henry Ford Health, Detroit, Mich
| | | | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | | | | | | | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Qin Y, Huang W, Zheng R, Wang Q, Yu Q, Li Y, Wang K, Tang J. The long-term efficacy of intra-cervical lymphatic immunotherapy on adults with allergic rhinitis: A randomized controlled study. Clin Transl Allergy 2024; 14:e12341. [PMID: 38343066 PMCID: PMC10859606 DOI: 10.1002/clt2.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The efficacy and safety of the novel immunotherapy method, intra-cervical lymphatic immunotherapy (ICLIT), need to be investigated. Comparing it with subcutaneous immunotherapy (SCIT), we clarified the long-term efficacy and safety of intra-cervical lymphatic immunotherapy on allergic rhinitis (AR), and investigated the improvement of clinical efficacy of the booster injection at 1 year after ICLIT treatment. METHODS Ninety adult patients with dust mite allergy were randomly divided into 3 groups: 30 in the SCIT group, 30 in the ILCLIT group, and 30 in ICLIT booster group. Changes in total symptom score (TSS), nasal symptom score (TNSS), ocular symptom score (TOSS) and total medication score (TMS) were evaluated in the three groups. Adverse reactions were recorded, and serum dust mite specific IgE (sIgE) and specific IgG4 were assessed in the ICLIT group and ICLIT booster group. RESULTS TSS, TNSS, TOSS, and TMS scores were significantly lower in the three groups at 36 months after treatment (p < 0. 05). And at 36 months the ICLIT-booster group showed results similar to SCIT and superior to ICLIT (p < 0. 05). Serum specific IgE decreased in all three groups at 12 and 36 months after treatment, p < 0.01. The ICLIT group and the ICLIT booster group showed a significant increase in sIgG4, p < 0.01. None of the patients in the three groups had any serious systemic adverse effects during the 3-year follow-up. CONCLUSION The ICLIT treatment is effective and safe on AR. One booster injection of allergens at 1 year can greatly improve its long-term efficacy. TRIAL REGISTRY Clinical trial registration number: ChiCTR1800017130.
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Affiliation(s)
- Yang Qin
- The First Clinical Medical CollegeGuangdong Medical UniversityZhanjiangChina
| | - Weijun Huang
- The Department of OtolaryngologyFirst People's Hospital of FoshanFoshanChina
| | - Rui Zheng
- The Department of OtolaryngologyThird Affiliated Hospital of Sun Y at‐sen UniversityGuangzhouChina
| | - Qixing Wang
- The Zhu Hai Campus of Zunyi Medical UniversityZhuhaiChina
| | - Qingqing Yu
- The Department of OtolaryngologyFirst People's Hospital of FoshanFoshanChina
| | - Yin Li
- The Department of OtolaryngologyFirst People's Hospital of FoshanFoshanChina
| | - Kai Wang
- The Department of OtolaryngologyFirst People's Hospital of FoshanFoshanChina
| | - Jun Tang
- The First Clinical Medical CollegeGuangdong Medical UniversityZhanjiangChina
- The Department of OtolaryngologyFirst People's Hospital of FoshanFoshanChina
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Layhadi JA, Lalioti A, Palmer E, van Zelm MC, Wambre E, Shamji MH. Mechanisms and Predictive Biomarkers of Allergen Immunotherapy in the Clinic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:59-66. [PMID: 37996041 DOI: 10.1016/j.jaip.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
Allergen immunotherapy (AIT) remains to be the only disease-modifying treatment for IgE-mediated allergic diseases such as allergic rhinitis. It can provide long-term clinical benefits when given for 3 years or longer. Mechanisms of immune tolerance induction by AIT are underscored by the modulation of several compartments within the immune system. These include repair of disruption in epithelial barrier integrity, modulation of the innate immune compartment that includes regulatory dendritic cells and innate lymphoid cells, and adaptive immune compartments such as induction of regulatory T and B cells. Altogether, these are also associated with the dampening of allergen-specific TH2 and T follicular helper cell responses and subsequent generation of blocking antibodies. Although AIT is effective in modifying the immune response, there is a lack of validated and clinically relevant biomarkers that can be used to monitor desensitization, efficacy, and the likelihood of response, all of which can contribute to accelerating personalized medication and increasing patient care. Candidate biomarkers comprise humoral, cellular, metabolic, and in vivo biomarkers; however, these are primarily studied in small trials and require further validation. In this review, we evaluate the current candidates of biomarkers of AIT and how we can implement changes in future studies to help us identify clinically relevant biomarkers of safety, compliance, and efficacy.
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Affiliation(s)
- Janice A Layhadi
- Department of National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Anastasia Lalioti
- Department of National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Elizabeth Palmer
- Department of National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Menno C van Zelm
- Department of Immunology, Monash University and Alfred Health, Melbourne, Victoria, Australia; Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Erik Wambre
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mohamed H Shamji
- Department of National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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