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Han X, Wang X, Chen X, Liu H, Liu J, Waye MMY, Liu G, Rao S. Intervention Efficacy of Slightly Processed Allergen/Meat in Oral Immunotherapy for Seafood Allergy: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis in Mouse Models and Clinical Patients. Nutrients 2024; 16:667. [PMID: 38474795 DOI: 10.3390/nu16050667] [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: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Background: Seafood allergy is a significant global health concern that greatly impacts a patient's quality of life. The intervention efficacy of oral immunotherapy (OIT), an emerging intervention strategy, for seafood allergy remains controversial. This study aimed to perform a systematic review and meta-analysis to evaluate the efficacy of slightly processed allergen/meat from fish and crustacea in OIT, both in mouse models and clinical patients. Methods: A comprehensive literature search was performed in four mainstream databases and the EBSCOhost database to identify all relevant case-control and cohort studies. The aim was to elucidate the intervention efficacy, encompassing various processing methods and assessing the efficacy of multiple major allergens in OIT. Results: The meta-analysis included five case-control studies on crustacean allergens in mouse models and 11 cohort studies on meat from fish and crustacea in clinical patients for final quantitative assessments. In mouse models, crustacean allergen substantially decreased the anaphylactic score after OIT treatment (mean difference (MD) = -1.30, p < 0.01). Subgroup analyses with low-level heterogeneities provided more reliable results for crab species (MD = -0.63, p < 0.01, I2 = 0), arginine kinase allergen (MD = -0.83, p < 0.01, I2 = 0), and Maillard reaction processing method (MD = -0.65, p < 0.01, I2 = 29%), respectively. In clinical patients, the main meta-analysis showed that the slightly processed meat significantly increased the incidence rate of oral tolerance (OT, incidence rate ratio (IRR) = 2.90, p < 0.01). Subgroup analyses for fish meat (IRR = 2.79, p < 0.01) and a simple cooking treatment (IRR = 2.36, p = 0.01) also demonstrated a substantial increase in the incidence rate of OT. Sensitivity and meta-regression analyses successfully identified specific studies contributing to heterogeneity in mouse models and clinical patients, although these studies did not impact the overall significant pooled effects. Conclusions: This meta-analysis provides preliminary evidence for the high intervention efficacy of slightly processed allergen/meat from fish and crustacea in OIT, both in mouse models and clinical patients. The Maillard reaction and cooking processing methods may emerge as potentially effective approaches to treating allergen/meat in OIT for clinical patients, offering a promising and specific treatment strategy for seafood allergy. However, these findings should be interpreted cautiously, and further supporting evidence is necessary.
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Affiliation(s)
- Xinyu Han
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen 361021, China
| | - Xinya Wang
- Department of Bioinformatics, Fujian Key Laboratory of Medical Bioinformatics, Institute of Precision Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350122, China
| | - Xiaotong Chen
- Department of Bioinformatics, Fujian Key Laboratory of Medical Bioinformatics, Institute of Precision Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350122, China
| | - Hong Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen 361021, China
| | - Jingwen Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen 361021, China
| | - Mary Miu Yee Waye
- The Nethersole School of Nursing, Croucher Laboratory for Human Genomics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Guangming Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen 361021, China
| | - Shitao Rao
- Department of Bioinformatics, Fujian Key Laboratory of Medical Bioinformatics, Institute of Precision Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350122, China
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
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Muacevic A, Adler JR, Alberi ZA, AlAam FA, Alshajarah AA, AlKhunaizi MF. Peanut-Induced Anaphylaxis in Children: A Literature Review. Cureus 2022; 14:e32946. [PMID: 36578844 PMCID: PMC9792142 DOI: 10.7759/cureus.32946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 12/28/2022] Open
Abstract
Peanut allergy has become more common among children and is considered one of the most common triggers for fatal anaphylaxis. Treatment of symptoms during a reaction is only one aspect of managing anaphylaxis; other elements include rigorous dietary avoidance and education about settings that could put the patient at a high risk of unintentional exposure. We aimed to review the prevalence, mechanism, diagnosis, treatment, and emergency action of peanut-induced anaphylaxis among children. We used a web-based literature search using the advanced features of databases such as PubMed, Scopus, Directory of Open Access Journals (DOAJ), Embase, Google Scholar, and Cochrane electronic databases. The most common food to cause fatal anaphylaxis and a common cause of food allergies is peanuts. Over the past two years, our knowledge improved more about peanut allergens, their prevalence, causes, diagnoses, and treatments. The research cited in this review demonstrates that the peanut allergens are most closely associated with disease differ across cultures, that early oral peanut exposure may reduce the occurrence of peanut allergy while early non-oral exposure may have the opposite effect, that complement activation by peanut constituents appears to promote peanut-induced anaphylaxis, and that oral immunotherapy, anti-IgE antibody, and a herbal formulation are all demonstrating promise as treatments. To conclude, peanut allergies have increased frequently during the past 10 years, especially in Westernized nations. Given that peanut allergy poses a danger for fatal anaphylaxis, response management is crucial. The current standard of care for those with nut allergies comprises complete food avoidance and the administration of injectable epinephrine to treat systemic symptoms.
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Yadav S, Singh S, Mandal P, Tripathi A. Immunotherapies in the treatment of immunoglobulin E‑mediated allergy: Challenges and scope for innovation (Review). Int J Mol Med 2022; 50:95. [PMID: 35616144 DOI: 10.3892/ijmm.2022.5151] [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: 12/24/2021] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
Abstract
Immunoglobulin E (IgE)‑mediated allergy or hypersensitivity reactions are generally defined as an unwanted severe symptomatic immunological reaction that occurs due to shattered or untrained peripheral tolerance of the immune system. Allergen‑specific immunotherapy (AIT) is the only therapeutic strategy that can provide a longer‑lasting symptomatic and clinical break from medications in IgE‑mediated allergy. Immunotherapies against allergic diseases comprise a successive increasing dose of allergen, which helps in developing the immune tolerance against the allergen. AITs exerttheirspecial effectiveness directly or indirectly by modulating the regulator and effector components of the immune system. The number of success stories of AIT is still limited and it canoccasionallyhave a severe treatment‑associated adverse effect on patients. Therefore, the formulation used for AIT should be appropriate and effective. The present review describes the chronological evolution of AIT, and provides a comparative account of the merits and demerits of different AITs by keeping in focus the critical guiding factors, such as sustained allergen tolerance, duration of AIT, probability of mild to severe allergic reactions and dose of allergen required to effectuate an effective AIT. The mechanisms by which regulatory T cells suppress allergen‑specific effector T cells and how loss of natural tolerance against innocuous proteins induces allergy are reviewed. The present review highlights the major AIT bottlenecks and the importantregulatory requirements for standardized AIT formulations. Furthermore, the present reviewcalls attention to the problem of 'polyallergy', which is still a major challenge for AIT and the emerging concept of 'component‑resolved diagnosis' (CRD) to address the issue. Finally, a prospective strategy for upgrading CRD to the next dimension is provided, and a potential technology for delivering thoroughly standardized AIT with minimal risk is discussed.
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Affiliation(s)
- Sarika Yadav
- Systems Toxicology and Health Risk Assessment Group, CSIR‑Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
| | - Saurabh Singh
- Systems Toxicology and Health Risk Assessment Group, CSIR‑Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
| | - Payal Mandal
- Food, Drugs and Chemical Toxicology Group, CSIR‑Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
| | - Anurag Tripathi
- Systems Toxicology and Health Risk Assessment Group, CSIR‑Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh 226001, India
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Wang J, Zhou J, Wang C, Fukunaga A, Li S, Yodoi J, Tian H. Thioredoxin-1: A Promising Target for the Treatment of Allergic Diseases. Front Immunol 2022; 13:883116. [PMID: 35572600 PMCID: PMC9095844 DOI: 10.3389/fimmu.2022.883116] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
Thioredoxin-1 (Trx1) is an important regulator of cellular redox homeostasis that comprises a redox-active dithiol. Trx1 is induced in response to various stress conditions, such as oxidative damage, infection or inflammation, metabolic dysfunction, irradiation, and chemical exposure. It has shown excellent anti-inflammatory and immunomodulatory effects in the treatment of various human inflammatory disorders in animal models. This review focused on the protective roles and mechanisms of Trx1 in allergic diseases, such as allergic asthma, contact dermatitis, food allergies, allergic rhinitis, and drug allergies. Trx1 plays an important role in allergic diseases through processes, such as antioxidation, inhibiting macrophage migration inhibitory factor (MIF), regulating Th1/Th2 immune balance, modulating allergic inflammatory cells, and suppressing complement activation. The regulatory mechanism of Trx1 differs from that of glucocorticoids that regulates the inflammatory reactions associated with immune response suppression. Furthermore, Trx1 exerts a beneficial effect on glucocorticoid resistance of allergic inflammation by inhibiting the production and internalization of MIF. Our results suggest that Trx1 has the potential for future success in translational research.
