An open study to assess the efficacy clinically and immunologically ofM. vaccaevaccine in patients with atopic dermatitis

Mycobacterium vaccae Lysate Induces Anti-Allergic Immune Response In Vitro

Mycobacterium vaccae is a soil saprophyte which exerts anti-allergic properties. There are data that mechanism of action of M. vaccae when used in the treatment of human and animal allergic diseases is associated with Th1-phenotype switch. Here we studied the properties of sonicated M. vaccae lysate in co-cultures of dendritic cells and CD4⁺T cells. M. vaccae lysate stimulated IL-10 synthesis in co-cultures and CD86 expression in dendritic cells, being more potent than heat-killed M. vaccae. The reported clinical data and the mechanism of action of M. vaccae lysate suggest that its use is a feasible option for the primary prevention of allergic diseases, in particular atopic dermatitis.

A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns

INTRODUCTION

Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns.

METHODS

Searches of Embase (2005-2016) and abstracts from selected meetings (2014-2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity.

RESULTS

Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids.

CONCLUSION

This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease.

FUNDING

Regeneron Pharmaceuticals Inc.

Adjuvant treatment with the bacterial lysate (OM-85) improves management of atopic dermatitis: A randomized study

Background

Environmental factors play a major role on atopic dermatitis (AD) which shows a constant rise in prevalence in western countries over the last decades. The Hygiene Hypothesis suggesting an inverse relationship between incidence of infections and the increase in atopic diseases in these countries, is one of the working hypothesis proposed to explain this trend.

Objective

This study tested the efficacy and safety of oral administration of the bacterial lysate OM-85 (Broncho-Vaxom^®, Broncho-Munal^®, Ommunal^®, Paxoral^®, Vaxoral^®), in the treatment of established AD in children.

Methods

Children aged 6 months to 7 years, with confirmed AD diagnosis, were randomized in a double-blind, placebo-controlled trial to receive, in addition to conventional treatment with emollients and topical corticosteroids, 3.5mg of the bacterial extract OM-85 or placebo daily for 9 months. The primary end-point was the difference between groups in the occurrence of new flares (NF) during the study period, evaluated by Hazard Ratio (HR) derived from conditional Cox proportional hazard regression models accounting for repeated events.

Results

Among the 179 randomized children, 170 were analysed, 88 in the OM-85 and 82 in the placebo group. As expected most children in both treatment groups experienced at least 1 NF during the study period (75 (85%) patients in the OM-85 group and 72 (88%) in the placebo group). Patients treated with OM-85 as adjuvant therapy had significantly fewer and delayed NFs (HR of repeated flares = 0.80; 95% confidence interval (CI): 0.67–0.96), also when potential confounding factors, as family history of atopy and corticosteroids use, were taken into account (HR = 0.82; 95% CI: 0.69–0.98). No major side effect was reported, with comparable and good tolerability for OM-85 and placebo.

Conclusions

Results show an adjuvant therapeutic effect of a well standardized bacterial lysate OM-85 on established AD.

Successful immunotherapy of canine flea allergy with injected Actinomycetales preparations

AIMS

Can heat-killed, borate-buffered suspensions of Gordonia bronchialis, Rhodococcus coprophilus or Tsukamurella inchonensis be used to treat canine flea allergy?

MATERIALS & METHODS

Organisms cultured on Sauton's medium into stationary phase were autoclaved in borate-buffered saline and stored at 10 mg wet weight/ml. Intradermal injections of 0.1 ml containing 1 mg of bacilli were administered on the first and 20th days of the study. G. bronchialis and R. coprophilus were most effective in a pilot study of a small number of dogs with flea allergy. A larger number of affected dogs were then randomized to receive placebo or either of the two selected reagents. The extent and severity of allergic signs and symptoms were scored and blood samples were collected just before the first injection and 28 days after the second.

RESULTS

Both selected reagents reduced the extent and severity of lesions (p < 0.001) and reduced scratching. Eosinophil numbers were reduced (p < 0.0001) between the first and second assessment.

CONCLUSIONS

Injections of G. bronchialis or R. coprophilus effectively reduce the signs and symptoms of flea allergy in dogs.

Potential for immunotherapy with heat-killed Mycobacterium vaccae in respiratory medicine

Immunotherapy with Mycobacterium vaccae has been shown to be beneficial as part of the treatment for a wide range of diseases. In the respiratory system, the late airway response in bronchial asthma is modified by a single dose and bronchial aspects of hayfever are reduced allowing a major reduction in the use of bronchial dilators. In studies of advanced adenocarcinoma of the lung survival is increased by an average of 4 months when up to five doses of M. vaccae are added to the course of chemotherapy. The quality of life of cancer patients receiving immunotherapy with M. vaccae is improved, even if survival is not increased. It is suggested that the mechanism of action of immunotherapy with heat-killed, borate-buffered M. vaccae is likely to be very similar in all these diseases for which human pulmonary tuberculosis provides a model. In this study, additional immunological data are reported from material stored from an earlier study of immunotherapy for pulmonary tuberculosis to help complete the information on the way that treatment with three monthly injections of heat-killed, borate-buffered M. vaccae (SRL172) may act.

Prevention of allergic respiratory disease in infants: current aspects and future perspectives

PURPOSE OF REVIEW

Primary and secondary prevention of severe atopic disease exemplified by atopic asthma represents an increasingly prominent focus of research in paediatric allergy. We review below the rationale for this approach and recent progress in development and testing of a range of potential preventive strategies.

RECENT FINDINGS

The principal areas reviewed relate to potential and currently available treatments targeting enhancement of overall immune functions, allergen-specific immunomodulation and respiratory viral infections, particularly during early childhood.

SUMMARY

The scientific rationale for prophylaxis of atopic diseases via early intervention strategies targeting young children is increasingly supported by findings from the experimental and clinical literature and significant progress may be expected in the mid-term future.