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Fan Y, Gu R, Zhang R, Wang M, Xu H, Wang M, Long C. Protective effects of extracts from Acer truncatum leaves on SLS-induced HaCaT cells. Front Pharmacol 2023; 14:1068849. [PMID: 37007019 PMCID: PMC10050454 DOI: 10.3389/fphar.2023.1068849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction:A. truncatum Bunge (Sapindaceae or formerly Aceraceae) is a tall deciduous tree native to China. Traditionally, the leaves of A. truncatum are decocted and used by Chinese Mongolians, Koreans, and Tibetans to treat skin itching, dry cracks, and other skin ailments, which indicates A. truncatum leaves may have a potential inhibitory effect on various skin inflammations.Methods: To examine the protective effect against skin inflammations of A. truncatum leaf extract (ATLE), an in vitro dermatitis model was established using sodium dodecyl sulfate (SLS)-induced HaCaT cells. The anti-inflammatory effect of ATLE was evaluated by analyzing cell viability, apoptosis, reactive oxygen species (ROS), interleukin 6 (IL-6), and prostaglandin E2 (PGE2) levels.Results: Orthogonal experiments showed that the pretreatment with ATLE can reduce the IL-6 levels, PGE2 levels, and apoptosis increased in SLS-stimulated HaCaT cells, which indicates that ATLE has positive efficacy for dermatitis. Furthermore, three flavonoid compounds kaempferol-3-O-α-L-rhamnoside, quercetin-3-O-α-L-rhamnopyranoside, kaempferol-3,7-di-O-α-L-rhamnoside, and 1,2,3,4,6-Penta-O-galloyl-β-D-glucopyranose (PGG) were isolated and identified. Among them, kaempferol-3,7-di-O-α-L-rhamnoside was isolated from this plant for the first time. These compounds have been proven to have an anti-inflammatory effect. They may contribute to the efficacy of A. truncatumin treating skin inflammation.Discussion: The results revealed that ATLE has the potential to be used as an additive in various skin care products to prevent skin inflammations and may be incorporated in formulations for topical application as a therapeutic approach against dermatitis.
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Abstract
Seit dem ersten Bericht über die Allergenimmuntherapie (AIT) durch Noon et al. vor 110 Jahren wurden zahlreiche klinische und grundlagenwissenschaftliche Studien durchgeführt, um die Effekte der einzigen kurativen Behandlung von Allergien zu untersuchen. Bei der atopischen Dermatitis (AD) findet sie jedoch nur selten Anwendung, obwohl es Evidenz dafür gibt, dass Aeroallergene zu Exazerbationen der Erkrankung beitragen können. Dieser Übersichtsbeitrag umfasst die aktuelle Studienlage, Metaanalysen und Leitlinienempfehlungen zur AIT bei AD-Patienten. Es zeigt sich eine große Heterogenität hinsichtlich Studiendesigns, Patientenkohorten, Allergenen, Applikationsformen und Endpunkten, wodurch die Vergleichbarkeit der Studien erschwert wird. Mehrere Untersuchungen zeigen eine positive Wirkung der AIT auf den Schweregrad der AD, was darauf hindeutet, dass zumindest eine Untergruppe von Patienten von der Behandlung profitieren kann. Weitere Entwicklungen auf dem Gebiet der AIT könnten dazu beitragen, dass die Therapie einen breiteren Einsatz bei AD-Patienten findet.
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3
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Malaviya R, Zhou Z, Raymond H, Wertheimer J, Jones B, Bunting R, Wilkinson P, Madireddy L, Hall L, Ryan M, Rao TS. Repeated exposure of house dust mite induces progressive airway inflammation in mice: Differential roles of CCL17 and IL-13. Pharmacol Res Perspect 2021; 9:e00770. [PMID: 33929099 PMCID: PMC8085917 DOI: 10.1002/prp2.770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
We conducted a systematic evaluation of lung inflammation indued by repeated intranasal exposure (for 10 consecutive days) to a human aeroallergen, house dust mite (HDM) in BALB/c mice. Peak influx of neutrophils, monocytes/lymphocytes, and eosinophils was observed in bronchoalveolar lavage (BAL) on days 1, 7 and 11, respectively, and normalized to baseline by day 21. Peak elevations of Th2, myeloid-derived cytokines/chemokines and serum IgE were seen both in BAL and lung tissue homogenates between days 7 and 11, and declined thereafter; however, IL-33 levels remained elevated from day 7 to day 21. Airway hyperreactivity to inhaled methacholine was significantly increased by day 11 and decreased to baseline by day 21. The lung tissue showed perivascular and peribronchial cuffing, epithelial hypertrophy and hyperplasia and goblet cell formation in airways by day 11, and resolution by day 21. Levels of soluble collagen and tissue inhibitors of metalloproteinases (TIMP) also increased reflecting tissue remodeling in the lung. Microarray analysis demonstrated a significant time-dependent up-regulation of several genes including IL-33, CLCA3, CCL17, CD4, CD10, CD27, IL-13, Foxa3, IL-4, IL-10, and CD19, in BAL cells as well as the lung. Pre-treatment of HDM challenged mice with CCL17 and IL-13 antibodies reduced BAL cellularity, airway hyper-responsiveness (AHR), and histopathological changes. Notably, anti-IL-13, but not anti-CCL17 monoclonal antibodies (mAbs) reduced BAL neutrophilia while both mAbs attenuated eosinophilia. These results suggest that CCL17 has an overlapping, yet distinct profile versus IL-13 in the HDM model of pulmonary inflammation and potential for CCL17-based therapeutics in treating Th2 inflammation.