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Affiliation(s)
- Jinquan Wang
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China
| | - Jiedong Zhou
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China
| | - Cuixue Wang
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shujing Li
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China
| | - Junji Yodoi
- Laboratory of Infection and Prevention, Department of Biological Response, Institute for Virus Research, Kyoto University, Kyoto, Japan
| | - Hai Tian
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China.,Department of Research and Development, Jiaozhimei Biotechnology (Shaoxing) Co., Ltd., Shaoxing, China
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5
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Pulik K, Ruszczyński M, Krenke R. Oral immunotherapy in children with a food allergy-Where do we stand? - Review. Clin Exp Pharmacol Physiol 2021; 49:191-201. [PMID: 34716938 DOI: 10.1111/1440-1681.13607] [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: 03/17/2020] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
The number of hospitalisations due to an anaphylactic reaction to food is continuously increasing. Therefore, there is an urgent need to seek effective therapy. Currently, the only way to treat food allergies is to avoid allergens and to administer intramuscular adrenaline if an accidental allergen intake occurs. The only causal therapeutic strategy is specific oral immunotherapy. An increasing amount of data confirms this therapy's effectiveness and safety, but the results remain inconclusive due to the lack of long-term follow-up. In this state-of-the-art review, we briefly summarise the latest placebo-controlled randomised controlled trials on oral immunotherapy (OIT) to treat food allergy. During the paper's review, we asked the following questions: does the therapy permanently increase the amount of allergen consumed without symptoms? Does it significantly increase or decrease the occurrence of severe systemic reactions - requiring the administration of adrenaline or hospitalisation? Many authors describe outcomes such as an increase in the amount of allergen that can be safely ingested; however, significant clinical benefits such as decreased hospitalisations or anaphylaxis incidence are rarely included in the results. To date, there is no unified protocol of therapy, which makes comparisons between studies difficult because of significant differences in types, doses, and routes of administration of the allergen, timeline for up-dosing and maintenance, duration of the therapy, and primary outcomes of OIT.
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Affiliation(s)
- Kaja Pulik
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marek Ruszczyński
- II Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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6
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Bégin P, Chan ES, Kim H, Wagner M, Cellier MS, Favron-Godbout C, Abrams EM, Ben-Shoshan M, Cameron SB, Carr S, Fischer D, Haynes A, Kapur S, Primeau MN, Upton J, Vander Leek TK, Goetghebeur MM. CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy. Allergy Asthma Clin Immunol 2020; 16:20. [PMID: 32206067 PMCID: PMC7079444 DOI: 10.1186/s13223-020-0413-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice. Objective To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and efficient food allergy management. Materials and methods Recommendations were developed using a reflective patient-centered multicriteria approach including 22 criteria organized in five dimensions (clinical, populational, economic, organizational and sociopolitical). Data was obtained from: (1) a review of scientific and ethic literature; (2) consultations of allergists, other healthcare professionals (pediatricians, family physicians, nurses, registered dieticians, psychologists, peer supporters), patients and caregivers; and patient associations through structured consultative panels, interviews and on-line questionnaire; and (3) organizational and economic data from the milieu of care. All data was synthesized by criteria in a multicriteria deliberative guide that served as a platform for structured discussion and development of recommendations for each dimension, based on evidence, ethical imperatives and other considerations. Results The deliberative grid included 162 articles from the literature and media reviews and data from consultations involving 85 individuals. Thirty-eight (38) recommendations were made for the practice of oral immunotherapy for the treatment of IgE mediated food allergy, based on evidence and a diversity of ethical imperatives. All recommendations were aimed at fostering a context conducive to achieving objectives identified by patients and caregivers with food allergy. Notably, specific recommendations were developed to promote a culture of shared responsibility between patients and healthcare system, equity in access, patient empowerment, shared decision making and personalization of OIT protocols to reflect patients' needs. It also provides recommendations to optimize organization of care to generate capacity to meet demand according to patient choice, e.g. OIT or avoidance. These recommendations were made acknowledging the necessity of ensuring sustainability of the clinical offer in light of various economic considerations. Conclusions This innovative CPG methodology was guided by patients' perspectives, clinical evidence as well as ethical and other rationales. This allowed for the creation of a broad set of recommendations that chart optimal clinical practice and define the conditions required to bring about changes to food allergy care that will be sustainable, equitable and conducive to the well-being of all patients in need.
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Affiliation(s)
- P Bégin
- 1Division of Clinical Immunology, Rheumatology and Allergy, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC Canada.,2Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC Canada.,3Research Center of the Sainte-Justine University Hospital Center, Montreal, QC Canada
| | - E S Chan
- 4Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC Canada
| | - H Kim
- 5Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada.,6Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - M Wagner
- 7Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montreal, QC Canada
| | - M S Cellier
- 3Research Center of the Sainte-Justine University Hospital Center, Montreal, QC Canada
| | - C Favron-Godbout
- 8Department of Bioethics, School of Public Health of the University of Montreal, Montreal, Canada
| | - E M Abrams
- 9Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - M Ben-Shoshan
- 10Division of Allergy Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC Canada
| | - S B Cameron
- 4Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC Canada.,Community Allergy Clinic, Victoria, BC Canada
| | - S Carr
- 12Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - D Fischer
- 5Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada
| | - A Haynes
- 13Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, NL Canada
| | - S Kapur
- 14Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - M N Primeau
- 15Division of Allergy and Clinical Immunology, Department of Medicine, CISSS Laval, Laval, QC Canada
| | - J Upton
- 16Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - T K Vander Leek
- 12Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - M M Goetghebeur
- 7Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montreal, QC Canada
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7
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Chu DK, Wood RA, French S, Fiocchi A, Jordana M, Waserman S, Brożek JL, Schünemann HJ. Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety. Lancet 2019; 393:2222-2232. [PMID: 31030987 DOI: 10.1016/s0140-6736(19)30420-9] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral immunotherapy is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear. We systematically reviewed the efficacy and safety of oral immunotherapy versus allergen avoidance or placebo (no oral immunotherapy) for peanut allergy. METHODS In the Peanut Allergen immunotherapy, Clarifying the Evidence (PACE) systematic review and meta-analysis, we searched MEDLINE, EMBASE, Cochrane Controlled Register of Trials, Latin American & Caribbean Health Sciences Literature, China National Knowledge Infrastructure, WHO's Clinical Trials Registry Platform, US Food and Drug Administration, and European Medicines Agency databases from inception to Dec 6, 2018, for randomised controlled trials comparing oral immunotherapy versus no oral immunotherapy for peanut allergy, without language restrictions. We screened studies, extracted data, and assessed risk of bias independently in duplicate. Main outcomes included anaphylaxis, allergic or adverse reactions, epinephrine use, and quality of life, meta-analysed by random effects. We assessed certainty (quality) of evidence by the GRADE approach. This study is registered with PROSPERO, number CRD42019117930. RESULTS 12 trials (n=1041; median age across trials 8·7 years [IQR 5·9-11·2]) showed that oral immunotherapy versus no oral immunotherapy increased anaphylaxis risk (risk ratio [RR] 3·12 [95% CI 1·76-5·55], I2=0%, risk difference [RD] 15·1%, high-certainty), anaphylaxis frequency (incidence rate ratio [IRR] 2·72 [1·57-4·72], I2=0%, RD 12·2%, high-certainty), and epinephrine use (RR 2·21 [1·27-3·83], I2=0%, RD 4·5%, high-certainty) similarly during build-up and maintenance (pinteraction=0·92). Oral immunotherapy increased serious adverse events (RR 1·92 [1·00-3·66], I2=0%, RD 5·7%, moderate-certainty), and non-anaphylactic reactions (vomiting: RR 1·79 [95%CI 1·35-2·38], I2=0%, high-certainty; angioedema: 2·25 [1·13-4·47], I2=0%, high-certainty; upper tract respiratory reactions: 1·36 [1·02-1·81], I2=0%, moderate-certainty; lower tract respiratory reactions: 1·55 [0·96-2·50], I2=28%, moderate-certainty). Passing a supervised challenge, a surrogate for preventing out-of-clinic reactions, was more likely with oral immunotherapy (RR 12·42 [95% CI 6·82-22·61], I2=0%, RD 36·5%, high-certainty). Quality of life was not different between groups (combined parents and self report RR 1·21 [0·87-1·69], I2=0%, RD 0·03%, low-certainty). Findings were robust to IRR, trial sequential, subgroup, and sensitivity analyses. INTERPRETATION In patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitisation. Safer peanut allergy treatment approaches and rigorous randomised controlled trials that evaluate patient-important outcomes are needed. FUNDING None.
