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Gurgel RK, Baroody FM, Damask CC, Mims JW, Ishman SL, Baker DP, Contrera KJ, Farid FS, Fornadley JA, Gardner DD, Henry LR, Kim J, Levy JM, Reger CM, Ritz HJ, Stachler RJ, Valdez TA, Reyes J, Dhepyasuwan N. Clinical Practice Guideline: Immunotherapy for Inhalant Allergy. Otolaryngol Head Neck Surg 2024; 170 Suppl 1:S1-S42. [PMID: 38408152 DOI: 10.1002/ohn.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence-based recommendations for improved patient care. PURPOSE The purpose of this clinical practice guideline (CPG) is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce the risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The GDG made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitizations, (2) reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre- and co-seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions (LRs) to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The GDG offered the following KASs as options: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta-blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.
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Affiliation(s)
| | - Fuad M Baroody
- The University of Chicago Medicine, Chicago, Illinois, USA
| | | | - James Whit Mims
- Wake Forest Baptist Health, Winston Salem, North Carolina, USA
| | | | - Dole P Baker
- Anderson ENT & Facial Plastics, Anderson, South Carolina, USA
| | | | | | - John A Fornadley
- Associated Otolaryngologists of PA, Inc, Hershey, Pennsylvania, USA
| | | | | | - Jean Kim
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua M Levy
- National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland, USA
| | - Christine M Reger
- Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Ellis AK, Gagnon R, Hammerby E, Shen J, Gosain S. Sublingual immunotherapy tablet: a cost-minimizing alternative in the treatment of tree pollen-induced seasonal allergic rhinitis in Canada. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2021; 17:66. [PMID: 34238358 PMCID: PMC8264484 DOI: 10.1186/s13223-021-00565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A cost-minimization analysis (CMA) was performed to evaluate the economic implications of introducing the SQ Tree sublingual immunotherapy (SLIT)-tablets marketed as ITULATEK® (Health Canada regulatory approval in April 2020) for the treatment of pollen-induced (birch, alder and/or hazel) seasonal allergic rhinitis in Canada (Ontario and Quebec), where Tree Pollen subcutaneous immunotherapy (SCIT) is already an available treatment option. METHODS A CMA was deemed appropriate and was based on the assumption that the SQ Tree SLIT-tablets have comparable efficacy to Tree Pollen SCIT. A societal perspective was adopted in the model, including relevant costs of medications, costs of health care services, and productivity losses. The time horizon in the model was three years, which corresponds to a minimal treatment course of allergy immunotherapy. Resource use and costs were based on published sources, where available, and validated by Canadian specialist clinicians (allergists) in active practice in Ontario and in Quebec, where applicable. A discount rate of 1.5% was applied in accordance with the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines. To assess the robustness of the results, scenario analyses were performed by testing alternative assumptions for selected parameters (e.g., Tree Pollen SCIT resource use, discount rates, number of injections, annual SCIT dosing with maintenance injections, and nurse time support), to evaluate their impact on the results of the analysis. RESULTS The direct costs, including the drug costs, and physician services costs, for three years of treatment, were similar for both SQ Tree SLIT-tablets vs. Tree Pollen SCIT in both Ontario and Quebec ($2799.01 and $2838.70 vs. $2233.76 and $2266.05 respectively). However, when the indirect costs (including patient's travel expenses and lost working hours) are included in the model, total savings for the treatment with SQ Tree SLIT-tablets of $1111.79 for Ontario and $1199.87 for Quebec were observed. Scenario analyses were conducted and showed that changes in assumptions continue to result in the savings of SQ Tree SLIT- tablets over Tree Pollen SCIT. CONCLUSIONS The CMA indicates that SQ Tree SLIT-tablets are a cost-minimizing alternative to Tree Pollen SCIT when considered from a societal perspective in Ontario and Quebec.
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Affiliation(s)
- Anne K. Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Rémi Gagnon
- Service D’Allergie Et Immunologie, Département de Médecine, CHU de Québec, Québec City, QC Canada
| | | | - Julia Shen
- PDCI Market Access Inc., Ottawa, ON Canada
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Cox L. Pharmacoeconomics of allergy immunotherapy versus pharmacotherapy. Expert Rev Clin Immunol 2021; 17:255-268. [PMID: 33645387 DOI: 10.1080/1744666x.2021.1886079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: The purpose of this review is to evaluate the cost-effectiveness of allergy immunotherapy (AIT) in the treatment of allergic rhinitis, asthma, and other allergic conditions.Area covered: An extensive search of the PubMed and Medline database (January 1996 up to June of 2020) was conducted using the search terms allergy immunotherapy, pharmacoeconomics, cost-effectiveness, allergic rhinitis, and asthma. Studies were included if they included information on the economics of AIT in comparison to pharmacotherapy in the treatment of allergic rhinitis or asthma either as actual costs or based on theoretical models. Systematic reviews were included if they included information about the cost-effectiveness of AIT.Most clinical trials found significant cost-savings with AIT. The cost-effective time-point ranged from a few months to several years after treatment initiation.. Cost savings were demonstrated as early as 3 months after treatment initiation and were as great as 80% less than SDT in some studies.Expert opinion: There is strong evidence in the collective literature that AIT is cost-effective as compared to SDT alone. The magnitude of AIT's cost-effectiveness is likely underestimated because most of the studies considered during treatment costs and not AIT's long-term benefits or preventive/prophylactic effects or its impact on co-morbid conditions.
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Affiliation(s)
- Linda Cox
- Department of Medicine, Associate Professor of Medicine Nova Southeastern University, Ft. Lauderdale, Florida, USA
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Tabar AI, Delgado J, González-Mancebo E, Arroabarren E, Soto Retes L, Domínguez-Ortega J. Recent Advances in Allergen-Specific Immunotherapy as Treatment for Allergic Asthma: A Practical Overview. Int Arch Allergy Immunol 2021; 182:496-514. [PMID: 33631755 DOI: 10.1159/000513811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022] Open
Abstract
The Global Initiative for Asthma Report updated in 2019 stated that potential benefits of allergen immunotherapy (AIT), compared to pharmacological and avoidance options, must be weighed against the risk of adverse effects and the inconvenience and cost of the prolonged course of therapy in asthma. Thus, with the aim of clarifying some aspects with regard to the possible use of AIT in allergic asthma treatment armamentarium, a group of expert allergists from the Spanish Allergy and Clinical Immunology Scientific Society (SEAIC), particularly from the Immunotherapy and Asthma Interest Groups developed a frequently asked questions in clinical practice. This document updates relevant topics on the use of AIT in asthma and could facilitate physician clinical decisions and improve health outcomes for individual patients.
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Affiliation(s)
- Ana I Tabar
- Department of Allergy, Hospital Complex of Navarra, Pamplona, Spain, .,Navarra Institute for Health Research (IdiSNA), Cooperative Health Research Thematic Networks (RETICs) for Asthma, Adverse Reactions to Drugs, and Allergy (ARADYAL) Research Network, Pamplona, Spain,
| | - Julio Delgado
- Clinical Management for Allergy Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Eloina González-Mancebo
- Department of Allergy, University Hospital Fuenlabrada, La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Cooperative Health Research Thematic Networks (RETICs) for Asthma, Adverse Reactions to Drugs and Allergy (ARADYAL) Research Network, Madrid, Spain
| | | | - Lorena Soto Retes
- Department of Pneumology and Allergy, Santa Creu i Sant Pau Hospital, Barcelona, Spain.,Department of Medicine, Sant Pau Biomedical Research Institute (IIB Sant Pau), Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, La Paz Hospital Institute for Health Research (IdiPAZ), CIBER of Respiratory Diseases, CIBERES, Madrid, Spain
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Bezerra Barros GC, Paiva Ferreira LKD, Ferreira LAMP, Mozzini Monteiro T, Alves AF, Pereira RDA, Piuvezam MR. 4-Carvomenthenol ameliorates the murine combined allergic rhinitis and asthma syndrome by inhibiting IL-13 and mucus production via p38MAPK/NF-κB signaling pathway axis. Int Immunopharmacol 2020; 88:106938. [PMID: 33182052 DOI: 10.1016/j.intimp.2020.106938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/07/2020] [Accepted: 08/23/2020] [Indexed: 01/11/2023]
Abstract
The aim of this study was to analyze the 4-carvomenthenol (carvo) oral treatment on the experimental model of the combined allergic rhinitis and asthma syndrome (CARAS). BALB/c mice were OVA-sensitized on day zero and 7th (50 μg/mL OVA in 10 mg/mL Al (OH)3) and OVA-challenged (5 mg/mL, 20 μL/animal) for three weeks. In the last week, the animals were dally challenged with aerosol of OVA and the carvo treatment (12.5, 25 or 50 mg/kg) occurred one hour before each OVA-challenge. Data were analyzed and p < 0.05 was considered significant. Carvo (12.5-50 mg/kg) decreased significantly the eosinophil migration into the nasal (NALF) and bronchoalveolar (BALF) cavities as well as on the nasal and lung tissues of sick animals. The treatment also decreased mucus production on both tissue sections stained with PAS (periodic acid-Schiff satin). In addition, the histological analyzes demonstrated that sick mice presented hyperplasia and hypertrophy of the lung smooth muscle layer followed by increasing of extracellular matrix and carvo (50 mg/kg) inhibited these asthmatic parameters. We analyzed the allergic rhinitis signals as nasal frictions and sneezing and observed that carvo decreased these two signals as well as serum OVA-specific IgE titer, type 2 cytokine synthesis, mainly IL-13, with increasing of IL-10 production. Decreasing of IL-13 production corroborated with decreasing of mucus production and these effects were dependent on p38MAPK/NF-κB(p65) signaling pathway inhibition. Therefore, these data demonstrated that a monoterpene of essential oils presents anti-allergic property on an experimental model of CARAS suggesting a new drug prototype to treat this allergic syndrome.