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Affiliation(s)
- Ravi Malaviya
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - Zhao Zhou
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - Holly Raymond
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - Josh Wertheimer
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - Brian Jones
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - Rachel Bunting
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - Patrick Wilkinson
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - Lohith Madireddy
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - LeRoy Hall
- Drug Safety Sciences (L.R.) Janssen Research & Development, LLCSpring HousePAUSA
| | - Mary Ryan
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
| | - Tadimeti S. Rao
- Discovery ImmunologyJanssen Research & Development, LLCSpring HousePAUSA
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4
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Leonard A, Wang J, Yu L, Liu H, Estrada Y, Greenlees L, McPhee R, Ruzin A, Guttman-Yassky E, Howell MD. Atopic Dermatitis Endotypes Based on Allergen Sensitization, Reactivity to Staphylococcus aureus Antigens, and Underlying Systemic Inflammation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:236-247.e3. [DOI: 10.1016/j.jaip.2019.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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5
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Park KH, Lee J, Lee JY, Lee SC, Sim DW, Shin JU, Park CO, Lee JH, Lee KH, Jeong KY, Park JW. Sensitization to various minor house dust mite allergens is greater in patients with atopic dermatitis than in those with respiratory allergic disease. Clin Exp Allergy 2018; 48:1050-1058. [PMID: 29700921 DOI: 10.1111/cea.13164] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/11/2018] [Accepted: 03/14/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Various allergenic proteins are produced by house dust mites (HDM). However, the allergenicity and clinical implications of these allergens are unknown. OBJECTIVE The purpose of this study was to identify allergens in Dermatophagoides farinae and elucidate the sensitization profiles to these in Korean patients suffering from respiratory (allergic rhinitis and/or asthma) and atopic dermatitis symptoms. METHODS IgE reactivities in sera from 160 HDM allergy patients were analysed by one- and two-dimensional gel electrophoresis and immunoblotting. IgE-reactive components were identified by liquid chromatography-coupled electrospray ionization-tandem mass spectrometry. Nine recombinant mite allergens (Der f 1, Der f 2, Der f 10, Der f 11, Der f 13, Der f 14, Der f 30, Der f 32 and Der f Alt a 10) were produced, and the IgE reactivity in sera to each was determined by ELISAs. RESULTS Der f 1 and Der f 2 were recognized by IgE in serum samples from 88.1% and 78.1% of all patients, respectively. Patients with respiratory allergies were mainly sensitized to these major allergens, whereas patients with atopic dermatitis symptoms showed polysensitization to major and minor allergen components (including Der f 11, Der f 13, Der f 14, Der f 32 and Der f Alt a 10). CONCLUSIONS Patients with respiratory allergic disease sensitize to major allergen components of HDM. Those with atopic dermatitis were sensitized to a broader range of minor allergen components of HDM (Der f 11, Der f 13, Der f 14, Der f 32 and Der f Alt a 10).