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Affiliation(s)
- Derek K Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, ON, Canada.
| | - Robert A Wood
- Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shannon French
- Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, ON, Canada
| | - Alessandro Fiocchi
- Allergy Division, Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Manel Jordana
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, ON, Canada
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, ON, Canada
| | - Jan L Brożek
- Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, ON, Canada; Michael G DeGroote Cochrane Canada Centre, Hamilton, ON, Canada
| | - Holger J Schünemann
- Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, ON, Canada; Michael G DeGroote Cochrane Canada Centre, Hamilton, ON, Canada
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Abstract
Purpose of Review We reviewed the existing evidence base to desensitisation for food allergy, applying the Grading of Recommendations, Assessment, Development and Evaluation approach to discuss whether desensitisation is likely to become part of routine treatment for patients with food allergy. Recent Findings Desensitisation for food allergy to peanut, egg and cow’s milk is efficacious, but whether such interventions are cost-effective is less clear, due to the issues over a sustained desensitisation effect and the increase in allergic reactions occurring in patients on treatment. Few studies have assessed the change in health-related quality of life associated with treatment, and most have not considered discordance between parent-reported changes in health-related quality of life (HRQL) outcomes compared to those of the patients themselves; none to date have controlled for the improvement in HRQL occurring after initial challenge which will confound outcomes. Summary The lack of longer-term safety and cost-effectiveness data, as well as an absence of current consensus in the reporting of patient-relevant outcomes, must be addressed in order to be able to recommend the introduction of desensitisation as a routine treatment in healthcare systems.
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Affiliation(s)
- Bettina Duca
- Section of Paediatrics (Allergy and Infectious Diseases), Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Nandinee Patel
- Section of Paediatrics (Allergy and Infectious Diseases), Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Paul J Turner
- Section of Paediatrics (Allergy and Infectious Diseases), Imperial College London, Norfolk Place, London, W2 1PG, UK.
- Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia.
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9
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Greenhawt M, Oppenheimer JJ. Life in the FAST lane. Ann Allergy Asthma Immunol 2019; 121:264-265. [PMID: 30219172 DOI: 10.1016/j.anai.2018.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew Greenhawt
- Food Challenge and Research Unit Children's Hospital of Colorado Section of Allergy and Immunology University of Colorado School of Medicine Aurora, Colorado.
| | - John J Oppenheimer
- Department of Internal Medicine New Jersey Medical School Newark, New Jersey; Pulmonary and Allergy Associates Morristown, New Jersey
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Greenhawt M, Hourihane JO. Looking into the seeds of time: Are home-based OIT programs the shape of things to come for selected patients? Ann Allergy Asthma Immunol 2019; 120:453-454. [PMID: 29729726 DOI: 10.1016/j.anai.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Matthew Greenhawt
- Food Challenge and Research Unit, Children's Hospital of Colorado, Section of Allergy and Immunology, University of Colorado School of Medicine, Aurora, Colorado.
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11
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Rodríguez del Río P, Escudero C, Sánchez-García S, Ibáñez MD, Vickery BP. Evaluating primary end points in peanut immunotherapy clinical trials. J Allergy Clin Immunol 2019; 143:494-506. [DOI: 10.1016/j.jaci.2018.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 12/20/2022]
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12
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Chang X, Wu Z, Zhao R, Zhang Y, Li X, Yang A, Tong P, Chen H. Analysis on MTGase catalysed cross-linked products of Ara h 2: structure and immunoreactivity. FOOD AGR IMMUNOL 2018. [DOI: 10.1080/09540105.2018.1529739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Xuejiao Chang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
- School of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
| | - Zhihua Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, People’s Republic of China
| | - Ruifang Zhao
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
| | - Ying Zhang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
- School of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
| | - Xin Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, People’s Republic of China
| | - Anshu Yang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, People’s Republic of China
| | - Ping Tong
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, People’s Republic of China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, People’s Republic of China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, People’s Republic of China
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Virkud YV, Wang J, Shreffler WG. Enhancing the Safety and Efficacy of Food Allergy Immunotherapy: a Review of Adjunctive Therapies. Clin Rev Allergy Immunol 2018; 55:172-189. [DOI: 10.1007/s12016-018-8694-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Bird JA, Spergel JM, Jones SM, Rachid R, Assa'ad AH, Wang J, Leonard SA, Laubach SS, Kim EH, Vickery BP, Davis BP, Heimall J, Cianferoni A, MacGinnitie AJ, Crestani E, Burks AW. Efficacy and Safety of AR101 in Oral Immunotherapy for Peanut Allergy: Results of ARC001, a Randomized, Double-Blind, Placebo-Controlled Phase 2 Clinical Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:476-485.e3. [PMID: 29092786 DOI: 10.1016/j.jaip.2017.09.016] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/06/2017] [Accepted: 09/18/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Peanut oral immunotherapy, using a variety of approaches, has been previously shown to induce desensitization in peanut-allergic subjects, but no products have been approved for clinical use by regulatory agencies. OBJECTIVE We performed the first phase 2 multicentered study to assess the safety and efficacy of AR101, a novel oral biologic drug product. METHODS A randomized, double-blind, placebo-controlled trial was conducted at 8 US centers. Eligible subjects were 4 to 26 years old, sensitized to peanut, and had dose-limiting symptoms to ≤143 mg of peanut protein in a screening double-blind, placebo-controlled food challenge (DBPCFC). Subjects were randomized 1:1 to daily AR101 or placebo and gradually up-dosed from 0.5 to 300 mg/day. The primary endpoint was the proportion of subjects in each arm able to tolerate ≥443 mg (cumulative peanut protein) at exit DBPCFC with no or mild symptoms. RESULTS Fifty-five subjects (29 AR101, 26 placebo) were enrolled. In the intention-to-treat analysis, 23 of 29 (79%) and 18 of 29 (62%) AR101 subjects tolerated ≥443 mg and 1043 mg at exit DBPCFC, respectively, versus 5 of 26 (19%) and 0 of 26 (0%) placebo subjects (both P < .0001). Compared with placebo, AR101 significantly reduced symptom severity during exit DBPCFCs and modulated peanut-specific cellular and humoral immune responses. Gastrointestinal (GI) symptoms were the most common treatment-related adverse events (AEs) in both groups, with 6 AR101 subjects (21%) withdrawing, 4 of those due primarily to recurrent GI AEs. CONCLUSIONS In this study, AR101 demonstrated an acceptable safety profile and demonstrated clinical activity as a potential immunomodulatory treatment option in peanut-allergic children over the age of 4, adolescents, and young adults.
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Affiliation(s)
- J Andrew Bird
- Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Tex.
| | - Jonathan M Spergel
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Rima Rachid
- Division of Allergy & Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Amal H Assa'ad
- Division of Allergy & Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Julie Wang
- Division of Allergy & Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie A Leonard
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego, Calif
| | - Susan S Laubach
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - Edwin H Kim
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Brian P Vickery
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC; Department of Clinical Development, Aimmune Therapeutics, Brisbane, Calif
| | - Benjamin P Davis
- Division of Immunology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jennifer Heimall
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Antonella Cianferoni
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Andrew J MacGinnitie
- Division of Allergy & Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Elena Crestani
- Division of Allergy & Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
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15
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Watson CT, Cohain AT, Griffin RS, Chun Y, Grishin A, Hacyznska H, Hoffman GE, Beckmann ND, Shah H, Dawson P, Henning A, Wood R, Burks AW, Jones SM, Leung DYM, Sicherer S, Sampson HA, Sharp AJ, Schadt EE, Bunyavanich S. Integrative transcriptomic analysis reveals key drivers of acute peanut allergic reactions. Nat Commun 2017; 8:1943. [PMID: 29203772 PMCID: PMC5715016 DOI: 10.1038/s41467-017-02188-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/09/2017] [Indexed: 02/07/2023] Open
Abstract
Mechanisms driving acute food allergic reactions have not been fully characterized. We profile the dynamic transcriptome of acute peanut allergic reactions using serial peripheral blood samples obtained from 19 children before, during, and after randomized, double-blind, placebo-controlled oral challenges to peanut. We identify genes with changes in expression triggered by peanut, but not placebo, during acute peanut allergic reactions. Network analysis reveals that these genes comprise coexpression networks for acute-phase response and pro-inflammatory processes. Key driver analysis identifies six genes (LTB4R, PADI4, IL1R2, PPP1R3D, KLHL2, and ECHDC3) predicted to causally modulate the state of coregulated networks in response to peanut. Leukocyte deconvolution analysis identifies changes in neutrophil, naive CD4+ T cell, and macrophage populations during peanut challenge. Analyses in 21 additional peanut allergic subjects replicate major findings. These results highlight key genes, biological processes, and cell types that can be targeted for mechanistic study and therapeutic targeting of peanut allergy.