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Affiliation(s)
- Grasiela Costa Bezerra Barros
- Department of Physiology and Pathology, Federal University of Paraíba, Laboratory of Immunopharmacology, João Pessoa, PB, Brazil
| | - Laércia K D Paiva Ferreira
- Department of Physiology and Pathology, Federal University of Paraíba, Laboratory of Immunopharmacology, João Pessoa, PB, Brazil
| | - Larissa A M P Ferreira
- Department of Physiology and Pathology, Federal University of Paraíba, Laboratory of Immunopharmacology, João Pessoa, PB, Brazil
| | | | - Adriano Francisco Alves
- Department of Physiology and Pathology, Federal University of Paraíba, Laboratory of Pathology, João Pessoa, PB, Brazil
| | - Ramon de Alencar Pereira
- Institute of Biological Sciences (ICB), Federal University of Minas Gerais, Department of General Pathology, Belo Horizonte, MG, Brazil
| | - Marcia Regina Piuvezam
- Department of Physiology and Pathology, Federal University of Paraíba, Laboratory of Immunopharmacology, João Pessoa, PB, Brazil.
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Cox LS, Murphey A, Hankin C. The Cost-Effectiveness of Allergen Immunotherapy Compared with Pharmacotherapy for Treatment of Allergic Rhinitis and Asthma. Immunol Allergy Clin North Am 2020; 40:69-85. [PMID: 31761122 DOI: 10.1016/j.iac.2019.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article evaluates the cost-effectiveness of allergy immunotherapy (AIT) in the treatment of allergic rhinitis, asthma, and other allergic conditions. An extensive search of the PubMed and Medline databases (up to December 2018) was conducted. There is strong evidence in the collective literature, which included individual studies and systematic reviews, that AIT is cost-effective in the management of allergic rhinitis and asthma as compared with standard drug treatment alone. The magnitude of AIT's cost-effectiveness is likely underestimated because most of the studies considered during-treatment costs and not the long-term benefits or preventive or prophylactic effects of AIT.
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Affiliation(s)
- Linda S Cox
- Nova Southeastern University, 1108 S. Wolcott Street, Casper, Wyoming 82601, USA.
| | - Andrew Murphey
- Asthma Allergy and Sinus Center, 1965 Andrew Drive, West Chester, PA 19380, USA
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Passalacqua G, Bagnasco D, Canonica GW. 30 years of sublingual immunotherapy. Allergy 2020; 75:1107-1120. [PMID: 31715001 DOI: 10.1111/all.14113] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
Allergen Immunotherapy (AIT) was introduced in clinical practice on an empirical basis more than 100 years ago. Since the first attempts, AIT was administered subcutaneously. Indeed, other routes of administration were proposed and studied, in particular to improve the safety, but only the sublingual route (SLIT) achieved a credibility based on evidence and was then accepted as a viable "alternative" option to the subcutaneous route. SLIT was largely used in clinical trials and clinical practice in this last 30 years. Thus, a large amount of data is available, coming from either controlled trials and postmarketing surveillance studies. It is clear that SLIT is overall effective, but it is also clear that the efficacy is not "class-related," as derived from meta-analyses, but restricted to each specific product. The 30-year lasting use of SLIT allowed to clarify many clinical aspects, such as efficacy, safety, use in asthma, regimens of administration, and optimal doses. In parallel, the mechanisms of action of AIT were elucidated, and new indications were proposed (eg food allergy, atopic dermatitis). In addition, the introduction of molecular-based diagnosis, allowed to better refine the prescription of SLIT, based on specific sensitization profiles. The present article will describe the origin and evolution of SLIT for respiratory allergy, taking into account the clinical context that suggested this form of treatment, the recently developed aspects, the future perspectives and unmet needs, This is not, therefore, a systematic review, rather a narrative historical description of the past history, and a look forward to the future opportunities.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
- Personalized Medicine Asthma & Allergy ‐ Humanitas Clinical and Research Center IRCCS Rozzano (MI) Italy
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8
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Abstract
This article evaluates the role of allergen immunotherapy (AIT) in the treatment of allergic rhinitis (AR). AIT has been shown to be effective in treating AR symptoms with resultant improvements in overall quality of life, comorbid illnesses, and medication requirements. Persistent clinical benefits have been shown years after AIT treatment discontinuation. AIT may prevent the progression of AR to asthma. AIT may more cost-effective than pharmacotherapy. Multiple individual studies and systematic reviews provide strong evidence for the clinical effectiveness of AIT in the treatment of AR. Cost-effectiveness and disease modification of AIT compared with standard drug treatment are additional advantages.
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Affiliation(s)
- Linda Cox
- Department of Medicine, Nova Southeastern University, Davie, FL, USA; Department of Medicine, University of Miami, Coral Gables, FL, USA.
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Rizk P, Rodenas M, De Benedetto A. Allergen Immunotherapy and Atopic Dermatitis: the Good, the Bad, and the Unknown. Curr Allergy Asthma Rep 2019; 19:57. [PMID: 31776678 DOI: 10.1007/s11882-019-0893-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW In light of the recent advancements in atopic dermatitis treatment, this review aims to summarize the utility and efficacy of allergy immunotherapy in atopic dermatitis patients. We examine its mechanism, pathophysiology, cost-efficacy, and current guidelines for clinical practice. RECENT FINDINGS The literature supports the use of allergy immunotherapy in atopic conditions such as allergic rhinitis and asthma but insufficient evidence exists to suggest its efficacy in atopic dermatitis. The use of allergy immunotherapy has been shown to provide long-term cost savings in both the USA and the European Union in certain populations but differences in prescribing patterns and manufacturing make it difficult to study its impact on a larger, generalizable scale. Conflicting meta-analyses data and conclusions highlight the need for better, higher quality research to better understand allergy immunotherapy utility in atopic dermatitis.
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Affiliation(s)
- Patrick Rizk
- Department of Dermatology, College of Medicine University of Florida, 4037 NW 86 Terrace, Gainesville, FL, 32606, USA
| | - Mario Rodenas
- Section of Allergy and Clinical Immunology, Division of Rheumatology, Department of Medicine, College of Medicine University of Florida, Gainesville, FL, USA
| | - Anna De Benedetto
- Department of Dermatology, College of Medicine University of Florida, 4037 NW 86 Terrace, Gainesville, FL, 32606, USA.
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Yu J, Zhong N, Luo Q, Liu Y, Yi H, Ye J, Zhang J. Early Efficacy Analysis of Cluster and Conventional Immunotherapy in Patients With Allergic Rhinitis. EAR, NOSE & THROAT JOURNAL 2019; 100:378-385. [PMID: 31547713 DOI: 10.1177/0145561319863370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Specific immunotherapy is an important immune-modifying treatment for patients with allergic rhinitis (AR). We compared the early efficacy and safety of cluster and conventional immunotherapies for patients with AR. METHODS One hundred forty-nine patients with persistent AR were enrolled in a randomized and open-label trial and were divided into the following 4 groups: 60 children treated conventionally, 33 children treated using the cluster schedule, 23 adults treated conventionally, and 33 adults treated using the cluster schedule. Patients in the cluster groups reached the maintenance dose within 6 weeks, while those receiving conventional therapy reached the maintenance dose within 14 weeks. Symptom scores and skin prick test scores (SPTs) were used to evaluate clinical efficacy and adverse reactions. RESULTS After buildup phase of treatment, symptom scores, and SPTs were significantly lower than those prior to treatment in each group (P < .05). No significant differences were found in the efficacy of nasal symptoms scores among four groups (P > .05).However, the efficacy of SPTs using conventional schedule was higher than cluster schedule in children groups (group A and B, 57.7 vs 30.2%, P = .001). Besides, the efficacy of SPTs in adults was higher than children when using the cluster treatment (group D and B, 53.0 vs 30.2%, P = .008). No severe adverse reaction occurred. CONCLUSIONS Conventional and cluster immunotherapy schedules have similar efficacies, which do not vary with age; both schedules are safe and reliable. Also, SPT facilitate evaluation of clinical efficacy.
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Affiliation(s)
- Jieqing Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Nongping Zhong
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qing Luo
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yuanhua Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Huarong Yi
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Jing Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Jian Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
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Paiva Ferreira LKD, Paiva Ferreira LAM, Monteiro TM, Bezerra GC, Bernardo LR, Piuvezam MR. Combined allergic rhinitis and asthma syndrome (CARAS). Int Immunopharmacol 2019; 74:105718. [PMID: 31255882 DOI: 10.1016/j.intimp.2019.105718] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/30/2019] [Accepted: 06/21/2019] [Indexed: 12/22/2022]
Abstract
Combined allergic rhinitis and asthma syndrome (CARAS) is a concept of "one airway - one disease" or "unified airway disease ". The upper and lower airway inflammation characterizes allergic rhinitis and asthma, respectively and both diseases have shown an intimate connection in their genesis, coexistence and similarities as triggered by the same etiological agents; the same inflammatory cell profile and share therapeutic treatment. This review highlights the concept of CARAS by its phenotype, endotype and biomarker classification. Indeed, rhinitis is divided into four major phenotypes: allergic rhinitis; infectious rhinitis; non-infective/non-allergic rhinitis and mixed rhinitis. On the other hand, asthma has no common consensus yet; however, the most accepted classification is based on the stage of life (early- or late- onset asthma) in which the clinical symptoms are presented. Experimental researches where animals develop a syndrome similar to CARAS have been contributed to better understand the pathogenesis of the syndrome. Therefore, the aim of this review is to clarify current terms related to CARAS as definition, phenotypes, endotypes/biomarkers, physiopathology and treatments.
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Affiliation(s)
- Laércia K D Paiva Ferreira
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Larissa A M Paiva Ferreira
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Talissa M Monteiro
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Grasiela Costa Bezerra
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Larissa Rodrigues Bernardo
- Department of Physiology and Pathology, Graduate Program in Development and Technological Innovation of Medicines, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Marcia Regina Piuvezam
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil; Department of Physiology and Pathology, Graduate Program in Development and Technological Innovation of Medicines, Federal University of Paraíba, João Pessoa, PB, Brazil.
