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Yarin Y, Kalaitzidou A, Bodrova K, Mösges R, Kalaidzidis Y. Validation of AI-based software for objectification of conjunctival provocation test. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100121. [PMID: 37779521 PMCID: PMC10509841 DOI: 10.1016/j.jacig.2023.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/19/2023] [Accepted: 04/07/2023] [Indexed: 10/03/2023]
Abstract
Background Provocation tests are widely used in allergology to objectively reveal patients' sensitivity to specific allergens. The objective quantification of an allergic reaction is a crucial characteristic of these tests. Because of the absence of objective quantitative measurements, the conjunctival provocation test (CPT) is a less frequently used method despite its sensitivity and simplicity. Objective We developed a new artificial intelligence (AI)-based method, called AllergoEye, for quantitative evaluation of conjunctival allergic reactions and validated it in a clinical study. Methods AllergoEye was implemented as a 2-component system. The first component is based on an Android smartphone camera for screening and imaging the patient's eye, and the second is personal computer-based for image analysis and quantification. For the validation of AllergoEye, an open-label, prospective, monocentric study was carried out on 41 patients. Standardized CPT was performed with sequential titration of grass allergens in 4 dilutions, with the reaction evaluated by subjective/qualitative symptom scores and by quantitative AllergoEye scores. Results AllergoEye demonstrated high sensitivity (98%) and specificity (90%) as compared with human estimation of allergic reaction. Tuning cutoff thresholds allowed us to increase the specificity of AllergoEye to 97%, at which point the correlation between detected sensitivity to allergen and specific IgE carrier-polymer system class becomes obvious. Strikingly, such correlation was not found with sensitivity to allergen detected on the basis of subjective and qualitative symptom scores. Conclusion The clinical validation demonstrated that AllergoEye is a sensitive and efficient instrument for objective measurement of allergic reactions in CPT for clinical studies as well as for routine therapy control.
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Affiliation(s)
- Yury Yarin
- Practice for ENT und Allergology, Dresden, Germany
| | | | - Kira Bodrova
- Practice for ENT und Allergology, Dresden, Germany
| | | | - Yannis Kalaidzidis
- Max Planck Institute for Molecular Cell Biology and Genetics, Dresden, Germany
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Agache I, Antolin‐Amerigo D, Blay F, Boccabella C, Caruso C, Chanez P, Couto M, Covar R, Doan S, Fauquert J, Gauvreau G, Gherasim A, Klimek L, Lemiere C, Nair P, Ojanguren I, Peden D, Perez‐de‐Llano L, Pfaar O, Rondon C, Rukhazde M, Sastre J, Schulze J, Silva D, Tarlo S, Toppila‐Salmi S, Walusiak‐Skorupa J, Zielen S, Eguiluz‐Gracia I. EAACI position paper on the clinical use of the bronchial allergen challenge: Unmet needs and research priorities. Allergy 2022; 77:1667-1684. [PMID: 34978085 DOI: 10.1111/all.15203] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 12/22/2022]
Abstract
Allergic asthma (AA) is a common asthma phenotype, and its diagnosis requires both the demonstration of IgE-sensitization to aeroallergens and the causative role of this sensitization as a major driver of asthma symptoms. Therefore, a bronchial allergen challenge (BAC) would be occasionally required to identify AA patients among atopic asthmatics. Nevertheless, BAC is usually considered a research tool only, with existing protocols being tailored to mild asthmatics and research needs (eg long washout period for inhaled corticosteroids). Consequently, existing BAC protocols are not designed to be performed in moderate-to-severe asthmatics or in clinical practice. The correct diagnosis of AA might help select patients for immunomodulatory therapies. Allergen sublingual immunotherapy is now registered and recommended for controlled or partially controlled patients with house dust mite-driven AA and with FEV1 ≥ 70%. Allergen avoidance is costly and difficult to implement for the management of AA, so the proper selection of patients is also beneficial. In this position paper, the EAACI Task Force proposes a methodology for clinical BAC that would need to be validated in future studies. The clinical implementation of BAC could ultimately translate into a better phenotyping of asthmatics in real life, and into a more accurate selection of patients for long-term and costly management pathways.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Dario Antolin‐Amerigo
- Servicio de Alergia Hospital Universitario Ramón y Cajal Instituto Ramón y Cajal de Investigación Sanitaria Madrid Spain