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Affiliation(s)
- C T Watson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Biochemistry and Molecular Genetics, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - A T Cohain
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - R S Griffin
- Department of Anesthesia, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Y Chun
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - A Grishin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - H Hacyznska
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - G E Hoffman
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - N D Beckmann
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - H Shah
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - P Dawson
- eEmmes Corporation, Rockville, MD, 20850, USA
| | - A Henning
- eEmmes Corporation, Rockville, MD, 20850, USA
| | - R Wood
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - A W Burks
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - S M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AS, 72202, USA
| | - D Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, CO, 80206, USA
| | - S Sicherer
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - H A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - A J Sharp
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - E E Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - S Bunyavanich
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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16
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Leung NYH, Wai CYY, Shu SA, Chang CC, Chu KH, Leung PSC. Low-Dose Allergen-Specific Immunotherapy Induces Tolerance in a Murine Model of Shrimp Allergy. Int Arch Allergy Immunol 2017; 174:86-96. [PMID: 29065408 DOI: 10.1159/000479694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/20/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The efficacy and safety of allergen-specific immunotherapy (AIT) are highly dose-dependent. METHODS We investigated the dosage effects of AIT and the underlying mechanisms in a murine model of shrimp hypersensitivity. BALB/c mice were sensitized with recombinant shrimp allergen rMet e 1 and challenged orally with a high dose of rMet e 1 to elicit an allergic response. These sensitized mice were then treated with a low (0.01 mg), medium (0.05 mg), or high dosage (0.1 mg) of rMet e 1 intraperitoneally before receiving a second oral challenge. The allergic responses and immunological changes in the gut were compared between animals receiving different dosages. RESULTS We found that all sensitized mice that received rMet e 1 immunotherapy were desensitized, regardless of the dosage, and protected at the second oral challenge. Nevertheless, the mice in the high-dosage group experienced severe systemic reactions during the treatment phase. In contrast, regulatory T (Treg) cell-associated genes were upregulated only in the low- and medium-dosage groups, and Foxp3+ cells were more abundant in the gut lymphoid tissues than in the high-dosage group. CONCLUSIONS Our results demonstrate that low-dosage immunotherapy favors the induction of local Foxp3+ Treg cells and the upregulation of regulatory cytokines. The safety advantages and long-term efficacy of low-dosage immunotherapy should be taken into consideration when developing immunotherapy dose schedules.
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Affiliation(s)
- Nicki Yat Hin Leung
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
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17
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Virkud YV, Burks AW, Steele PH, Edwards LJ, Berglund JP, Jones SM, Scurlock AM, Perry TT, Pesek RD, Vickery BP. Novel baseline predictors of adverse events during oral immunotherapy in children with peanut allergy. J Allergy Clin Immunol 2017; 139:882-888.e5. [PMID: 27609653 PMCID: PMC5337444 DOI: 10.1016/j.jaci.2016.07.030] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 06/02/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Though peanut oral immunotherapy (OIT) is a promising investigational therapy, its potential is limited by substantial adverse events (AEs), which are relatively understudied. OBJECTIVE A retrospective analysis was conducted, pooling data from 3 pediatric peanut OIT trials, comprising the largest analysis of peanut OIT safety to date. METHODS We pooled data from 104 children with peanut allergy from 3 peanut OIT studies. We catalogued AEs from parental reports, daily symptom diaries, and dose escalations. We included events that were considered likely related to OIT and identified potential baseline predictors of higher AE rates using generalized linear regression models. RESULTS Eighty percent of subjects experienced likely related AEs during OIT (72% during buildup and 47% during maintenance). Of these AEs, over 90% occurred while at home. Approximately 42% of subjects experienced systemic reactions, and 49% experienced gastrointestinal symptoms. Twenty percent of subjects dropped out, with half (10% of the overall group) due to persistent gastrointestinal symptoms. Baseline allergic rhinitis (AR) and peanut SPT wheal size were significant predictors of higher overall AE rates. SPT wheal size predicted increased gastrointestinal AEs, and AR predicted increased systemic reactions. Over the course of OIT, 61% of subjects received treatment for likely related AEs, 59% with antihistamines and 12% with epinephrine. CONCLUSIONS Peanut OIT is associated with frequent AEs, with rates declining over time, and most graded mild. However, systemic reactions and intolerable gastrointestinal AEs do occur and are significantly associated with AR and peanut SPT wheal size, respectively. Further study is needed of predictive biomarkers and the overall risks and benefits of OIT.
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Affiliation(s)
- Yamini V Virkud
- Department of Pediatrics, Massachusetts General Hospital, Boston, Mass
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Pamela H Steele
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Lloyd J Edwards
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | | | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Robert D Pesek
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Brian P Vickery
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
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18
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Wu Z, Lian J, Zhao R, Li K, Li X, Yang A, Tong P, Chen H. Ara h 2 cross-linking catalyzed by MTGase decreases its allergenicity. Food Funct 2017; 8:1195-1203. [DOI: 10.1039/c6fo01365a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Ara h 2 cross-linking involving linear allergen epitopes significantly decreases its allergenicity.
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Affiliation(s)
- Zhihua Wu
- State Key Laboratory of Food Science and Technology
- Nanchang University
- Nanchang 330047
- China
- Sino-German Joint Research Institute
| | - Jun Lian
- State Key Laboratory of Food Science and Technology
- Nanchang University
- Nanchang 330047
- China
- School of Food Science and Technology
| | - Ruifang Zhao
- State Key Laboratory of Food Science and Technology
- Nanchang University
- Nanchang 330047
- China
- School of Food Science and Technology
| | - Kun Li
- State Key Laboratory of Food Science and Technology
- Nanchang University
- Nanchang 330047
- China
- School of Environment & Chemical Engineering
| | - Xin Li
- State Key Laboratory of Food Science and Technology
- Nanchang University
- Nanchang 330047
- China
- School of Food Science and Technology
| | - Anshu Yang
- State Key Laboratory of Food Science and Technology
- Nanchang University
- Nanchang 330047
- China
- Sino-German Joint Research Institute
| | - Ping Tong
- State Key Laboratory of Food Science and Technology
- Nanchang University
- Nanchang 330047
- China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Technology
- Nanchang University
- Nanchang 330047
- China
- Sino-German Joint Research Institute
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19
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Burk CM, Dellon ES, Steele PH, Virkud YV, Kulis M, Burks AW, Vickery BP. Eosinophilic esophagitis during peanut oral immunotherapy with omalizumab. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:498-501. [PMID: 28017628 DOI: 10.1016/j.jaip.2016.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/01/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Caitlin M Burk
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Evan S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC; Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Pamela H Steele
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Yamini V Virkud
- Department of Pediatrics, Massachusetts General Hospital, Boston, Mass
| | - Mike Kulis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Brian P Vickery
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
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20
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Chen J, Gu X, Chen J, Luo Y, Wang M, Yang H, Guo X, Zhu X. Immunomodulatory effects of Glycyrrhiza uralensis polysaccharide in glycinin-induced allergic mouse model. FOOD AGR IMMUNOL 2016. [DOI: 10.1080/09540105.2016.1251393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jie Chen
- Department of Animal Science and Technology, Faculty of Animal Nutrition and Feed Science, Shihezi University, Shihezi, Xinjiang, People’s Republic of China
| | - Xinli Gu
- Department of Animal Science and Technology, Faculty of Animal Nutrition and Feed Science, Shihezi University, Shihezi, Xinjiang, People’s Republic of China
| | - Jianguo Chen
- Urumqi County Health and Epidemic Prevention Station, Urumqi, Xinjiang, People’s Republic of China
| | - Yan Luo
- Department of Animal Science and Technology, Faculty of Animal Nutrition and Feed Science, Shihezi University, Shihezi, Xinjiang, People’s Republic of China
| | - Mengyuan Wang
- Department of Animal Science and Technology, Faculty of Animal Nutrition and Feed Science, Shihezi University, Shihezi, Xinjiang, People’s Republic of China
| | - Hongyang Yang
- Department of Animal Science and Technology, Faculty of Animal Nutrition and Feed Science, Shihezi University, Shihezi, Xinjiang, People’s Republic of China
| | - Xiao Guo
- Department of Animal Science and Technology, Faculty of Animal Nutrition and Feed Science, Shihezi University, Shihezi, Xinjiang, People’s Republic of China
| | - Xiaoqing Zhu
- Department of Animal Science and Technology, Faculty of Animal Nutrition and Feed Science, Shihezi University, Shihezi, Xinjiang, People’s Republic of China
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21
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Aricigil M, Muluk NB, Sakarya EU, Sakalar EG, Senturk M, Reisacher WR, Cingi C. New Routes of Allergen Immunotherapy. Am J Rhinol Allergy 2016; 30:193-197. [DOI: 10.2500/ajra.2016.30.4379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives Allergen immunotherapy is the only cure for immunoglobulin E mediated type I respiratory allergies. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are the most common treatments. In this article, we reviewed new routes of allergen immunotherapy. Methods Data on alternative routes to allow intralymphatic immunotherapy (ILIT), epicutaneous immunotherapy (EPIT), local nasal immunotherapy (LNIT), oral immunotherapy (OIT), and oral mucosal immunotherapy (OMIT) were gathered from the literature and were discussed. Results ILIT features direct injection of allergens into lymph nodes. ILIT may be clinically effective after only a few injections and induces allergen-specific immunoglobulin G, similarly to SCIT. A limitation of ILIT is that intralymphatic injections are required. EPIT features allergen administration by using patches mounted on the skin. EPIT seeks to target epidermal antigen–presenting Langerhans cells rather than mast cells or the vasculature; this should reduce both local and systemic adverse effects. LNIT involves the spraying of allergen extracts into the nasal cavity. Natural or chemically modified allergens (the latter, termed allergoids, lack immunoglobulin E reactivity) are prepared in a soluble form. OIT involves the regular administration of small amounts of a food allergen by mouth and commences with low oral doses, which are then increased as tolerance develops. OMIT seeks to deliver allergenic proteins to an expanded population of Langerhans cells in the mucosa of the oral cavity. Conclusions ILIT, EPIT, LNIT, OIT, and OMIT are new routes for allergen immunotherapy. They are safe and effective.