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Ellis AK, Gagnon R, Hammerby E, Lau A. Sublingual immunotherapy tablet for the treatment of house dust mite allergic rhinitis in Canada: an alternative to minimize treatment costs? ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2019; 15:27. [PMID: 31061666 PMCID: PMC6487002 DOI: 10.1186/s13223-019-0344-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND A cost-minimization analysis (CMA) was performed to estimate the economic impact of introducing the SQ house dust mite sublingual immunotherapy (SQ HDM SLIT)-tablet marketed as ACARIZAX™ (regulatory approval May 2017) for the treatment of HDM-induced allergic rhinitis in Canada (Ontario and Quebec), where house dust mite subcutaneous immunotherapy (HDM SCIT) is already an available treatment option. METHODS A CMA was deemed appropriate and was based on the assumption that the SQ HDM SLIT-tablet has comparable efficacy to HDM SCIT. A societal perspective was adopted in the model, including relevant costs of medications, health care services and productivity loss. A 3 year time horizon was used corresponding to a recommended treatment course of allergy immunotherapy. Resource use and costs were based on published sources, where possible, and validated and complemented by a Canadian specialist clinician (allergist) in active practice in Ontario and in Quebec, respectively, where applicable. A discount rate of 1.5% was applied in accordance with the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines. To assess the robustness of the results, sensitivity analyses were performed by testing alternative assumptions for selected parameters, to understand their impact on the results of the analysis. RESULTS The direct treatment costs for a 3-year treatment with SQ HDM SLIT-tablets were higher than for HDM SCIT for both provinces, Ontario and Quebec ($4732.12 and $4829.03 vs. $3434.51 and $2987.74). However, when adding the indirect costs to the model, total savings for the treatment with SQ HDM SLIT-tablets of $1833.00 for Ontario and $769.03 for Quebec were observed. Sensitivity analyses with varying HDM SCIT resource use, discount rates, titration and maintenance injections, nurse time, and number of injections per vial resulted in savings of SQ HDM SLIT-tablets over HDM SCIT in all scenarios analysed. CONCLUSIONS The CMA indicates that SQ HDM SLIT-tablets are a cost-minimizing alternative to HDM SCIT when considered from a societal perspective in Ontario and Quebec.
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Affiliation(s)
- Anne K. Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Rémi Gagnon
- Service d’Allergie et Immunologie, Département de médecine, CHU de Québec, Quebec, Canada
| | | | - Andrea Lau
- PDCI Market Access Inc., Ottawa, ON Canada
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Peveri S, Pattini S, Costantino M, Incorvaia C, Montagni M, Roncallo C, Villalta D, Savi E. Molecular diagnostics improves diagnosis and treatment of respiratory allergy and food allergy with economic optimization and cost saving. Allergol Immunopathol (Madr) 2019; 47:64-72. [PMID: 30245286 DOI: 10.1016/j.aller.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/23/2018] [Accepted: 05/10/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Component resolved diagnosis (CRD) allows to precisely identify the sensitization to specific molecules of a given allergenic source, resulting in an important improvement in clinical management, particularly of polysensitized subjects. This will end in the correct prescription of allergen immunotherapy (AIT) for respiratory allergy and in adequate avoidance diets or prescription of self-injectable adrenaline in food allergy. OBJECTIVE The aim of this multicenter, real life study is to evaluate the percentage change of the diagnostic-therapeutic choice in polysensitized patients with respiratory allergy and in patients with food allergy, after using CRD compared to a first level diagnosis, along with an economic analysis of the patient's overall management according to the two different approaches. METHODS An overall number of 462 polysensitized patients, as suggested by skin prick tests (SPT), and with clinical symptoms related to a respiratory (275 pts) or food (187 pts) allergy, were recruited. All patients underwent CRD for specific IgE against food or inhalant recombinant molecules, which were chosen according to medical history and positivity to SPT. The first diagnostic-therapeutic hypothesis, based only on medical history and SPT, was recorded for each patient while the final diagnostic-therapeutic choice was based on the results from CRD. The rate of change of the diagnostic-therapeutic choice from the first hypothesis to the final choice was statistically evaluated. The economic impact of CRD on the overall management of the allergic patients was analyzed to evaluate whether the increase in the diagnostic costs would be compensated and eventually exceeded by savings coming from the improved diagnostic-therapeutic appropriateness. RESULTS An approximate 50% change (k index 0.54) in the prescription of AIT for respiratory allergy as well as a change in the prescription of self-injectable adrenaline (k index 0.56) was measured; an overall saving of financial resources along with a higher diagnostic-therapeutic appropriateness was also detected. CONCLUSION There is moderate agreement concerning prescription of AIT and self-injectable adrenaline before and after performing CRD: this highlights the usefulness of CRD, at least in polysensitized patients, in indicating the risk assessment and therefore the correct therapy of respiratory and food allergy, which results in a cost-saving approach.
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14
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Novak N, Buhl T, Pfaar O. Adherence During Early Allergen Immunotherapy and Strategies to Motivate and Support Patients. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10312545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Allergic rhinitis is one of the most common chronic inflammatory conditions, affecting up to 30% of people in Europe. Allergen immunotherapy (AIT) is the only treatment for allergic rhinitis and asthma that has a disease-modifying effect, and it is recommended in European guidelines for use in conjunction with patient education, specific allergen avoidance, and symptomatic pharmacotherapy. Reported AIT adherence rates vary widely but are often low in real-world settings. Factors known to affect adherence are patient, treatment, or physician-related, and vary between healthcare settings. Misconceptions or a lack of AIT knowledge among patients with regard to efficacy and side effects may contribute to high rates of discontinuation observed during the first year of AIT treatment. Interventions to improve patient adherence are multifaceted and should focus on patient education, particularly the provision of accurate information regarding adverse effects of AIT and when to expect an improvement in symptoms, patient-support programmes, and the use of regular eHealth reminders via a telephone call, text message, or social media. Serum-based biomarkers also have the potential to play a role in evaluating early response to AIT and in monitoring treatment adherence in clinical practice. In this review, the authors explore barriers to continuation with AIT and discuss initiatives to motivate and support patients through the challenging early months of treatment, prior to the onset of clinical effect and when side effects are most common, to encourage long-term adherence to therapy and achieve optimal patient outcomes.
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University of Bonn Medical Center, Bonn, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Georg-August University, Göttingen, Germany; Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen and University of Osnabrück, Osnabrück, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
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15
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Nolte H, Maloney J. The global development and clinical efficacy of sublingual tablet immunotherapy for allergic diseases. Allergol Int 2018; 67:301-308. [PMID: 29759659 DOI: 10.1016/j.alit.2018.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/16/2018] [Indexed: 01/07/2023] Open
Abstract
Allergy immunotherapy (AIT) is a treatment option for respiratory allergy that is complementary to pharmacotherapy, with a distinct mechanism of action. Alternative methods to subcutaneous administration of AIT that enable patients to safely self-administer AIT is considered an unmet clinical need. The sublingual immunotherapy tablet (SLIT-tablet) is an orally disintegrating pharmaceutical formulation (oral lyophilisate) containing standardized allergens. SLIT-tablets have been developed for sublingual immunotherapy (SLIT) of cedar-pollen, grass-pollen, ragweed-pollen, tree-pollen, and house dust mite allergies. It is a once-daily tablet treatment to be self-administered after the first dose has been provided under the supervision of a physician with experience in the diagnosis and treatment of allergic diseases. Once the first dose is adequately tolerated, subsequent doses may be self-administered. SLIT-tablets have proven efficacy for allergic rhinitis (AR) with and without conjunctivitis (C) and allergic asthma (AA) in adults, children, and poly-sensitized allergic patients. Meta-analyses indicate that SLIT-tablets have superior or similar efficacy compared with anti-allergic pharmacotherapies for seasonal AR and superior efficacy for perennial AR. SLIT-tablets have also demonstrated clinically relevant improvements of asthma, with significant reductions in the following: daily inhaled corticosteroid use, risk of asthma exacerbations, and asthma symptoms. SLIT-tablets are generally well tolerated, with a low risk of systemic allergic reactions. The most common treatment-related adverse events are mild-moderate oral reactions. Current evidence supports SLIT-tablets to be considered as an alternative or add-on treatment to pharmacotherapy for AR/C and asthma. Future SLIT developments may include early intervention to prevent the development or progression of allergic disease in children.
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16
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Molnár V, Nagy A, Tamási L, Gálffy G, Böcskei R, Bikov A, Czaller I, Csoma Z, Krasznai M, Csáki C, Zsigmond G, Csontos Z, Kurucz A, Kurucz E, Fábos B, Bálint BL, Sasvári-Székely M, Székely A, Kótyuk E, Kozma GT, Cserta G, Farkas A, Gál Z, Gézsi A, Millinghoffer A, Antal P, Szalai C. From genomes to diaries: a 3-year prospective, real-life study of ragweed-specific sublingual immunotherapy. Immunotherapy 2018; 9:1279-1294. [PMID: 29130793 DOI: 10.2217/imt-2017-0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
During the last decades, the prevalence of allergy has dramatically increased. Allergen-specific immunotherapy is the only currently available medical intervention that has the potential to affect the natural course of the disease, but there are still many questions and unmet needs hindering its widespread use to fulfill its treatment potential and maximize its benefits for the society. To provide a comprehensive phenome-wide overview in sublingual immunotherapy, using ragweed allergy as a target, we planned and carried out a longitudinal, prospective, observational, open-label study (DesensIT). In this paper we present challenges of using deep and comprehensive phenotypes embracing biological, clinical and patient-reported outcomes in allergen-specific immunotherapy and show how we designed the DesensIT project to optimize data collection, processing and evaluation.