| | - Frederic Blay
- ALYATEC Environmental Exposure Chamber Chest Diseases Department Strasbourg University Hospital University of Strasbourg Strasbourg France
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario A. Gemelli ‐ IRCCS Rome Italy
| | | | - Pascal Chanez
- Department of Respiratory CIC Nord INSERMINRAE C2VN Aix Marseille University Marseille France
| | - Mariana Couto
- Centro de Alergia Hospital CUF Descobertas Lisboa Portugal
| | - Ronina Covar
- Pediatrics National Jewish Health Denver Colorado USA
| | | | | | - Gail Gauvreau
- Division of Respirology Department of Medicine McMaster University Hamilton Ontario Canada
| | - Alina Gherasim
- ALYATEC Environmental Exposure Chamber Strasbourg France
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Catherine Lemiere
- Research Centre Centre Intégré Universitaire de santé et de services sociaux du Nord‐de‐l'île‐de‐Montréal Montréal Quebec Canada
- Faculty of Medicine Université de Montreal Montreal Quebec Canada
| | - Parameswaran Nair
- Department of Medicine Firestone Institute of Respiratory Health at St. Joseph's Healthcare McMaster University Hamilton Ontario Canada
| | - Iñigo Ojanguren
- Departament de Medicina Servei de Pneumología Hospital Universitari Valld´Hebron Universitat Autònoma de Barcelona (UAB) Institut de Recerca (VHIR) CIBER de Enfermedades Respiratorias (CIBERES) Barcelona Spain
| | - David Peden
- Division of Pediatric Allergy and Immunology Center for Environmental Medicine, Asthma and Lung Biology The School of Medicine The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Luis Perez‐de‐Llano
- Department of Respiratory Medicine University Hospital Lucus Augusti Lugo Spain
| | - Oliver Pfaar
- Section of Rhinology and Allergy Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Carmen Rondon
- Allergy Unit Hospital Regional Universitario de Malaga Instituto de Investigacion Biomedica de Malaga (IBIMA) Malaga Spain
| | - Maia Rukhazde
- Center of Allergy & Immunology Teaching University Geomedi LLC Tbilisi Georgia
| | - Joaquin Sastre
- Allergy Unit Hospital Universitario Fundación Jiménez Díaz Center for Biomedical Network of Respiratory Diseases (CIBERES) Instituto de Salud Carlos III (ISCIII) Madrid Spain
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology Pulmonology and Cystic Fibrosis Goethe‐University Hospital Frankfurt am Main Germany
| | - Diana Silva
- Basic and Clinical Immunology Unit Department of Pathology Faculty of Medicine University of Porto and Serviço de Imunoalergologia Centro Hospitalar São João, EPE Porto Portugal
| | - Susan Tarlo
- Respiratory Division Department of Medicine University Health Network, Toronto Western Hospital University of Toronto Department of Medicine, and Dalla Lana Department of Public Health Toronto Ontario Canada
| | - Sanna Toppila‐Salmi
- Haartman Institute, Medicum, Skin and Allergy Hospital Hospital District of Helsinki and Uusimaa Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Jolanta Walusiak‐Skorupa
- Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Łódź Poland
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology Pulmonology and Cystic Fibrosis Goethe‐University Hospital Frankfurt am Main Germany
| | - Ibon Eguiluz‐Gracia
- Allergy Unit Hospital Regional Universitario de Malaga Instituto de Investigacion Biomedica de Malaga (IBIMA) Malaga Spain
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Pfaar O, Zieglmayer P. Allergen exposure chambers: implementation in clinical trials in allergen immunotherapy. Clin Transl Allergy 2020; 10:33. [PMID: 32742636 PMCID: PMC7388504 DOI: 10.1186/s13601-020-00336-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
Allergen exposure chambers (AECs) have been developed for controlled allergen challenges of allergic patients mimicking natural exposure. As such, these facilities have been utilized e.g., for proof of concept, dose finding or the demonstration of onset of action and treatment effect sizes of antiallergic medication. Moreover, clinical effects of and immunological mechanisms in allergen immunotherapy (AIT) have been investigated in AECs. In Europe AIT products have to fulfill regulatory requirements for obtaining market authorization through Phase I to III clinical trials. Multiple Phase II (dose-range-finding or proof-of-concept) trials on AIT products have been performed in AECs. However, they are not accepted by regulatory bodies for pivotal (Phase III) trials and a more thorough technical and clinical validation is requested. Recently, a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI) has outlined unmet needs in further development of AECs. The following review aims to address some of these needs on the basis of recently published data in the first part, whereas the second part overviews published examples of most relevant Phase II trials in AIT performed in AEC facilities.