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Affiliation(s)
- K H Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - J Lee
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - J-Y Lee
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - S C Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - D W Sim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - J U Shin
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - C O Park
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - J-H Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - K H Lee
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - K Y Jeong
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - J-W Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
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6
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Chaisri U, Tungtrongchitr A, Indrawattana N, Meechan P, Phurttikul W, Tasaniyananda N, Saelim N, Chaicumpa W, Sookrung N. Immunotherapeutic efficacy of liposome-encapsulated refined allergen vaccines against Dermatophagoides pteronyssinus allergy. PLoS One 2017; 12:e0188627. [PMID: 29182623 PMCID: PMC5705073 DOI: 10.1371/journal.pone.0188627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/10/2017] [Indexed: 12/17/2022] Open
Abstract
Allergen specific immunotherapy (AIT) can modulate the allergic response causing a long-term symptom subsidence/abolishment which leads to reduced drug use and prevention of new sensitization. AIT of house dust mite allergy (HDM) using the mite crude extract (CE) as the therapeutic agent is not only less effective than the AIT for many other allergens, but also frequently causes adverse effects during the treatment course. In this study, mouse model of Dermatophagoides pteronyssinus (Dp) allergy was invented for testing therapeutic efficacies of intranasally administered liposome (L) encapsulated vaccines made of single Dp major allergens (L-Der p 1, L-Der p 2), combined allergens (L-Der p 1 and Der p 2), and crude Dp extract (L-CE). The allergen sparing intranasal route was chosen as it is known that the effective cells induced at the nasal-associated lymphoid tissue can exert their activities at the lower respiratory tissue due to the common mucosal traffic. Liposome was chosen as the vaccine delivery vehicle and adjuvant as the micelles could reduce toxicity of the entrapped cargo. The Dp-CE allergic mice received eight doses of individual vaccines/placebo on alternate days. All vaccine formulations caused reduction of the Th2 response of the Dp allergic mice. However, only the vaccines made of single refined allergens induced expressions of immunosuppressive cytokines (TGF-β, IL-35 and/or IL-10) which are the imperative signatures of successful AIT. The data emphasize the superior therapeutic efficacy of single refined major allergen vaccines than the crude allergenic extract vaccine.
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Affiliation(s)
- Urai Chaisri
- Department of Tropical Pathology, Faculty of Tropical Medicine, Bangkok, Thailand
| | - Anchalee Tungtrongchitr
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nitaya Indrawattana
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Bangkok, Thailand
| | - Panisara Meechan
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Watchara Phurttikul
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Natt Tasaniyananda
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nawannaporn Saelim
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanpen Chaicumpa
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nitat Sookrung
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Abstract
Therapy of severe atopic dermatitis, which is refractory to consistent treatment with topical steroids and topical calcineurin inhibitors is still a problem in many cases. The use of cyclosporine, which is the only approved systemic drug for the therapy of severe atopic dermatitis, is often limited by contraindications or adverse reactions. In this context, results from controlled and open-label studies with novel therapeutic approaches such as methotrexate, omalizumab or rituximab, which are in part very promising, are of great interest. In this work we would like to provide an overview of established and new therapeutic options for the treatment of severe atopic dermatitis.
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8
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Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the most recent findings on indoor allergens and their impact on allergic diseases. RECENT FINDINGS Indoor allergens are present inside buildings (home, work environment, school), and given the chronic nature of the exposures, indoor allergies tend to be associated with the development of asthma. The most common indoor allergens are derived from dust mites, cockroaches, mammals (including wild rodents and pets), and fungi. The advent of molecular biology and proteomics has led to the identification, cloning, and expression of new indoor allergens, which have facilitated research to elucidate their role in allergic diseases. This review is an update on new allergens and their molecular features, together with the most recent reports on their avoidance for allergy prevention and their use for diagnosis and treatment. Research progress on indoor allergens will result in the development of new diagnostic tools and design of coherent strategies for immunotherapy.
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Affiliation(s)
- Anna Pomés
- Indoor Biotechnologies, Inc., 700 Harris Street, Charlottesville, VA, 22903, USA.
| | - Martin D Chapman
- Indoor Biotechnologies, Inc., 700 Harris Street, Charlottesville, VA, 22903, USA
| | - Sabina Wünschmann
- Indoor Biotechnologies, Inc., 700 Harris Street, Charlottesville, VA, 22903, USA
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9
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Abstract
BACKGROUND Dust mites (DMs) play a role in type I respiratory allergy. Studies relating to DM irritant versus immune reactions are somewhat conflicting in atopic dermatitis (AD). OBJECTIVE The aim of this study was to assess the diagnostic use of patch testing to DM in patients with AD and other dermatitides. METHODS We performed a prospective study of 323 adults recruited in a patch testing clinic. Patch testing antigens were DM extract (0.01%, 0.1%, 1%, 10%, and 20% in petrolatum; Chemotechnique) and/or 200 index of reactivity in petrolatum (Stallergenes). Patches were placed and read at 48 hours with delayed readings after 72 to 168 hours. RESULTS There was no association of DM positivity with AD, asthma, hay fever, or demographic factors. There was no association of DM positivity with the clinical diagnosis or phenotype. The number of positive (+, ++, and +++) and doubtful reactions to Chemotechnique DM extract increased with higher concentrations. Positive reactions to DM had a morphological appearance characterized by numerous discrete erythematous papules and, rarely, papulovesicles. Positive reactions to Stallergenes DM 200 IR were infrequent and all weak reactions, similar to DM 0.01%. CONCLUSIONS Patch testing to DM does not seem to have clinical use for determining the etiology of dermatitis.