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Affiliation(s)
- Viktor Molnár
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Adrienne Nagy
- Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Renáta Böcskei
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Ibolya Czaller
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Zsuzsanna Csoma
- National Korányi Institute of TB & Pulmonology, 1121 Budapest, Pihenő út 1, Hungary
| | - Magdolna Krasznai
- Department of Otorhinolaryngology, Semmelweis University, Head & Neck Surgery, 1083 Budapest, Szigony u. 36, Hungary
| | - Csilla Csáki
- Svábhegyi Healing Facility, 1037 Budapest, Bokor u. 17, Hungary
| | | | - Zoltán Csontos
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Anikó Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Edina Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Beáta Fábos
- Somogy County Kaposi Mór Teaching Hospital, 7400 Kaposvár Tallián Gyula u. 20-32, Hungary
| | - Bálint L Bálint
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary
| | - Mária Sasvári-Székely
- Institute of Medical Chemistry, Molecular Biology & Pathobiochemistry, Semmelweis University, 1094 Budapest, Tűzoltó utca 37-47, Hungary
| | - Anna Székely
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Eszter Kótyuk
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Gergely T Kozma
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Gábor Cserta
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Anita Farkas
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Zsófia Gál
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Gézsi
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Millinghoffer
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary.,Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Péter Antal
- Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Csaba Szalai
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary.,Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary.,Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
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17
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Abstract
House dust mite (HDM) is a predominant source of indoor aeroallergen worldwide, which induces allergic diseases including allergic rhinoconjunctivitis, allergic asthma, atopic eczema and other allergic skin diseases. Allergen specific immunotherapy (AIT) is the only potential disease-modifying treatment of HDM allergic subjects. However, AIT remains underused due to no universally accepted allergen standardization and a shortage of rigorous clinical studies to confirm safety and efficacy. With the effort of doctors and researchers in allergy field, efficacy, safety, standardization and strategy of AIT are being continuously developed. This review presents the updated research based on recently published trials and meta-analyses.
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Affiliation(s)
- Lin Yang
- a Department of Allergy , Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology , Wuhan , China
| | - Rongfei Zhu
- a Department of Allergy , Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology , Wuhan , China
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18
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Richards JR, Stumpf JL. House Dust Mite Sublingual Immunotherapy for Pediatric Patients With Allergic Asthma. Ann Pharmacother 2018; 52:1019-1030. [PMID: 29642713 DOI: 10.1177/1060028018769443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To review the published literature evaluating administration of house dust mite (HDM) sublingual immunotherapy (SLIT) in pediatric patients with allergic asthma. DATA SOURCES PubMed database search (1966 to November 2017) using the search terms allergy, allergic rhinitis, asthma, allergic asthma, house dust mite, allergen immunotherapy, subcutaneous immunotherapy, sublingual immunotherapy, MK-8237, children, and pediatric. Package labeling and references from identified articles were also reviewed. STUDY SELECTION AND DATA EXTRACTION Studies published in English evaluating the efficacy of HDM SLIT in children <18 years of age were included. DATA SYNTHESIS Patients with allergic asthma who fail to improve with pharmacotherapy may require disease-modifying, HDM-specific immunotherapy. Acceptance of subcutaneous immunotherapy (SCIT) in the pediatric population is limited by the need for weekly injections and the risk of systemic adverse effects. Trials in pediatric patients with allergic rhinitis and asthma monosensitized to HDM demonstrated mixed results, likely because of variability in methodologies. SLIT reduced asthma symptoms in 8 placebo-controlled studies; however, asthma medication use was reduced in just 4 trials. Compared with pharmacotherapy alone, SLIT and SCIT decreased asthma symptom scores similarly for up to 3 years. Sequential SCIT/SLIT decreased both asthma symptoms and medication scores and was more effective than SLIT alone. CONCLUSIONS Sublingual HDM immunotherapy reduces symptom scores in pediatric patients with allergic asthma but may be slower in onset and less effective than SCIT in reducing asthma medication use.
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Affiliation(s)
- Jessika R Richards
- 1 St. John Hospital and Medical Center Department of Pharmacy Services, Detroit, MI, USA
| | - Janice L Stumpf
- 2 Michigan Medicine Department of Pharmacy Services, Ann Arbor, MI, USA.,3 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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19
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Quirt J, Gagnon R, Ellis AK, Kim HL. CSACI position statement: prescribing sublingual immunotherapy tablets for aeroallergens. Allergy Asthma Clin Immunol 2018; 14:1. [PMID: 29339956 PMCID: PMC5759887 DOI: 10.1186/s13223-017-0225-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/15/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- J Quirt
- McMaster University, Hamilton, Canada
| | - R Gagnon
- Laval University, Quebec City, Canada
| | | | - H L Kim
- McMaster University, Hamilton, Canada.,Western University, London, Canada.,525 Belmont Ave West, Suite 205, Kitchener, ON N2M 5E2 Canada
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20
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Bao Y, Chen J, Cheng L, Guo Y, Hong S, Kong W, Lai H, Li H, Li H, Li J, Li T, Lin X, Liu S, Liu Z, Lou H, Meng J, Qiu Q, Shen K, Tang W, Tao Z, Wang C, Wang X, Wei Q, Xiang L, Xie H, Xu Y, Zhang G, Zhang Y, Zheng Y, Zhi Y, Chen D, Hong H, Li Q, Liu L, Meng Y, Wang N, Wang Y, Zhou Y, Zhang L. Chinese Guideline on allergen immunotherapy for allergic rhinitis. J Thorac Dis 2017; 9:4607-4650. [PMID: 29268533 DOI: 10.21037/jtd.2017.10.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present document is based on a consensus reached by a panel of experts from Chinese Society of Allergy (CSA) and Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G). Allergen immunotherapy (AIT), has increasingly been used as a treatment for allergic rhinitis (AR) globally, as it has been shown to provide a long-term effect in improving nasal and ocular symptoms, reducing medication need, and improving quality of life. AIT is currently the only curative intervention that can potentially modify the immune system in individuals suffering from AR and prevent the development of new sensitization and the progression of disease from AR to asthma. Although the use of AIT is becoming more acceptable in China, to date no AR immunotherapy guideline from China is available for use by the international community. This document has thus been produced and covers the main aspects of AIT undertaken in China; including selection of patients for AIT, the allergen extracts available on the Chinese market, schedules and doses of allergen employed in different routes of AIT, assessment of effect and safety, patients' administration and follow-up, and management of adverse reactions. The Chinese guideline for AR immunotherapy will thus serve as a reference point by doctors, healthcare professionals and organizations involved in the AIT of AR in China. Moreover, this guideline will serve as a source of information for the international community on AIT treatment strategies employed in China.
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Affiliation(s)
- Yixiao Bao
- Department of Pediatric Respiratory Medicine, Pubin Children Hospital, Shanghai Children Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lei Cheng
- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing 210029, China
| | - Yinshi Guo
- Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Suling Hong
- Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - He Lai
- Department of Allergy, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Houyong Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Huabin Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, Allergy and Clinical Immunology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Tianying Li
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoping Lin
- The PLA Center of respiratory and allergic disease diagnosing and management, Shenyang 110016, China
| | - Shixi Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zheng Liu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Juan Meng
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qianhui Qiu
- Department of Otorhinolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Kunling Shen
- Department of Pediatric Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wei Tang
- Department of Pulmonary and Critical Care Medicine, Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Zezhang Tao
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Qingyu Wei
- Department of Allergy, NO.202 Hospital of PLA, Shenyang 110003, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Hua Xie
- Department of Respiratory Medicine, the General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Yu Xu
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Yiwu Zheng
- Scientific Affairs, ALK, Guangzhou 510300, China
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100720, China
| | - Dehua Chen
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Haiyu Hong
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Quansheng Li
- Department of Allergy, NO.202 Hospital of PLA, Shenyang 110003, China
| | - Lin Liu
- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Nan Wang
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yihui Wang
- Department of Pediatric Respiratory Medicine, Pubin Children Hospital, Shanghai Children Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yue Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China
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21
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Björstad Å, Cardell LO, Hahn-Pedersen J, Svärd M. A Cost-Minimisation Analysis Comparing Sublingual Immunotherapy to Subcutaneous Immunotherapy for the Treatment of House Dust Mite Allergy in a Swedish Setting. Clin Drug Investig 2017; 37:541-549. [PMID: 28326466 DOI: 10.1007/s40261-017-0516-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES In Sweden, approximately 6% of children and 10% of adults suffer from house dust mite (HDM) allergy with symptoms of allergic rhinitis and allergic asthma. Treatment is aimed at reducing HDM exposure and to control the symptoms of allergic rhinitis and allergic asthma by symptom-relieving pharmacotherapy. This pharmacotherapy is often effective, but some patients remain inadequately controlled. For these patients, allergy immunotherapy (AIT, subcutaneous or sublingual) with repeated administration of HDM allergen should be considered. The objective of this study was to compare the costs for sublingual AIT (SLIT; SQ® SLIT-tablet) to the costs for subcutaneous AIT (SCIT; SQ® SCIT) for the treatment of HDM allergy in a cost-minimisation analysis (CMA). METHODS The CMA included resources (and costs) for treatment, healthcare visits, travelling and lost productivity. Resource use based on Swedish clinical treatment practice and costs were obtained from medical price lists. Analyses were conducted from the societal, as well as healthcare perspective, by use of a time horizon of 3 years. RESULTS The results show that SQ® SLIT-tablet is a cost-saving treatment as compared to SQ® SCIT for the treatment of HDM allergy (€6800 over 3 years). The results are mainly driven by the cost of healthcare visits and the frequency of SCIT administrations. CONCLUSION In conclusion, cost-savings of €6800 over 3 years are expected from treating HDM allergy with SQ® SLIT-tablet as compared to SQ® SCIT, including costs for treatment, healthcare visits, travelling and lost productivity. The reduced number of healthcare visits compensates for higher medication costs.
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Affiliation(s)
| | - Lars-Olaf Cardell
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden
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Fu LQ, Li YL, Fu AK, Wu YP, Wang YY, Hu SL, Li WF. Pidotimod exacerbates allergic pulmonary infection in an OVA mouse model of asthma. Mol Med Rep 2017; 16:4151-4158. [PMID: 28731127 DOI: 10.3892/mmr.2017.7046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 05/16/2017] [Indexed: 11/05/2022] Open
Abstract
Pidotimod is a synthetic dipeptide with biological and immuno‑modulatory properties. It has been widely used for treatment and prevention of recurrent respiratory infections. However, its impact on the regulation of allergic pulmonary inflammation is still not clear. In the current study, an ovalbumin (OVA)‑induced allergic asthma model was used to investigate the immune‑modulating effects of pidotimod on airway eosinophilia, mucus metaplasia and inflammatory factor expression compared with dexamethasone (positive control). The authors determined that treatment with pidotimod exacerbated pulmonary inflammation as demonstrated by significantly increased eosinophil infiltration, dramatically elevated immunoglobulin E production, and enhanced T helper 2 response. Moreover, treatment failed to attenuate mucus production in lung tissue, and did not reduce OVA‑induced high levels of FIZZ1 and Arg1 expression in asthmatic mice. In contrast, administration of dexamethasone was efficient in alleviating allergic airway inflammation in OVA‑induced asthmatic mice. These data indicated that pidotimod as an immunotherapeutic agent should be used cautiously and the effectiveness for controlling allergic asthma needs further evaluation and research.