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Affiliation(s)
- O Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
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Zielen S, Kuna P, Aberer W, Lassmann S, Pfaar O, Klimek L, Wade A, Kluehr K, Raab J, Wessiepe D, Lee D, Kramer M, Gunawardena K, Higenbottam T, Heath M, Skinner M, de Kam P. Strong dose response after immunotherapy with PQ grass using conjunctival provocation testing. World Allergy Organ J 2019; 12:100075. [PMID: 31709029 PMCID: PMC6831906 DOI: 10.1016/j.waojou.2019.100075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background Pollinex Quattro Grass (PQ Grass) is an effective, well-tolerated, short pre-seasonal subcutaneous immunotherapy to treat seasonal allergic rhinoconjunctivitis (SAR) due to grass pollen. In this Phase II study, 4 cumulative doses of PQ Grass and placebo were evaluated to determine its optimal cumulative dose. Methods Patients with grass pollen-induced SAR were randomised to either a cumulative dose of PQ Grass (5100, 14400, 27600 and 35600 SU) or placebo, administered as 6 weekly subcutaneous injections over 31-41 days (EudraCT number 2017-000333-31). Standardized conjunctival provocation tests (CPT) using grass pollen allergen extract were performed at screening, baseline and post-treatment to determine the total symptom score (TSS) assessed approximately 4 weeks after dosing. Three models were pre-defined (Emax, logistic, and linear in log-dose model) to evaluate a dose response relationship. Results In total, 95.5% of the 447 randomized patients received all 6 injections. A highly statistically significant (p < 0.0001), monotonic dose response was observed for all three pre-specified models. All treatment groups showed a statistically significant decrease from baseline in TSS compared to placebo, with the largest decrease observed after 27600 SU (p < 0.0001). The full course of 6 injections was completed by 95.5% of patients. Treatment-emergent adverse events were similar across PQ Grass groups, and mostly mild and transient in nature. Conclusions PQ Grass demonstrated a strong curvilinear dose response in TSS following CPT without compromising its safety profile.
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Key Words
- ADRs, adverse drug reactions
- AE, adverse events
- AIT, allergen immunotherapy
- ANCOVA, analysis of covariance
- ARC, adverse reaction complexes
- Allergen immunotherapy
- Allergoid
- CIA-CPT, Culture – Independent Assessment of the Conjunctival Provocation Test
- CPT, conjunctival provocation test
- Cumulative dose
- Curvilinear dose response
- EAACI, European Academy of Allergy and Clinical Immunology
- EMA, European Medicine Agency
- FAS, Full Analysis Set
- FEV, forced expiratory volume
- FVC, forced vital capacity
- Grass pollen
- HEP, Histamine Equivalent Potency
- LPS, lipopolysaccharide
- MCP-Mod, Multiple Comparison Procedure and Modelling
- MCT, microcrystalline tyrosine
- MPL, Monophosphoryl Lipid A
- MedDRA, Medical Dictionary for Regulatory Activities
- PPS, Per Protocol Set
- SAEs, serious adverse events
- SAF, safety set
- SAR, seasonal allergic rhinoconjunctivitis
- SD, standard deviation
- SU, standardized units
- TEAEs, treatment-emergent adverse events
- TLR, Toll-like receptor
- TSS, Total Symptom Score
- mFAS, Modified Full Analysis Set
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Affiliation(s)
- S. Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - P. Kuna
- Poradnia Alergologii i Chorób Płuc Lodz, Poland
| | - W. Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S. Lassmann
- Specialist in Otolaryngology, Saalfeld, Germany
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Germany
| | - L. Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - A. Wade
- Allergy Therapeutics Ltd., Worthing, UK
| | - K. Kluehr
- Allergy Therapeutics Ltd., Worthing, UK
| | - J. Raab
- Allergy Therapeutics Ltd., Worthing, UK
| | - D. Wessiepe
- Metronomia Clinical Research GmbH, Munich, Germany
| | - D. Lee
- Allergy Therapeutics Ltd., Worthing, UK
| | | | | | | | | | | | - P.J. de Kam
- Allergy Therapeutics Ltd., Worthing, UK
- Corresponding author. Allergy Therapeutics (UK) Ltd, Dominion Way Worthing, West Sussex BN14 8SA, UK
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