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Affiliation(s)
- Mitat Aricigil
- ENT Department, Meram Medical Faculty, Necmettin Erbakan University, Konya Turkey
| | - Nuray Bayar Muluk
- Department of Otorhinolaryngology, Medical Faculty, Kirikkale University, Kirikkale, Turkey
| | | | | | - Mehmet Senturk
- ENT Clinics, Konya Training and Research Hospital, Konya, Turkey
| | | | - Cemal Cingi
- Department of Otorhinolaryngology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
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22
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Commins SP, Kim EH, Orgel K, Kulis M. Peanut Allergy: New Developments and Clinical Implications. Curr Allergy Asthma Rep 2016; 16:35. [PMID: 27039393 DOI: 10.1007/s11882-016-0613-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Food allergies have increased in prevalence over the past 20 years, now becoming an important public health concern. Although there are no therapies currently available for routine clinical care, recent reports have indicated that immunotherapies targeting the mucosal immune system may be effective. Oral immunotherapy is conducted by administering small, increasing amounts of food allergen; it has shown promise for desensitizing individuals with peanut, egg, or milk allergies. Sublingual immunotherapy also desensitizes allergic patients to foods-two major studies have examined the effects of sublingual immunotherapy in subjects with peanut allergies. We review the complex nature of IgE-mediated food allergies and the therapies being evaluated in clinical trials. We focus on the diagnosis and management of food allergies and investigational therapies.
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Affiliation(s)
- Scott P Commins
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. .,Thurston Arthritis Research Center, Chapel Hill, NC, USA. .,Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA. .,Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of North Carolina, 3300 Thurston Building, CB 7280, Chapel Hill, NC, 27599-7280, USA.
| | - Edwin H Kim
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Thurston Arthritis Research Center, Chapel Hill, NC, USA.,Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kelly Orgel
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mike Kulis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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23
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Wu Z, Lian J, Han Y, Zhou N, Li X, Yang A, Tong P, Chen H. Crosslinking of peanut allergen Ara h 2 by polyphenol oxidase: digestibility and potential allergenicity assessment. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2016; 96:3567-3574. [PMID: 26597340 DOI: 10.1002/jsfa.7542] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/29/2015] [Accepted: 11/24/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Peanut is one of the eight major food allergens. Its allergen, Ara h 2, can be recognized by over 90% of serum IgE samples from peanut-allergic patients. Therefore, reducing the allergenicity of Ara h 2 is especially important. RESULTS In the present study, polyphenol oxidase (PPO), a protein cross-linking reaction catalyst that acts on tyrosine residue, was used to modify Ara h 2. After crosslinking, the microstructure, digestibility, IgG binding capability and IgE binding capability of Ara h 2 were analyzed. Cross-linking decreased the potential allergenicity of Ara h 2 by masking the allergen epitope, while the antigenicity of Ara h 2 changed slightly. After crosslinking, the apparent diameter of Ara h 2 was altered from 300 to 1700 nm or 220 nm, indicating that polymerization could either be inter- or intramolecular. Regarding digestibility, crosslinked Ara h 2 was relatively more easily digested by gastric fluid compared with the untreated Ara h 2, but much more difficult in the intestinal fluid. CONCLUSION The crosslinking reaction catalyzed by PPO, as a non-thermal process, may be beneficial for avoiding food allergy. The reaction could mask allergen epitopes, decreasing the allergenicity of Ara h 2. © 2015 Society of Chemical Industry.
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Affiliation(s)
- Zhihua Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, 330047, China
| | - Jun Lian
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, China
| | - Yuanlong Han
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, China
- Jiangxi Synergy Pharmaceutical Co., Ltd, Fengxin, 330700, China
| | - Ningling Zhou
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, China
| | - Xin Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, China
- Department of Food Science, Nanchang University, Nanchang, 330047, China
| | - Anshu Yang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, 330047, China
| | - Ping Tong
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, 330047, China
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24
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Semancik E, Sayej WN. Oral immunotherapy for peanut allergy induces eosinophilic esophagitis: three pediatric case reports. Pediatr Allergy Immunol 2016; 27:539-41. [PMID: 26888330 DOI: 10.1111/pai.12554] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Eileen Semancik
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Wael N Sayej
- University of Connecticut School of Medicine, Farmington, CT, USA. .,Digestive Diseases, Hepatology and Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA.
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Srivastava KD, Siefert A, Fahmy TM, Caplan MJ, Li XM, Sampson HA. Investigation of peanut oral immunotherapy with CpG/peanut nanoparticles in a murine model of peanut allergy. J Allergy Clin Immunol 2016; 138:536-543.e4. [DOI: 10.1016/j.jaci.2016.01.047] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/14/2015] [Accepted: 01/21/2016] [Indexed: 01/25/2023]
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Abstract
Baked milk and egg have the potential to act as a form of oral immunotherapy (OIT). Clinical studies have shown that a majority of milk- and egg-allergic children can tolerate these allergens modified in baked form, and immunologic changes reported in subjects ingesting baked milk and egg mirror those seen in food allergy OIT trials. In addition, several studies have indicated that resolution of milk and egg allergies occur sooner in populations regularly ingesting baked milk and egg. Oral food challenges remain the best method for determining tolerability of baked milk and egg since baseline characteristics and diagnostic testing have not been reliable predictors. In this review, we explore the tolerability of baked milk and egg and their potential as OIT treatment for milk and egg allergy.
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Gregory JA, Shepley-McTaggart A, Umpierrez M, Hurlburt BK, Maleki SJ, Sampson HA, Mayfield SP, Berin MC. Immunotherapy using algal-produced Ara h 1 core domain suppresses peanut allergy in mice. PLANT BIOTECHNOLOGY JOURNAL 2016; 14:1541-50. [PMID: 26801740 PMCID: PMC5066676 DOI: 10.1111/pbi.12515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 05/26/2023]
Abstract
Peanut allergy is an IgE-mediated adverse reaction to a subset of proteins found in peanuts. Immunotherapy aims to desensitize allergic patients through repeated and escalating exposures for several months to years using extracts or flours. The complex mix of proteins and variability between preparations complicates immunotherapy studies. Moreover, peanut immunotherapy is associated with frequent negative side effects and patients are often at risk of allergic reactions once immunotherapy is discontinued. Allergen-specific approaches using recombinant proteins are an attractive alternative because they allow more precise dosing and the opportunity to engineer proteins with improved safety profiles. We tested whether Ara h 1 and Ara h 2, two major peanut allergens, could be produced using chloroplast of the unicellular eukaryotic alga, Chlamydomonas reinhardtii. C. reinhardtii is novel host for producing allergens that is genetically tractable, inexpensive and easy to grow, and is able to produce more complex proteins than bacterial hosts. Compared to the native proteins, algal-produced Ara h 1 core domain and Ara h 2 have a reduced affinity for IgE from peanut-allergic patients. We further found that immunotherapy using algal-produced Ara h 1 core domain confers protection from peanut-induced anaphylaxis in a murine model of peanut allergy.