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Affiliation(s)
- Luo-Qin Fu
- Key Laboratory of Molecular Animal Nutrition and Feed Sciences, College of Animal Science, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
| | - Ya-Li Li
- Key Laboratory of Molecular Animal Nutrition and Feed Sciences, College of Animal Science, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
| | - Ai-Kun Fu
- Key Laboratory of Molecular Animal Nutrition and Feed Sciences, College of Animal Science, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
| | - Yan-Ping Wu
- Key Laboratory of Molecular Animal Nutrition and Feed Sciences, College of Animal Science, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
| | - Yuan-Yuan Wang
- Key Laboratory of Molecular Animal Nutrition and Feed Sciences, College of Animal Science, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
| | - Sheng-Lan Hu
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, Guangzhou, Guangdong 510640, P.R. China
| | - Wei-Fen Li
- Key Laboratory of Molecular Animal Nutrition and Feed Sciences, College of Animal Science, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
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Allergen-Specific Immunotherapy for Respiratory Allergy in Children: Unmet Needs and Future Goals. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:946-950. [PMID: 28389302 DOI: 10.1016/j.jaip.2017.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/15/2016] [Accepted: 01/19/2017] [Indexed: 12/20/2022]
Abstract
Allergen-specific immunotherapy for the treatment of respiratory allergy is currently supported, at least for selected products, by evidence of efficacy and effectiveness in the pediatric age. However, unmet needs remain in terms of administration regimens, duration of treatment, biomarkers, and preventive effects. These knowledge gaps need to be urgently addressed to provide pediatricians and pediatric allergists with more definite recommendations for the use of this treatment in children. This article critically appraises the most relevant debated issues on allergen-specific immunotherapy in children, focusing on allergen standardization procedures, heterogeneity of clinical studies, and regulatory and pharmacoeconomic aspects.
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Brunton S, Nelson HS, Bernstein DI, Lawton S, Lu S, Nolte H. Sublingual immunotherapy tablets as a disease-modifying add-on treatment option to pharmacotherapy for allergic rhinitis and asthma. Postgrad Med 2017; 129:581-589. [PMID: 28326908 DOI: 10.1080/00325481.2017.1308208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Allergic rhinitis (AR) with or without conjunctivitis (AR/C) is associated with a significant health and economic burden, and is often accompanied by asthma. Pharmacotherapies are the mainstay treatment options for AR and asthma, but guidelines also recommend allergy immunotherapy (AIT). Unlike pharmacotherapies, AIT has the ability to modify the underlying immunologic mechanisms of AR and asthma with the potential for long-term benefits after treatment is discontinued. Immunotherapy may also prevent progression of AR/C to asthma. Sublingual immunotherapy (SLIT)-tablets are a self-administered alternative to subcutaneous immunotherapy that provide the benefits of AIT without the cost and inconvenience of frequent office visits or the discomfort of injections. SLIT-tablets are also an option that can be utilized by primary care clinicians. Pharmacotherapies are generally effective in mild disease although a number of patients remain uncontrolled. SLIT-tablets have proven efficacy for AR in adults, children, and poly-sensitized allergic patients. Indirect comparisons indicate that SLIT-tablets have superior or comparable efficacy compared with traditional pharmacotherapies for seasonal AR, and superior efficacy for perennial AR. House dust mite (HDM) SLIT-tablets have also demonstrated clinically relevant benefits for asthma, with significant observed reductions in daily inhaled corticosteroid use, risk of asthma exacerbations, and asthma symptoms. SLIT-tablets are well tolerated, with minimal risk of systemic allergic reactions. The most common treatment-related adverse events are oral site reactions such as oral pruritus and throat irritation. Based on the favorable efficacy and safety profile, as well as the convenience of at-home oral administration and disease-modifying effects, SLIT-tablets should be considered as an alternative or add-on treatment to pharmacotherapy for AR/C, and as an add-on treatment for HDM allergic asthma.
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Affiliation(s)
- Stephen Brunton
- a Primary Care Respiratory Group , Lake View Terrace , CA , USA
| | - Harold S Nelson
- b Department of Medicine , National Jewish Health , Denver , CO , USA
| | - David I Bernstein
- c Bernstein Clinical Research Center and Department of Medicine and Environmental Health , University of Cincinnati , Cincinnati , OH , USA
| | | | - Susan Lu
- e Merck & Co., Inc. , Kenilworth , NJ , USA
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Demoly P, Makatsori M, Casale TB, Calderon MA. The Potential Role of Allergen Immunotherapy in Stepping Down Asthma Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:640-648. [PMID: 28042004 DOI: 10.1016/j.jaip.2016.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022]
Abstract
For patients whose asthma is controlled and who have a low risk for future exacerbations, current guidelines recommend gradually stepping down pharmacotherapy to identify the lowest dose needed to maintain control. This review article will discuss the benefits and risks of step down in asthma management and the different strategies of achieving step down with particular focus on allergen immunotherapy (AIT). A literature search was conducted to identify studies that assessed the effect of AIT on asthma step down and evaluated this and asthma control as one of the outcomes. Six studies were identified: 2 subcutaneous and 4 sublingual AIT studies. Five studies assessed house dust mite-induced asthma, whereas 1 study focused on birch-induced seasonal asthma. Regarding house dust mite-induced asthma, the AIT studies reviewed suggest that individuals with moderate rather than mild asthma are the patients who are more likely to benefit from the addition of AIT for their asthma condition. The potential value of AIT is likely to be in enabling successful step down of the inhaled corticosteroid dose in Global Initiative for Asthma step 3 or 4. It is important to further explore this effect so that affected individuals can benefit from this treatment.
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Affiliation(s)
- Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Sorbonne Universités, Paris, France
| | - Melina Makatsori
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom.
| | - Thomas B Casale
- Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
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Cox L. The role of allergen immunotherapy in the management of allergic rhinitis. Am J Rhinol Allergy 2016; 30:48-53. [PMID: 26867530 DOI: 10.2500/ajra.2016.30.4253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the role of allergen immunotherapy (AIT) in the treatment of allergic rhinitis (AR). METHOD Individual studies, systematic reviews, and practice guidelines that included information on sublingual AIT (SLIT) and subcutaneous AIT (SCIT) in the treatment of AR were considered. RESULTS AIT via the SLIT or SCIT route has been shown to be effective in treating AR symptoms with resultant improvements in overall quality of life, comorbid illnesses, and medication requirements. Persistent clinical benefits have been demonstrated years after AIT treatment discontinuation. AIT may prevent the progression of AR to asthma. In addition, studies that evaluated the pharmacoeconomics of AR treatment indicate that AIT may be more cost effective than pharmacotherapy. The AIT cost savings are likely underestimated in that few cost comparison studies considered AIT's long-term benefits or preventive effects. CONCLUSION Multiple individual studies and systematic reviews provide strong evidence for the clinical effectiveness of AIT in the treatment of AR. Cost-effectiveness and disease modification are additional advantages of AIT compared with standard drug treatment in the management of AR.
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Affiliation(s)
- Linda Cox
- Department of Medicine, Nova Southeastern University, Davie, Florida, USA
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Calderon MA, Demoly P, Casale T, Akdis CA, Bachert C, Bewick M, Bilò BM, Bohle B, Bonini S, Bush A, Caimmi DP, Canonica GW, Cardona V, Chiriac AM, Cox L, Custovic A, De Blay F, Devillier P, Didier A, Di Lorenzo G, Du Toit G, Durham SR, Eng P, Fiocchi A, Fox AT, van Wijk RG, Gomez RM, Haathela T, Halken S, Hellings PW, Jacobsen L, Just J, Tanno LK, Kleine-Tebbe J, Klimek L, Knol EF, Kuna P, Larenas-Linnemann DE, Linneberg A, Matricardi M, Malling HJ, Moesges R, Mullol J, Muraro A, Papadopoulos N, Passalacqua G, Pastorello E, Pfaar O, Price D, Del Rio PR, Ruëff R, Samolinski B, Scadding GK, Senti G, Shamji MH, Sheikh A, Sisul JC, Sole D, Sturm GJ, Tabar A, Van Ree R, Ventura MT, Vidal C, Varga EM, Worm M, Zuberbier T, Bousquet J. Allergy immunotherapy across the life cycle to promote active and healthy ageing: from research to policies: An AIRWAYS Integrated Care Pathways (ICPs) programme item (Action Plan B3 of the European Innovation Partnership on active and healthy ageing) and the Global Alliance against Chronic Respiratory Diseases (GARD), a World Health Organization GARD research demonstration project. Clin Transl Allergy 2016; 6:41. [PMID: 27895895 PMCID: PMC5120439 DOI: 10.1186/s13601-016-0131-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/02/2016] [Indexed: 12/17/2022] Open
Abstract
Allergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Santé). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.