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10
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Pomés A, Chapman MD, Wünschmann S. Indoor Allergens and Allergic Respiratory Disease. Curr Allergy Asthma Rep 2016. [PMID: 27184001 DOI: 10.1007/s11882-016-0622-9.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the most recent findings on indoor allergens and their impact on allergic diseases. RECENT FINDINGS Indoor allergens are present inside buildings (home, work environment, school), and given the chronic nature of the exposures, indoor allergies tend to be associated with the development of asthma. The most common indoor allergens are derived from dust mites, cockroaches, mammals (including wild rodents and pets), and fungi. The advent of molecular biology and proteomics has led to the identification, cloning, and expression of new indoor allergens, which have facilitated research to elucidate their role in allergic diseases. This review is an update on new allergens and their molecular features, together with the most recent reports on their avoidance for allergy prevention and their use for diagnosis and treatment. Research progress on indoor allergens will result in the development of new diagnostic tools and design of coherent strategies for immunotherapy.
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Affiliation(s)
- Anna Pomés
- Indoor Biotechnologies, Inc., 700 Harris Street, Charlottesville, VA, 22903, USA.
| | - Martin D Chapman
- Indoor Biotechnologies, Inc., 700 Harris Street, Charlottesville, VA, 22903, USA
| | - Sabina Wünschmann
- Indoor Biotechnologies, Inc., 700 Harris Street, Charlottesville, VA, 22903, USA
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11
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Slavyanakaya TA, Derkach VV, Sepiashvili RI. Debates in allergy medicine: specific immunotherapy efficiency in children with atopic dermatitis. World Allergy Organ J 2016; 9:15. [PMID: 27134696 PMCID: PMC4836162 DOI: 10.1186/s40413-016-0106-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 03/17/2016] [Indexed: 12/19/2022] Open
Abstract
Allergen specific immunotherapy (AIT) has been the only pathogenetically relevant treatment of IgE-mediated allergic diseases (ADs) for many years. The use of AIT for atopic dermatitis (AD) treatment is dubious and has both followers and opponents. The improvement of subcutaneous AIT (SCIT) and introduction of Sublingual immunotherapy (SLIT) gives prospects of their application both for adults and children suffering from AD. This review presents results of scientific research, system and meta-analyses that confirm the clinical efficacy of AIT for children with AD who has the sensitization to allergens of house dust mite, grass and plant pollen suffering from co-occurring respiratory ADs and with moderate and severe course of allergic AD. There have been analyzed the most advanced achievements in AIT studies as well as there have been specified the unmet needs in AD. The preliminary diagnostics of IgE-mediated AD and pathophysiological disorders, including immune ones, will allow a doctor to develop appropriate comprehensive treatment algorithm for children's AD aimed at its correction. The including of AIT to the children's comprehensive therapy program is reasonable only if AD has the allergic form. It is necessary better to design the randomized research studies and to acquire extended clinical practice in children with AD. Use of the successes of molecular-based allergy diagnostics will help to optimize and personalize the process of selecting the necessary allergens to determine the most appropriate vaccines for children considering the results of the allergen component diagnostics. The strategy of treatment of children with AD in future will be based on individual target therapy.
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Affiliation(s)
- Tatiana A. Slavyanakaya
- />People’s Friendship University of Russia, Moscow, Moscow region Russia
- />Institute of Immunophysiology, Moscow, Russia
| | - Vladislava V. Derkach
- />Institute of Immunophysiology, Moscow, Russia
- />Pacific State Medical University, Vladivostok, Russia
| | - Revaz I. Sepiashvili
- />People’s Friendship University of Russia, Moscow, Moscow region Russia
- />Institute of Immunophysiology, Moscow, Russia
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12
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Galli E, Neri I, Ricci G, Baldo E, Barone M, Belloni Fortina A, Bernardini R, Berti I, Caffarelli C, Calamelli E, Capra L, Carello R, Cipriani F, Comberiati P, Diociaiuti A, El Hachem M, Fontana E, Gruber M, Haddock E, Maiello N, Meglio P, Patrizi A, Peroni D, Scarponi D, Wielander I, Eichenfield LF. Consensus Conference on Clinical Management of pediatric Atopic Dermatitis. Ital J Pediatr 2016; 42:26. [PMID: 26936273 PMCID: PMC4776387 DOI: 10.1186/s13052-016-0229-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/14/2016] [Indexed: 01/01/2023] Open
Abstract
The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease.