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Affiliation(s)
- James A Gregory
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ariel Shepley-McTaggart
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Umpierrez
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barry K Hurlburt
- U.S. Department of Agriculture, Agricultural Research Service, Southern Regional Research Center, New Orleans, LA, USA
| | - Soheila J Maleki
- U.S. Department of Agriculture, Agricultural Research Service, Southern Regional Research Center, New Orleans, LA, USA
| | - Hugh A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen P Mayfield
- Department of Biology, University of California San Diego, La Jolla, CA, USA
| | - M Cecilia Berin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Pagovich OE, Wang B, Chiuchiolo MJ, Kaminsky SM, Sondhi D, Jose CL, Price CC, Brooks SF, Mezey JG, Crystal RG. Anti-hIgE gene therapy of peanut-induced anaphylaxis in a humanized murine model of peanut allergy. J Allergy Clin Immunol 2016; 138:1652-1662.e7. [PMID: 27372563 DOI: 10.1016/j.jaci.2016.03.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/09/2016] [Accepted: 03/28/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Peanuts are the most common food to provoke fatal or near-fatal anaphylactic reactions. Treatment with an anti-hIgE mAb is efficacious but requires frequent parenteral administration. OBJECTIVE Based on the knowledge that peanut allergy is mediated by peanut-specific IgE, we hypothesized that a single administration of an adeno-associated virus (AAV) gene transfer vector encoding for anti-hIgE would protect against repeated peanut exposure in the host with peanut allergy. METHODS We developed a novel humanized murine model of peanut allergy that recapitulates the human anaphylactic response to peanuts in NOD-scid IL2Rgammanull mice transferred with blood mononuclear cells from donors with peanut allergy and then sensitized with peanut extract. As therapy, we constructed an adeno-associated rh.10 serotype vector coding for a full-length, high-affinity, anti-hIgE antibody derived from the Fab fragment of the anti-hIgE mAb omalizumab (AAVrh.10anti-hIgE). In the reconstituted mice peanut-specific IgE was induced by peanut sensitization and hypersensitivity, and reactions were provoked by feeding peanuts to mice with symptoms similar to those of human subjects with peanut allergy. RESULTS A single administration of AAVrh.10anti-hIgE vector expressed persistent levels of anti-hIgE. The anti-hIgE vector, administered either before sensitization or after peanut sensitization and manifestation of the peanut-induced phenotype, blocked IgE-mediated alterations in peanut-induced histamine release, anaphylaxis scores, locomotor activity, and free IgE levels and protected animals from death caused by anaphylaxis. CONCLUSION If this degree of persistent efficacy translates to human subjects, AAVrh.10anti-hIgE could be an effective 1-time preventative therapy for peanut allergy and possibly other severe, IgE-mediated allergies.
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Affiliation(s)
- Odelya E Pagovich
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Bo Wang
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY; Department of Respiratory Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Maria J Chiuchiolo
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Stephen M Kaminsky
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Dolan Sondhi
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Clarisse L Jose
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Christina C Price
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, Conn
| | - Sarah F Brooks
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Jason G Mezey
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY; Department of Biological Statistics and Computational Biology, Cornell University, Ithaca, NY
| | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY.
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Song TW. A practical view of immunotherapy for food allergy. KOREAN JOURNAL OF PEDIATRICS 2016; 59:47-53. [PMID: 26958062 PMCID: PMC4781731 DOI: 10.3345/kjp.2016.59.2.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/05/2015] [Accepted: 10/12/2015] [Indexed: 11/27/2022]
Abstract
Food allergy is common and sometimes life threatening for Korean children. The current standard treatment of allergen avoidance and self-injectable epinephrine does not change the natural course of food allergy. Recently, oral, sublingual, and epicutaneous immunotherapies have been studied for their effectiveness against food allergy. While various rates of desensitization (36% to 100%) and tolerance (28% to 75%) have been induced by immunotherapies for food allergy, no single established protocol has been shown to be both effective and safe. In some studies, immunologic changes after immunotherapy for food allergy have been revealed. Adverse reactions to these immunotherapies have usually been localized, but severe systemic reactions have been observed in some cases. Although immunotherapy cannot be recommended for routine practice yet, results from recent studies demonstrate that immunotherapies are promising for the treatment of food allergy.
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Affiliation(s)
- Tae Won Song
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Affiliation(s)
- Katherine Anagnostou
- Department of Pediatric Allergy, Guy's and St Thomas' Hospitals NHS Foundation Trust, London SE1 7EH, United Kingdom;
| | - Andrew Clark
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom;
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31
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Abstract
Anaphylaxis prevalence has increased within the last few years. This may be due to a marked increase in allergic sensitization to foods especially in the pediatric population, as well as to an increase in outdoor recreational habits and the availability of new biologic medications. Furthermore, guidelines for the diagnosis of anaphylaxis have been published, thus facilitating the recognition of this disorder. Diagnosis of anaphylaxis is mainly based on history and clinical criteria of organ system involvement. The serum tryptase assay is now commercially available and may be a helpful diagnostic tool in certain clinical situations involving hypotension, but not in the context of food-induced anaphylaxis. Treatment of anaphylaxis mainly involves the use of epinephrine as a first line medication for severe manifestations followed by symptomatic management of specific symptoms, such as antihistamines for urticaria and albuterol for wheezing. Although commonly practiced, treatment with systemic corticosteroids is not supported by evidence-based literature. Observation in a medical facility for 4-6 hours is recommended to monitor for late phase reactions, although these rarely occur. Education is an essential component of management of a patient with a previous history of anaphylaxis, emphasizing early use of epinephrine and providing a written action plan. Referral to a board-certified allergist/immunologist is recommended to determine the cause of the anaphylaxis as well as to rule out other potential conditions. In this review, our main focus will be on the treatment and prevention of anaphylaxis while providing our readers with a brief introduction to the diagnosis of anaphylaxis, its prevalence and its most common causes.
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Affiliation(s)
- Anne-Marie Irani
- Department of Pediatrics, Virginia Commonwealth University, Richmon, Virginia, 23298, USA
| | - Elias G Akl
- Department of Pediatrics, Virginia Commonwealth University, Richmon, Virginia, 23298, USA
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Greenhawt M. The Learning Early About Peanut Allergy Study: The Benefits of Early Peanut Introduction, and a New Horizon in Fighting the Food Allergy Epidemic. Pediatr Clin North Am 2015; 62:1509-21. [PMID: 26456447 DOI: 10.1016/j.pcl.2015.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Observational studies have explored associations between timing of peanut, egg, and milk introduction and food allergy development, noting significant associations with reduced respective rates of milk, egg, and peanut allergy associated with earlier timing of introduction. Interventional studies developed to more definitively explore these outcomes have been published for egg and peanut, and are ongoing for multiple other allergens. This review focuses on the recent publication regarding the LEAP (Learning Early About Peanut Allergy) study, its highly favorable results, the policy implications of its findings, and the horizon for primary prevention as a realistic strategy to prevent food allergy.
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Affiliation(s)
- Matthew Greenhawt
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby H-2100, Box 442, Ann Arbor, MI 48106, USA; Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby H-2100, Box 442, Ann Arbor, MI 48106, USA.
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33
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Lomas JM, Järvinen KM. Managing nut-induced anaphylaxis: challenges and solutions. J Asthma Allergy 2015; 8:115-23. [PMID: 26604803 PMCID: PMC4631427 DOI: 10.2147/jaa.s89121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The prevalence of peanut and tree nut allergy in the USA has increased, especially in the pediatric population. Nut allergy remains the leading cause of fatal anaphylactic reactions. Management of anaphylaxis includes not only treatment of symptoms during a reaction, but strict dietary avoidance and education on potential situations, which may place the patient at high risk for accidental exposure. Cross-reactivity between various nuts along with various cross-contamination sources should be discussed with all nut-allergic individuals. Exciting research continues to emerge on other potential treatments for patients allergic to nuts, including allergen immunotherapy. Results of such interventions have been encouraging, though further studies are needed regarding safety and long-term outcomes before these can be applied to clinical practice.
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Affiliation(s)
- Jeanne M Lomas
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kirsi M Järvinen
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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34
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An Examination of Clinical and Immunologic Outcomes in Food Allergen Immunotherapy by Route of Administration. Curr Allergy Asthma Rep 2015; 15:35. [PMID: 26141581 DOI: 10.1007/s11882-015-0536-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Allergen immunotherapy for the treatment of food allergy has been a subject of intensive study within the last 10 years. After an unsuccessful attempt with subcutaneous immunotherapy for peanut allergy, other routes with varying degrees of safety and efficacy have been tested for peanut, milk, and egg allergies. In this review, we summarize the results to date with oral immunotherapy, sublingual immunotherapy, and epicutaneous immunotherapy for the treatment of food allergy. While results of immunotherapy trials are promising, increases in efficacy are commonly associated with an increased side effect profile. There is a need for additional research beginning at the preclinical level to develop safe and effective treatments for food allergy.