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Affiliation(s)
- M A Calderon
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - P Demoly
- Unité d'allergologie, Département de Pneumologie et AddictologieHôpital Arnaud de Villeneuve, CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - T Casale
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - C A Akdis
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Swiss Institute of Allergy and Asthma Research (SIAF)University of Zurich, Davos, Switzerland
| | - C Bachert
- Upper Airways Research Laboratory (URL), ENT Department, University Hospital Ghent, Ghent, Belgium
| | - M Bewick
- iQ4U consultants Ltd, London, UK
| | - B M Bilò
- Allergy Unit, Department of Internal Medicine, University Hosp Ospedali Riuniti, Ancona, Italy
| | - B Bohle
- Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - S Bonini
- Second University of Naples and IFT-CNR, Rome, Italy
| | - A Bush
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - D P Caimmi
- Unité d'allergologie, Département de Pneumologie et AddictologieHôpital Arnaud de Villeneuve, CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - G W Canonica
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - V Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A M Chiriac
- Division of Allergy, Hôpital Arnaud de Villeneuve, Department of Pulmonology, University Hospital of Montpellier, Montpellier - UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France
| | - L Cox
- Nova Southeastern University, Ft. Lauderdale, FL USA
| | - A Custovic
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
| | - P Devillier
- University Versailles Saint-Quentin and Clinical Pharmacology Unit, UPRES EA 220, Department of Airway Diseases, Foch Hospital, Suresnes, France
| | - A Didier
- Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
| | - G Di Lorenzo
- Dipartimento BioMedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), University of Palermo, Palermo, Italy
| | - G Du Toit
- Guy's and St. Thomas' NHS Trust, Kings College, London, UK
| | - S R Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - P Eng
- Department of Pediatric Pulmonology and Allergy, Children's Hospital, Aarau, Switzerland
| | - A Fiocchi
- Division of Allergy, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Vatican City, Rome, Italy
| | - A T Fox
- King's College London Allergy Academy, London, UK
| | - R Gerth van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Building Rochussenstraat, Rotterdam, The Netherlands
| | - R M Gomez
- Unidad Alergia and Asma, Hospital San Bernardo, Salta, Argentina
| | - T Haathela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - S Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - P W Hellings
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - L Jacobsen
- Allergy Learning and Consulting, Secretary Immunotherapy Interest Group EAACI, Copenhagen, Denmark
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau, INSERM, UMR_S 1136, Sorbonne Universités, UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - L K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil ; University Hospital of Montpellier, Montpellier, France ; UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Universités, Paris, France
| | - J Kleine-Tebbe
- Allergy and Asthma Center Westend, Outpatient Clinic and Clinical Research Center, Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - L Klimek
- Center for Rhinology and Allergology, German Society for Otorhinolaryngology HNS, Wiesbaden, Germany
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - P Kuna
- Medical University of Lodz, Lodz, Poland
| | | | - A Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark ; Department of Clinical Experimental Research, Rigshospitalet, Copenhagen, Denmark ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Matricardi
- Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - H J Malling
- Danish Allergy Centre, Allergy Clinic, Gentofte University Hospital, Hellerup, Denmark
| | - R Moesges
- IMSIE, Klinikum der Universität zu Köln A. ö. R., Cologne, Germany
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, ENT Department, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, Barcelona, Catalonia Spain
| | - A Muraro
- Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy
| | - N Papadopoulos
- Allergy Unit, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, Univesity of Genoa, Genoa, Italy
| | - E Pastorello
- ASST Grande Ospedale Metropolitano Niguarda, P.zza Ospedale Maggiore, Milan, Italy
| | - O Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Mannheim, Germany ; Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany ; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - D Price
- Division of Applied Health Sciences, Primary Care Respiratory Medicine, Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, UK ; Research in Real Life (RiRL), Oakington, Cambridge, UK ; Optimum Patient Care Ltd, Singapore, Singapore
| | | | - R Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximillian University, Munich, Germany
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - G K Scadding
- Royal National Throat, Nose and Ear Hospital, London, UK ; University College London, London, UK
| | - G Senti
- Clinical Trials Center, University Hospital of Zurich, Zurich, Switzerland
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - A Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | | | - D Sole
- Programa de Pòs-Graduação em Pediatria e Ciências Aplicadas à Pediatria, Departamento de Pediatria EPM, UNIFESP, São Paulo, Brazil
| | - G J Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria ; Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
| | - A Tabar
- Servicio de Alergologia, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - R Van Ree
- Departments of Experimental Immunology and Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M T Ventura
- Unit of Geriatric Immunoallergology, Interdisciplinary Department of Medicine, University of Bari Medical School, Bari, Italy
| | - C Vidal
- Allergy Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E M Varga
- Respiratory and Allergic Disease Division, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - M Worm
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Zuberbier
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Bousquet
- University Hospital of Montpellier, Montpellier, France ; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Paris, France ; INSERM, VIMA, U1168, Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, Paris, France ; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles Cedex, France ; CHRU, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
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Zieglmayer P, Focke-Tejkl M, Schmutz R, Lemell P, Zieglmayer R, Weber M, Kiss R, Blatt K, Valent P, Stolz F, Huber H, Neubauer A, Knoll A, Horak F, Henning R, Valenta R. Mechanisms, safety and efficacy of a B cell epitope-based vaccine for immunotherapy of grass pollen allergy. EBioMedicine 2016; 11:43-57. [PMID: 27650868 PMCID: PMC5049999 DOI: 10.1016/j.ebiom.2016.08.022] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/13/2016] [Accepted: 08/15/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We have developed a recombinant B cell epitope-based vaccine (BM32) for allergen-specific immunotherapy (AIT) of grass pollen allergy. The vaccine contains recombinant fusion proteins consisting of allergen-derived peptides and the hepatitis B surface protein domain preS as immunological carrier. METHODS We conducted a randomized, double-blind, placebo-controlled AIT study to determine safety, clinical efficacy and immunological mechanism of three subcutaneous injections of three BM32 doses adsorbed to aluminum hydroxide versus aluminum hydroxide (placebo) applied monthly to grass pollen allergic patients (n=70). Primary efficacy endpoint was the difference in total nasal symptom score (TNSS) through grass pollen chamber exposure before treatment and 4weeks after the last injection. Secondary clinical endpoints were total ocular symptom score (TOSS) and allergen-specific skin response evaluated by titrated skin prick testing (SPT) at the same time points. Treatment-related side effects were evaluated as safety endpoints. Changes in allergen-specific antibody, cellular and cytokine responses were measured in patients before and after treatment. RESULTS Sixty-eight patients completed the trial. TNSS significantly decreased with mean changes of -1.41 (BM32/20μg) (P=0.03) and -1.34 (BM32/40μg) (P=0.003) whereas mean changes in the BM32/10μg and placebo group were not significant. TOSS and SPT reactions showed a dose-dependent decrease. No systemic immediate type side effects were observed. Only few grade 1 systemic late phase reactions occurred in BM32 treated patients. The number of local injection site reactions was similar in actively and placebo-treated patients. BM32 induced highly significant allergen-specific IgG responses (P<0.0001) but no allergen-specific IgE. Allergen-induced basophil activation was reduced in BM32 treated patients and addition of therapy-induced IgG significantly suppressed T cell activation (P=0.0063). CONCLUSION The B cell epitope-based recombinant grass pollen allergy vaccine BM32 is well tolerated and few doses are sufficient to suppress immediate allergic reactions as well as allergen-specific T cell responses via a selective induction of allergen-specific IgG antibodies. (ClinicalTrials.gov number, NCT01445002.).
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Affiliation(s)
| | - Margarete Focke-Tejkl
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Milena Weber
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Renata Kiss
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Katharina Blatt
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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Rønborg S, Johnsen CR, Theilgaard S, Winther A, Hahn-Pedersen J, Andreasen JN, Olsen J. Cost-minimization analysis of sublingual immunotherapy versus subcutaneous immunotherapy for house dust mite respiratory allergic disease in Denmark. J Med Econ 2016; 19:735-41. [PMID: 26909663 DOI: 10.3111/13696998.2016.1158718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objectives Currently, patients with persistent moderate-to-severe house dust mite (HDM) allergic rhinitis despite use of symptom-relieving medication can be offered subcutaneously administered allergy immunotherapy (SQ SCIT; Alutard SQ) as standard care of treatment in Denmark. Recently, a HDM sublingually administered allergy immunotherapy tablet (SQ SLIT-tablet; ACARIZAX) has been developed for at-home treatment. The purpose of this analysis is to compare the costs related to treatment and administration of SQ SLIT-tablet and SQ SCIT. Methods Assuming equal efficacy between ther SQ SLIT-tablet and SQ SCIT, the cost-minimization analysis was the most appropriate for the comparison. According to guidelines and Summary of Product Characteristics, the treatment duration of SQ SLIT-tablet is 3 years and 3-5 years for SQ SCIT. The courses of treatment vary among patients and, therefore, the costs of treatment have been calculated for an average patient with HDM respiratory allergic disease (RAD) receiving either SQ SLIT-tablet or SQ SCIT. All costs associated with allergy immunotherapy were collected, i.e., cost of medication, administration and treatment setting, and discounted according to Danish guidelines. Comprehensive univariate sensitivity analyses were carried out. Results The treatment costs for an average patient with HDM RAD are €3094 for SQ SLIT-tablet and €3799 for SQ SCIT; however, when adding indirect costs to the calculations the total costs of the treatments are €3697 and €6717 for SQ SLIT-tablet and SQ SCIT, respectively. Therefore, if 2500 patients with HDM RAD were treated with SQ SLIT-tablet instead of SQ SCIT, it would elicit a saving to the healthcare system of ∼€1.8 million. The conclusion was robust to any changes in the sensitivity analysis. Conclusion With regards to the cost of treating Danish patients with HDM RAD, it is clearly cost-saving to treat patients with SQ SLIT-tablet compared to SQ SCIT.
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Affiliation(s)
| | - Claus R Johnsen
- b Department of Dermato-Allergology , Copenhagen University Hospital , Gentofte , Denmark
| | | | | | | | | | - Jens Olsen
- f Health Economics Department , Incentive , Holte , Denmark
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Cox L, Calderon MA. Allergen Immunotherapy for Atopic Dermatitis: Is There Room for Debate? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:435-44. [DOI: 10.1016/j.jaip.2015.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/06/2015] [Accepted: 12/18/2015] [Indexed: 12/21/2022]
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Caimmi D, Calderon MA, Bousquet J, Demoly P. Allergen Immunotherapy Outcomes and Unmet Needs. Immunol Allergy Clin North Am 2016; 36:181-9. [DOI: 10.1016/j.iac.2015.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Licari A, Castagnoli R, Bottino C, Marseglia A, Marseglia G, Ciprandi G. Emerging drugs for the treatment of perennial allergic rhinitis. Expert Opin Emerg Drugs 2016; 21:57-67. [PMID: 26733401 DOI: 10.1517/14728214.2016.1139082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Allergic rhinitis is a worldwide health problem, currently affecting up to 40% of the general population, and characterized by the following symptoms in a variable degree of severity and duration: nasal congestion/obstruction, rhinorrhea, itchy nose and/or eyes, and/or sneezing. General symptoms like fatigue, reduced quality of sleep, impaired concentration and reduced productivity, if left untreated, may significantly affect quality of life. In addition, of being associated to various comorbidities, allergic rhinitis is also an independent risk factor for the development and worsening of asthma. Perennial allergic rhinitis is caused by allergens present around the year. AREAS COVERED Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines currently recommend a stepwise therapeutic approach that combines patient education with specific allergen avoidance, symptomatic pharmacotherapy and allergen immunotherapy. The available treatment strategies provide suboptimal symptom relief in patients with moderate-to-severe disease who continue to experience symptoms while treated, even on multiple therapies. EXPERT OPINION New insights into current therapy have been provided with the development of new symptomatic drugs with improved pharmacokinetics and safety. However, the ultimate research goal is beyond symptomatic treatment, and is mainly directed at modifying the immune response to allergens and prevent the progression of allergic rhinitis towards asthma. In this direction, promising advances are expected in the fields of allergen immunotherapy and biological drugs, such as omalizumab. Finally, significant research efforts are also focused on the growing number of new specific molecular targets involved in the Th2 pathway inflammation of allergic diseases.
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Affiliation(s)
- Amelia Licari
- a Department of Pediatrics, Foundation IRCCS Policlinico San Matteo , University of Pavia , Pavia , Italy
| | - Riccardo Castagnoli
- a Department of Pediatrics, Foundation IRCCS Policlinico San Matteo , University of Pavia , Pavia , Italy
| | - Chiara Bottino
- a Department of Pediatrics, Foundation IRCCS Policlinico San Matteo , University of Pavia , Pavia , Italy
| | - Alessia Marseglia
- a Department of Pediatrics, Foundation IRCCS Policlinico San Matteo , University of Pavia , Pavia , Italy
| | - GianLuigi Marseglia
- a Department of Pediatrics, Foundation IRCCS Policlinico San Matteo , University of Pavia , Pavia , Italy
| | - Giorgio Ciprandi
- b Department of Medicine , IRCCS-A.O.U. San Martino di Genova , Genoa , Italy
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Canonica GW, Bachert C, Hellings P, Ryan D, Valovirta E, Wickman M, De Beaumont O, Bousquet J. Allergen Immunotherapy (AIT): a prototype of Precision Medicine. World Allergy Organ J 2015; 8:31. [PMID: 26594303 PMCID: PMC4640346 DOI: 10.1186/s40413-015-0079-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/23/2015] [Indexed: 11/10/2022] Open
Abstract
Precision medicine is a medical model aiming to deliver customised healthcare - with medical decisions, practices, and/or products tailored to the individual patient informed but not directed by guidelines. Allergen immunotherapy has unique immunological rationale, since the approach is tailored to the specific IgE spectrum of an individual and modifies the natural course of the disease as it has a persistent efficacy after completion of treatment. In this perspective Allergen Immunotherapy - AIT has to be presently considered a prototype of Precision Medicine. Precise information and biomarkers provided by systems medicine and network medicine will address the discovery of Allergen immunotherapy biomarkers for (i) identification of the causes, (ii) stratification of eligible patients for AIT and (iii) the assessment of AIT efficacy. This area of medical technology is evolving rapidly and, compelemented by e-health, will change the way we practice medicine. It will help to monitor patients’ disease control and data for (i) patient stratification, (ii) clinical trials, (iii) monitoring the efficacy and safety of targeted therapies which are critical for reaching an appropriate reimbursement. Biomarkers associated with e-health combined with a clinical decision support system (CDSS) will change the scope of Allergen immunotherapy. The cost/effectiveness of Allergen immunotherapy is a key issue for successful implementation. It should include the long-term benefits in the pharmaco-economic evaluation, since no other allergy treatment has this specific characteristic. AIT is the prototype of current and future precision medicine.
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Affiliation(s)
- G W Canonica
- Allergy and Respiratory Diseases -DIMI Department of Internal Medicine, University of Genova, IRCCS AOU San Martino, Genova, 16132 Italy
| | - C Bachert
- Upper Airways Research Laboratory, ENT-Department, University of Ghent, 9000 Ghent, Belgium
| | - P Hellings
- Department of Otorhinolaryngology, University of Leuven, Leuven, Belgium ; Department of Otorhinolaryngology, University of Amsterdam, Amsterdam, The Netherlands
| | - D Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - E Valovirta
- Department of Pulmonary and Allergic Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - M Wickman
- Department of Environmental Medecine, Karolinska Institutet, Sachs' Children's Hospital, Stockholm, Sweden
| | | | - J Bousquet
- University hospital, Montpellier, MACVIA-LR, Contre les Maladies Chronique spour un Vieillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; INSERM, VIMA : Ageing and chronic diseases Epidemiological and public health approaches, U1168 Paris, France ; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France
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Passalacqua G, Canonica GW. Allergen Immunotherapy: History and Future Developments. Immunol Allergy Clin North Am 2015; 36:1-12. [PMID: 26617223 DOI: 10.1016/j.iac.2015.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Allergen immunotherapy (AIT) was introduced in clinical practice more than 100 years ago. The clinical effectiveness in allergic rhinitis (and asthma) and in hymenoptera allergy was apparent early on but it was not until the mid-1900s that randomized placebo-controlled trials proved its efficacy. In the 1980s, sublingual immunotherapy (SLIT) was accepted in official guidelines. The availability of safer routes, such as SLIT, prompted increasing investigation of AIT for food allergy. The introduction of molecular-based diagnosis introduced the possibility of better targeted prescription of AIT. Other approaches are being explored, such as immunogenic peptides, recombinant allergens, and adjuvants.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa 16132, Italy.
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa 16132, Italy
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Pleskovic N, Bartholow A, Gentile DA, Skoner DP. The Future of Sublingual Immunotherapy in the United States. Curr Allergy Asthma Rep 2015; 15:44. [PMID: 26149585 DOI: 10.1007/s11882-015-0545-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sublingual immunotherapy (SLIT) is a safe and effective treatment for allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC). The Food and Drug Administration (FDA) in the USA has approved three SLIT tablets for the treatment of AR and ARC in relation to pollen. Specifically, Grastek® and Oralair® are two formulations approved to treat patients suffering with AR/ARC to grass pollen, and Ragwitek™ is a formulation approved to treat patients suffering with AR/ARC to ragweed pollen. Although these approvals provide support for physicians to prescribe SLIT, barriers to prescribing SLIT still remain such as FDA approval for additional formulations, a standard dose and dosing schedule, and cost/insurance coverage. In order to further support the use of SLIT, research is currently being conducted to expand the indication for SLIT to other common comorbidities to AR/ARC. For example, allergic asthma, food allergies, and atopic dermatitis are other diseases which are being explored. The future of SLIT in the USA is unknown; however, education will be necessary for both providers and patients.
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Affiliation(s)
- Nicole Pleskovic
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA, USA,
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Passalacqua G, Canonica GW. AIT (allergen immunotherapy): a model for the "precision medicine". Clin Mol Allergy 2015; 13:24. [PMID: 26451132 PMCID: PMC4597399 DOI: 10.1186/s12948-015-0028-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/06/2015] [Indexed: 12/19/2022] Open
Abstract
The interpretation of medical approaches, especially therapy, evolved rapidly in the last century. Starting from the simple description of symptoms, we moved to the pathophysiological descriptions, to the evidence-based medicine, until the so-called "precision medicine". This latter can be defined as a structural model aimed at customizing healthcare, with medical decisions/products tailored on an individual patient at a highly detailed level. In this sense, allergen immunotherapy represents an optimal model of "precision medicine", since we know and describe symptoms, function, aetiological agents at molecular level, and we have the possibility to intervene on the natural history of the disease. If considered under the point of view of pharmaco-economy, that is prescribing the optimal treatment to the right patient, allergen immunotherapy represents an almost-ideal model of precision medicine.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine, S. Martino Hospital, IRCCS San Martino-IST-University of Genoa, Pad.Maragliano, L.go R Benzi 10, 16133 Genoa, Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases, Department of Internal Medicine, S. Martino Hospital, IRCCS San Martino-IST-University of Genoa, Pad.Maragliano, L.go R Benzi 10, 16133 Genoa, Italy
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Incorvaia C, Mauro M, Ridolo E. Sublingual immunotherapy for allergic rhinitis: where are we now? Immunotherapy 2015; 7:1105-10. [DOI: 10.2217/imt.15.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Sublingual immunotherapy (SLIT) was introduced in the 1980s as a safer option to subcutaneous immunotherapy and in the latest decade achieved significant advances. Its efficacy in allergic rhinitis is supported by a number of meta-analyses. The development of SLIT preparations in tablets to fulfill the requirements of regulatory agencies for quality of allergen extracts made available optimal products for grass-pollen-induced allergic rhinitis. Preparations of other allergens based on the same production methods are currently in progress. A notable outcome of SLIT, that is shared with subcutaneous immunotherapy, is the evident cost–effectiveness, showing significant cost savings as early as 3 months from starting the treatment, that become as high as 80% compared with drug treatment in the ensuing years.
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Affiliation(s)
- Cristoforo Incorvaia
- Allergy/Pulmonary Rehabilitation, ICP Hospital, via Bignami 1, 20100 Milan, Italy
| | | | - Erminia Ridolo
- Department of Clinical & Experimental Medicine, University of Parma, Parma, Italy
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Passalacqua G, Canonica GW. Sublingual immunotherapy: focus on tablets. Ann Allergy Asthma Immunol 2015; 115:4-9. [PMID: 26123419 DOI: 10.1016/j.anai.2015.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/25/2015] [Accepted: 03/30/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa, Italy.