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35
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Wu Z, Zhou N, Xiong F, Li X, Yang A, Tong P, Tang R, Chen H. Allergen composition analysis and allergenicity assessment of Chinese peanut cultivars. Food Chem 2015; 196:459-65. [PMID: 26593515 DOI: 10.1016/j.foodchem.2015.09.070] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 08/25/2015] [Accepted: 09/16/2015] [Indexed: 11/17/2022]
Abstract
Peanut (Arachis hypogaea) is among the eight major food allergens in the world. Several attempts have been made to decrease or eliminate the allergenicity of peanut. Systemic screening of thousands of peanut cultivars may identify peanut with low allergenicity. In this study, the allergen compositions of 53 Chinese peanut cultivars were characterized, and their allergenicity to sera IgE of Chinese patients and in a mouse model was assessed. Contents of total protein and allergens were quantified by SDS-PAGE and densitometry analysis on gel. Although the contents of allergens broadly varied among cultivars, they were related to one another. The IgE binding capacity of cultivars was tested by ELISA, and their allergenicity was further evaluated in a mouse model by oral sensitization. Results showed that the allergenicity of peanut was affected by allergen composition rather than a single allergen. Peanut cultivars with low allergenicity may contain more Ara h 3/4 (24 kDa), Ara h 2 and less Ara h 3/4 (43, 38, and 36 kDa), Ara h 6. Screening based on allergen composition would facilitate the identification of low-allergenic peanut.
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Affiliation(s)
- Zhihua Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
| | - Ningling Zhou
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China; Department of Food Science, Nanchang University, Nanchang 330047, China
| | - Faqian Xiong
- Cash Crops Research Institute, Guangxi Academy of Agricultural Sciences, Nanning 530007, China
| | - Xin Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; Department of Food Science, Nanchang University, Nanchang 330047, China
| | - Anshu Yang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
| | - Ping Tong
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Ronghua Tang
- Cash Crops Research Institute, Guangxi Academy of Agricultural Sciences, Nanning 530007, China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China.
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36
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Nowak-Węgrzyn A, Albin S. Oral immunotherapy for food allergy: mechanisms and role in management. Clin Exp Allergy 2015; 45:368-83. [PMID: 25077670 DOI: 10.1111/cea.12382] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the emergence of food allergy as an important public health problem, it has become clear that there is an unmet need in regard to treatment. In particular, IgE-mediated food allergy that is associated with risk of fatal anaphylaxis has been the subject of multiple studies in the past decade. The growing body of evidence derived from multiple centres and various study designs indicates that for IgE-mediated food allergy, immunomodulation through food immunotherapy is possible; however, the extent of protection afforded by such treatment is highly variable. At this time, the capacity for food immunotherapy to restore permanent tolerance to food has not been demonstrated conclusively. This review will discuss these topics as they apply to the most important studies of food oral immunotherapy.
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Affiliation(s)
- A Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
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37
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Nickolls C, Campbell DE. Top 10 food allergy myths. J Paediatr Child Health 2015; 51:852-6. [PMID: 25940828 DOI: 10.1111/jpc.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Claire Nickolls
- Department of Allergy and Immunology, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Dianne E Campbell
- Department of Allergy and Immunology, Children's Hospital Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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38
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Vickery BP. Does clinical protection persist after food allergen oral immunotherapy? Immunotherapy 2015; 7:851-3. [PMID: 26314347 DOI: 10.2217/imt.15.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Brian P Vickery
- Division of Pediatric Allergy, Immunology & Rheumatology, University of North Carolina, Chapel Hill, NC, USA
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39
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Anagnostou K. Recent advances in immunotherapy and vaccine development for peanut allergy. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:55-65. [PMID: 26288733 DOI: 10.1177/2051013615591739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Peanut allergy is a common problem and can be the cause of severe, life-threatening allergic reactions. It rarely resolves, with the majority of patients carrying the disease onto adulthood. Peanut allergy poses a significant burden on the quality of life of sufferers and their families, which results mainly from the fear of accidental peanut ingestion, but is also due to dietary and social restrictions. Current standard management involves avoidance, patient education and provision of emergency medication, for use in allergic reactions, when they occur. Efforts have been made to develop a vaccine for peanut allergy. Recent developments have also highlighted the use of immunotherapy, which has shown promise as an active form of treatment and may present a disease-modifying therapy for peanut allergy. So far, results, especially from oral immunotherapy studies, have shown good efficacy in achieving desensitization to peanut with a good safety profile. However, the capacity to induce long-term tolerance has not been demonstrated conclusively yet and larger, phase III studies are required to further investigate safety and efficacy of this intervention. Peanut immunotherapy is not currently recommended for routine clinical use or outside specialist allergy units.
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Affiliation(s)
- Katherine Anagnostou
- Department of Paediatric Allergy, Guy's and St Thomas' Hospitals NHS Foundation Trust, Westminster Bridge Road, London-SE1 7EH, UK
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41
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Umetsu DT, Rachid R, Schneider LC. Oral immunotherapy and anti-IgE antibody treatment for food allergy. World Allergy Organ J 2015; 8:20. [PMID: 26185589 PMCID: PMC4491881 DOI: 10.1186/s40413-015-0070-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/11/2015] [Indexed: 01/30/2023] Open
Abstract
Food allergy is a major public health problem affecting nearly 10 % of children in most industrialized countries. Unfortunately, there are no effective therapies for food allergy, relegating patients to simply avoid the offending foods and treat reactions that occur on accidental exposure. Recently however, studies suggest that food immunotherapy may provide a promising new approach to food allergy, particularly using the oral form of immunotherapy (OIT). Enthusiasm for this approach though must be tempered because of the significant allergic reactions that often occur with OIT that tends to limit its use to patients with less severe disease. On the other hand, recent studies suggest that concomitant treatment of patients with omalizumab (anti-IgE monoclonal antibody) during the updosing phase of OIT may greatly reduce the allergic reactions associated with OIT, even in high-risk patients. This combined method may provide a novel approach to successfully and rapidly treat a large fraction of patients with high-risk food allergy.
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Affiliation(s)
- Dale T Umetsu
- Genetech, One DNA Way, MS 453b, South San Francisco, California 94080 USA
| | - Rima Rachid
- Division of Immunology and Allergy, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115 USA
| | - Lynda C Schneider
- Division of Immunology and Allergy, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115 USA
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42
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Sandrini A, Rolland JM, O'Hehir RE. Current developments for improving efficacy of allergy vaccines. Expert Rev Vaccines 2015; 14:1073-87. [PMID: 26013124 DOI: 10.1586/14760584.2015.1050385] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Allergic diseases are prevalent worldwide. Allergen immunotherapy (AIT) is a current treatment for allergy, leading to modification of the natural course of disease. Mechanisms of efficacy include Treg through release of IL-10 and TGF-β and specific IgG4 blocking antibodies. Subcutaneous and sublingual routes are popular, but uptake is limited by inconvenience and safety concerns. Inclusion criteria limit application to a small proportion of allergic patients. New forms of immunotherapy are being investigated for more efficacious, convenient and safer options with promising advances in recent years. The rationale of reducing vaccine allergenicity to increase safety while improving immunogenicity led to investigation of T-cell epitope-based peptides and recombinant allergen derivatives. Additionally, different routes of administration and adjuvants and adjunct therapies are being explored. This review discusses the current status of AIT and recent advances to improve clinical efficacy, safety and long-term immune tolerance.
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Affiliation(s)
- Alessandra Sandrini
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
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43
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Nachshon L, Goldberg MR, Elizur A, Levy MB, Schwartz N, Katz Y. A Web site-based reporting system for monitoring home treatment during oral immunotherapy for food allergy. Ann Allergy Asthma Immunol 2015; 114:510-5. [PMID: 25940735 DOI: 10.1016/j.anai.2015.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/25/2015] [Accepted: 04/13/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reactions during the home treatment phase of oral immunotherapy (OIT) are not uncommon. An ongoing accurate reporting of home treatment outcomes is crucial for the safety and success of OIT. Previous reports have shown that as few as 20% of patients are truly compliant with paper-based diaries. OBJECTIVE To develop a Web site-based electronic reporting system (web-RS) for monitoring home treatment during OIT for food allergy. METHODS A web-RS was developed and incorporated a thorough questionnaire querying for pertinent data including the dose(s) consumed, occurrence and details of adverse reactions, treatment(s), and relevant potential exacerbating factors. All patients enrolled in milk, peanut, or egg OIT programs for at least 4 weeks from November 2012 through January 2014 were introduced to web-RS (n = 157). Successful reporting through web-RS was defined by consecutive reporting during the first home treatment phase (24 days) after its introduction. Comparisons were made with a previous group of OIT-treated patients (n = 100) who reported by E-mail. RESULTS Successful reporting was achieved by 142 of 157 patients (90.44%) in contrast to a 75% success rate with E-mail (P = .0009). The odds for successful reporting using web-RS were 3.1 (95% confidence interval 1.6-6.3) times higher compared with using E-mail. Mild reactions were reported more frequently with web-RS (P = .0032). Patient reports were constantly available in real time for medical staff review. No complaints regarding web-RS feasibility were reported. One risk factor for failure to use web-RS was a patient's prior successful OIT experience without using web-RS (P = .012). CONCLUSION A web-RS can be a powerful tool for improving OIT safety by achieving a high level of patient cooperation in reporting home treatment results.
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Affiliation(s)
- Liat Nachshon
- Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Beer Yaakov, Israel
| | - Michael R Goldberg
- Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Beer Yaakov, Israel
| | - Arnon Elizur
- Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Beer Yaakov, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Beer Yaakov, Israel
| | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Yitzhak Katz
- Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Beer Yaakov, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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44
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Kulis M, Wright BL, Jones SM, Burks AW. Diagnosis, management, and investigational therapies for food allergies. Gastroenterology 2015; 148:1132-42. [PMID: 25633563 PMCID: PMC4793977 DOI: 10.1053/j.gastro.2015.01.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 12/14/2022]
Abstract
Food allergies have increased in prevalence over the past 20 years, now becoming an important public health concern. Although there are no therapies currently available for routine clinical care, recent reports have indicated that immunotherapies targeting the mucosal immune system may be effective. Oral immunotherapy is conducted by administering small, increasing amounts of food allergen; it has shown promise for desensitizing individuals with peanut, egg, or milk allergies. Sublingual immunotherapy also desensitizes allergic patients to foods-2 major studies have examined the effects of sublingual immunotherapy in subjects with peanut allergies. We review the complex nature of IgE-mediated food allergies and the therapies being evaluated in clinical trials. We focus on the diagnosis and management of food allergies and investigational therapies.
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Affiliation(s)
- Mike Kulis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Benjamin L. Wright
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Stacie M. Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - A. Wesley Burks
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Burks AW, Wood RA, Jones SM, Sicherer SH, Fleischer DM, Scurlock AM, Vickery BP, Liu AH, Henning AK, Lindblad R, Dawson P, Plaut M, Sampson HA. Sublingual immunotherapy for peanut allergy: Long-term follow-up of a randomized multicenter trial. J Allergy Clin Immunol 2015; 135:1240-8.e1-3. [PMID: 25656999 PMCID: PMC4527157 DOI: 10.1016/j.jaci.2014.12.1917] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/03/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND We previously reported the initial results of the first multicenter, randomized, double-blind, placebo-controlled clinical trial of peanut sublingual immunotherapy (SLIT), observing a favorable safety profile associated with modest clinical and immunologic effects in the first year. OBJECTIVE We sought to provide long-term (3-year) clinical and immunologic outcomes for our peanut SLIT trial. Key end points were (1) percentage of responders at 2 years (ie, could consume 5 g of peanut powder or a 10-fold increase from baseline), (2) percentage reaching desensitization at 3 years, (3) percentage attaining sustained unresponsiveness after 3 years, (4) immunologic end points, and (5) assessment of safety parameters. METHODS Response to treatment was evaluated in 40 subjects aged 12 to 40 years by performing a 10-g peanut powder oral food challenge after 2 and 3 years of daily peanut SLIT therapy. At 3 years, SLIT was discontinued for 8 weeks, followed by another 10-g oral food challenge and an open feeding of peanut butter to assess sustained unresponsiveness. RESULTS Approximately 98% of the 18,165 doses were tolerated without adverse reactions beyond the oropharynx, with no severe symptoms or uses of epinephrine. A high rate (>50%) discontinued therapy. By study's end, 4 (10.8%) of 37 SLIT-treated participants were fully desensitized to 10 g of peanut powder, and all 4 achieved sustained unresponsiveness. Responders at 2 years showed a significant decrease in peanut-specific basophil activation and skin prick test titration compared with nonresponders. CONCLUSIONS Peanut SLIT induced a modest level of desensitization, decreased immunologic activity over 3 years in responders, and had an excellent long-term safety profile. However, most patients discontinued therapy by the end of year 3, and only 10.8% of subjects achieved sustained unresponsiveness.
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Affiliation(s)
- A Wesley Burks
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Scott H Sicherer
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David M Fleischer
- Department of Pediatrics, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Denver, Colo
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Brian P Vickery
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Andrew H Liu
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | | | | | | | - Marshall Plaut
- National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda, Md
| | - Hugh A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
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The future of biologics: applications for food allergy. J Allergy Clin Immunol 2015; 135:312-23. [PMID: 25662303 DOI: 10.1016/j.jaci.2014.12.1908] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/20/2014] [Accepted: 12/03/2014] [Indexed: 01/18/2023]
Abstract
Allergic diseases affect millions worldwide, with growing evidence of an increase in allergy occurrence over the past few decades. Current treatments for allergy include corticosteroids to reduce inflammation and allergen immunotherapy; however, some subjects experience treatment-resistant inflammation or adverse reactions to these treatments, and there are currently no approved therapeutics for the treatment of food allergy. There is a dire need for new therapeutic approaches for patients with poorly controlled atopic diseases and a need to improve the safety and effectiveness of allergen immunotherapy. Improved understanding of allergy through animal models and clinical trials has unveiled potential targets for new therapies, leading to the development of several biologics to treat allergic diseases. This review focuses on the mechanisms that contribute to allergy, with an emphasis on future targets for biologics for the treatment of food allergy. These biologics include immunotherapy with novel anti-IgE antibodies and analogs, small-molecule inhibitors of cell signaling, anti-type 2 cytokine mAbs, and TH1-promoting adjuvants.
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Boguniewicz M, Leung DYM. Targeted therapy for allergic diseases: at the intersection of cutting-edge science and clinical practice. J Allergy Clin Immunol 2015; 135:354-6. [PMID: 25662304 DOI: 10.1016/j.jaci.2014.12.1907] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and the University of Colorado School of Medicine, Denver, Colo.
| | - Donald Y M Leung
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and the University of Colorado School of Medicine, Denver, Colo
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Le UH, Burks AW. Oral and sublingual immunotherapy for food allergy. World Allergy Organ J 2014; 7:35. [PMID: 25709745 PMCID: PMC4325942 DOI: 10.1186/1939-4551-7-35] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 10/31/2014] [Indexed: 11/10/2022] Open
Abstract
IgE-mediated food allergy is a potentially life-threatening allergic disease with an increase in prevalence in developed countries over the past 15 years. Currently, there are no approved forms of therapy and the standard of care is dietary restriction and ready access to emergency medications, such as self-injectable epinephrine and antihistamines. Allergen-specific modalities of treatment currently being studied include oral immunotherapy (OIT) and sublingual immunotherapy (SLIT). Both forms demonstrate the ability to desensitize patients to a variety of specific food allergens and show great promise. However, more research is needed to evaluate the safety and efficacy of OIT and SLIT prior to routine use in clinical practice.
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Affiliation(s)
- Uyenphuong H Le
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill NC 260 MacNider Hall, CB 7220, Chapel Hill, NC 27599-7220 USA
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill NC 260 MacNider Hall, CB 7220, Chapel Hill, NC 27599-7220 USA
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Greenhawt MJ, Vickery BP. Allergist-reported trends in the practice of food allergen oral immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 3:33-8. [PMID: 25577615 DOI: 10.1016/j.jaip.2014.06.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/18/2014] [Accepted: 06/27/2014] [Indexed: 11/17/2022]
Abstract
Food allergen oral immunotherapy (OIT) is an experimental, immune-modifying therapy that may induce clinical desensitization in some patients. OIT is still in early phase clinical research, but some providers may offer OIT as a clinical service. To understand the current practices of allergists who perform OIT, an online survey was sent by e-mail to members of the American Academy of Allergy Asthma & Immunology. Among 442 respondents, 61 reported participating in using OIT (13.8%), including 28 in nonacademic settings. Informed consent for OIT was obtained by 91.3%, institutional review board approval by 47.7% and Investigational New Drug approval by 38.1%. Compared with nonacademic participants, more academic participants used peanut OIT, obtained institutional review board and Investigational New Drug (P < .0001 respectively), and challenged patients before entry (P = .008). More nonacademic providers billed the patient or insurance for reimbursement (P < .0001). Low reported regard for the importance for US Food and Drug Administration approval or a standardized product (increased odds), and a high regard for better safety data (decreased odds) were associated with considering offering OIT as a service. Significant differences exist with OITs that occur in academic versus nonacademic settings. Further assessment is needed regarding the different motivations and practice styles among providers who offer OIT and those who are considering doing so.
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Affiliation(s)
- Matthew J Greenhawt
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, The University of Michigan Medical School, University of Michigan Health System; The University of Michigan Food Allergy Center; The Child Health Evaluation and Research Unit, Department of Pediatrics, The University of Michigan Medical School, Ann Arbor, Mich
| | - Brian P Vickery
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, The University of North Carolina-Chapel Hill, Chapel Hill, NC.
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