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Domínguez-Ortega J, Phillips-Anglés E, Barranco P, Quirce S. Cost-effectiveness of asthma therapy: a comprehensive review. J Asthma 2015; 52:529-37. [PMID: 25539023 DOI: 10.3109/02770903.2014.999283] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asthma has an important impact in terms of both direct and indirect costs. In Europe, the disease costs € 19 000 million a year. Moreover, the cost is greater among patients with severe uncontrolled asthma and is even higher when the work productivity is also taken into account. Improved control of the disease results in cost savings. In this context, cost-effectiveness and cost-utility studies offer important information for clinicians in deciding the best treatment options for asthmatic patients and contribute to ensure an efficient use of the available healthcare resources. METHODS An English and Spanish literature search using electronic search engines (PubMed and EMBASE) was conducted in peer-review journals, from 2009 to June 2014. In order to perform the search for the most suitable and representative articles, key words were selected ("asthma", "cost-effectiveness", "cost-utility", "QALY", "cost-benefit", "economic impact of asthma" "healthcare cost", "asthma treatment" and "work productivity with asthma"). RESULTS Two-hundred forty-three titles and abstracts were identified by the primary literature search. The full text of the potentially 76 eligible papers was reviewed, and 22 articles were qualified to be finally included. CONCLUSIONS This article provides a comprehensive review on the evidence of cost-effectiveness of asthma treatments derived from the published literature and offers an overall summary of the socioeconomic burden of asthma and its relationship with the degree of disease control. Management alternatives, such as the use of combination therapy with ICS/LABA or omalizumab, when administered according to their current therapeutic indications, have been shown to be cost-effective.
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Affiliation(s)
- Javier Domínguez-Ortega
- a Department of Allergy , Hospital La Paz Institute for Health Research (IdiPAZ) , Madrid , Spain
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Calderon MA, Cox L, Casale TB, Mösges R, Pfaar O, Malling HJ, Sastre J, Khaitov M, Demoly P. The effect of a new communication template on anticipated willingness to initiate or resume allergen immunotherapy: an internet-based patient survey. Allergy Asthma Clin Immunol 2015; 11:17. [PMID: 26015786 PMCID: PMC4443522 DOI: 10.1186/s13223-015-0083-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/13/2015] [Indexed: 11/17/2022] Open
Abstract
Background A patient’s knowledge of his/her allergic condition and treatment is a key factor in adherence and effectiveness. Methods To assess patients’ understanding of allergy and acceptance of allergen immunotherapy on the basis of (i) information given by their physician at the time of prescription and (ii) a new communication template viewed some months later, we performed an Internet-based survey of patient panels in France, Germany, Spain, the USA and Russia. The survey participants were either recent “early abandoners” (having discontinued allergen immunotherapy before the end of the prescribed course) or “non-starters” (having decided not to initiate a course of allergen immunotherapy recommended by their physician). All participants completed an on-line questionnaire immediately before and immediately after viewing the new communication template. The study’s main objectives were to validate the new communication template and to assess its impact on anticipated willingness to initiate or resume allergen immunotherapy. Results We surveyed a total of 261 patients (France: 57; Germany: 51; Spain: 52; USA: 51; Russia: 50), comprising 127 “early abandoners” and 134 “non-starters”. The mean time since symptom onset and selection for the study was 14.5 years. Subcutaneous allergen immunotherapy had been prescribed in 60 % of cases. Twenty-eight percent of the participants did not know for which allergy they were being treated. Early abandoners reported a perception of low effectiveness (39 %) and complained about expense (39 %) and practical constraints (32 %). Twenty-two percent of the non-starters feared side effects. The communication template was considered to be clear (by 92 % of the patients), convincing (by 75 %) and reassuring (by 89 %); 80 % of the participants felt better informed afterwards, and 67 % stated that viewing the communication template would have made them more likely to continue or initiate allergen immunotherapy (overall willingness score: 5.65 out of 10 before viewing and 7.1 out of 10 afterwards). Conclusions After viewing a new communication template on allergy and allergen immunotherapy, patients participating in the survey felt better informed and more likely to initiate or complete this therapy. It now remains to investigate the communication template’s effect on actual acceptance of and adherence to allergen immunotherapy. Electronic supplementary material The online version of this article (doi:10.1186/s13223-015-0083-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London - National Heart & Lung Institute, Royal Brompton Hospital, Dovehouse Street, London, United Kingdom
| | - Linda Cox
- Nova Southeastern University, Davie, FL USA
| | - Thomas B Casale
- Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Ralph Mösges
- Universitätsklinikum Köln, Universität zu Köln, Köln, Germany
| | - Oliver Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany ; Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans-Jørgen Malling
- Allergy Clinic, Danish AllergyCenter, Dermato-Allergological Department, Gentofte University Hospital, Copenhagen, Denmark
| | - Joaquin Sastre
- Allergy Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Musa Khaitov
- NRC Institute of Immunology FMBA, Moscow, Russian Federation
| | - Pascal Demoly
- Department of Pulmonology - Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France
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El-Qutob D. Vaccine development and new attempts of treatment for ragweed allergy. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:41-7. [PMID: 25922684 DOI: 10.1177/2051013614565354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ragweeds are flowering plants in the genus Ambrosia in the aster family, Asteraceae. They are distributed in the tropical and subtropical regions of the New World, especially North America. Short ragweed is the most important weed. The ragweed flowering occurs late in the summer and the pollination period extends from the beginning of August to mid-October. Sensitization to ragweed pollen has risen in United States in the past decade and probably worldwide. The major allergenic compound in the pollen has been identified as Amb a 1. Ragweed allergies usually cause allergic rhinitis and asthma. Ragweed allergic patients may show signs of oral allergy syndrome caused by crossreactivity between ragweed allergens and food allergens. In the present article, an update about vaccine development and new knowledge for ragweed allergy is exhaustively revised.
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Affiliation(s)
- David El-Qutob
- University Hospital La Plana, Carretera Vila-Real to Burriana km 0.5, Vila-Real, 12540, Spain
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Yang X, Zhu J, Tung CY, Gardiner G, Wang Q, Chang HC, Zhou B. Lunasin alleviates allergic airway inflammation while increases antigen-specific Tregs. PLoS One 2015; 10:e0115330. [PMID: 25646897 PMCID: PMC4315393 DOI: 10.1371/journal.pone.0115330] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/21/2014] [Indexed: 12/22/2022] Open
Abstract
Lunasin is a naturally occurring peptide isolated from soybeans and has been explored in cancer treatment. Lunasin inhibits NF-κB activation and thus pro-inflammatory cytokine and mediator production in macrophages. In this study we demonstrate that lunasin can effectively suppress allergic airway inflammation in two murine models of asthma. In an OVA+Alum sensitization model, intranasal lunasin treatment at the time of OVA challenges significantly reduced total cells counts in bronchoalveolar lavage (BAL) fluid and eosinophilia, peribronchiolar inflammatory infiltration, goblet cell metaplasia and airway IL-4 production. In an OVA+LPS intranasal sensitization model, lunasin treatment either at the time of sensitization or challenge has similar effects in suppress allergic airway inflammation including significantly reduced total cell and eosinophil counts in BAL fluid, inflammatory gene Fizz1 expression in the lung, and IL-4 production by OVA re-stimulated cells from mediastinal lymph nodes. We further show that intranasal instillation of OVA+lunasin significantly increases OVA-specific regulatory T cell (Treg) accumulation in the lung comparing to OVA only treatment. Taken together, our results suggest lunasin as an anti-inflammatory agent can be potentially used in asthma therapy or as an adjuvant to enhance the induction of antigen-specific Tregs and thus boost the efficacy of allergy immunotherapy.
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Affiliation(s)
- Xiaowei Yang
- Department of Pediatrics, HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
- Department of Veterinary Medicine, Southwest University at Rongchang, Rongchang, China
| | - Jingjing Zhu
- Department of Pediatrics, HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Chun-Yu Tung
- Department of Biology, School of Science, Indiana University Purdue University at Indianapolis, Indianapolis, IN, 46202, United States of America
| | - Gail Gardiner
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Qun Wang
- Department of Pediatrics, HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Hua-Chen Chang
- Department of Biology, School of Science, Indiana University Purdue University at Indianapolis, Indianapolis, IN, 46202, United States of America
- * E-mail: (HCC); (BZ)
| | - Baohua Zhou
- Department of Pediatrics, HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
- * E-mail: (HCC); (BZ)
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Ivanova JI, Kelkar S, King S, Birnbaum HG, Hocker S, Phipps R, Lankow R. Budget impact model of a 5-grass sublingual immunotherapy tablet for the treatment of grass pollen-induced allergic rhinitis. J Med Econ 2015; 18:909-18. [PMID: 26481690 DOI: 10.3111/13696998.2015.1061533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Allergic rhinitis (AR) is a chronic disease with a substantial clinical and economic burden. This study estimated the potential budget impact (BI) associated with market entry of Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens Allergen Extract Tablet for Sublingual Use ('5-grass SLIT tablet') for patients aged 10-65 with grass pollen-induced AR. METHODS A budget impact model was constructed to estimate the potential BI from a US payer perspective. The model calculated pharmacy, medical, and total (pharmacy + medical) costs per-member-per-month (PMPM) with and without market entry of the 5-grass SLIT tablet, considering a 3-year time horizon. The target population was determined using an epidemiological approach and existing literature. The treatment market shares without 5-grass SLIT tablet entry were derived from an analysis of de-identified insurance claims data. Pharmacy costs and medical utilization rates and costs were obtained from the claims data analysis and existing literature. One-way sensitivities were conducted for key model inputs. RESULTS Using an illustrative example of a hypothetical health plan with one million members, the estimated target population of AR patients aged 10-65 was 26,320. On a PMPM basis, pharmacy costs increased by $0.36, $0.44, and $0.51, while total costs (after medical cost offsets) increased by $0.15, $0.18, and $0.22 in the first, second, and third years following entry of the 5-grass SLIT tablet, respectively. Results were most sensitive to changes in the compliance rate, treatment duration, and price. The BI will vary from the base case example when alternative, payer-specific inputs are used. CONCLUSIONS Using base case inputs, use of the 5-grass SLIT tablet to treat grass pollen-induced AR increased the pharmacy budget for a hypothetical third-party payer. Higher pharmacy costs were partially offset by lower medical budget due to reduced resource use compared with existing treatments.
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Affiliation(s)
| | | | - Sarah King
- b b Analysis Group, Inc. , Boston , MA , USA
| | | | - Sue Hocker
- c c The Lindyn Group, Inc. , Baltimore , MD , USA
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Makatsori M, Calderon MA. Sublingual allergen immunotherapy for respiratory allergies: what is new? Expert Rev Clin Immunol 2014; 10:1641-7. [DOI: 10.1586/1744666x.2014.982536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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