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Affiliation(s)
- Elena Galli
- Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy.
| | - Iria Neri
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Giampaolo Ricci
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Ermanno Baldo
- Pediatric Department, "S. Maria del Carmine" Hospital of Rovereto, APSS (Provincial Agency for Health Services), Trento, Italy.
| | | | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
| | | | - Irene Berti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
| | - Carlo Caffarelli
- Pediatric Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
| | - Elisabetta Calamelli
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Lucetta Capra
- Department of Medical Sciences, Section of Paediatrics, University of Ferrara, Ferrara, Italy.
| | - Rossella Carello
- Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy.
| | - Francesca Cipriani
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | | | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Fontana
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
| | - Michaela Gruber
- Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy.
| | - Ellen Haddock
- Departments of Pediatrics and Dermatology, School of Medicine, University of California, San Diego, CA, USA.
| | - Nunzia Maiello
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.
| | - Paolo Meglio
- Primary Care Pediatrician, Health National Service, Rome, Italy.
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Diego Peroni
- Department of Medical Sciences, Section of Paediatrics, University of Ferrara, Ferrara, Italy.
| | - Dorella Scarponi
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Ingrid Wielander
- Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy.
| | - Lawrence F Eichenfield
- Departments of Pediatrics and Dermatology, School of Medicine, University of California, San Diego, CA, USA.
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13
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Tam H, Calderon MA, Manikam L, Nankervis H, García Núñez I, Williams HC, Durham S, Boyle RJ. Specific allergen immunotherapy for the treatment of atopic eczema. Cochrane Database Syst Rev 2016; 2:CD008774. [PMID: 26871981 PMCID: PMC8761476 DOI: 10.1002/14651858.cd008774.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Specific allergen immunotherapy (SIT) is a treatment that may improve disease severity in people with atopic eczema (AE) by inducing immune tolerance to the relevant allergen. A high quality systematic review has not previously assessed the efficacy and safety of this treatment. OBJECTIVES To assess the effects of specific allergen immunotherapy (SIT), including subcutaneous, sublingual, intradermal, and oral routes, compared with placebo or a standard treatment in people with atopic eczema. SEARCH METHODS We searched the following databases up to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 7, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), Web of Science™ (from 2005), the Global Resource of EczemA Trials (GREAT database), and five trials databases. We searched abstracts from recent European and North American allergy meetings and checked the references of included studies and review articles for further references to relevant trials. SELECTION CRITERIA Randomised controlled trials (RCTs) of specific allergen immunotherapy that used standardised allergen extracts in people with AE. DATA COLLECTION AND ANALYSIS Two authors independently undertook study selection, data extraction (including adverse effects), assessment of risk of bias, and analyses. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We identified 12 RCTs for inclusion in this review; the total number of participants was 733. The interventions included SIT in children and adults allergic to either house dust mite (10 trials), grass pollen, or other inhalant allergens (two trials). They were administered subcutaneously (six trials), sublingually (four trials), orally, or intradermally (two trials). Overall, the risk of bias was moderate, with high loss to follow up and lack of blinding as the main methodological concern.Our primary outcomes were 'Participant- or parent-reported global assessment of disease severity at the end of treatment'; 'Participant- or parent-reported specific symptoms of eczema, by subjective measures'; and 'Adverse events, such as acute episodes of asthma or anaphylaxis'. SCORing Atopic Dermatitis (SCORAD) is a means of measuring the effect of atopic dermatitis by area (A); intensity (B); and subjective measures (C), such as itch and sleeplessness, which we used.For 'Participant- or parent-reported global assessment of disease severity at the end of treatment', one trial (20 participants) found improvement in 7/9 participants (78%) treated with the SIT compared with 3/11 (27%) treated with the placebo (risk ratio (RR) 2.85, 95% confidence interval (CI) 1.02 to 7.96; P = 0.04). Another study (24 participants) found no difference: global disease severity improved in 8/13 participants (62%) treated with the SIT compared with 9/11 (81%) treated with the placebo (RR 0.75, 95% CI 0.45 to 1.26; P = 0.38). We did not perform meta-analysis because of high heterogeneity between these two studies. The quality of the evidence was low.For 'Participant- or parent-reported specific symptoms of eczema, by subjective measures', two trials (184 participants) did not find that the SIT improved SCORAD part C (mean difference (MD) -0.74, 95% CI -1.98 to 0.50) or sleep disturbance (MD -0.49, 95% CI -1.03 to 0.06) more than placebo. For SCORAD part C itch severity, these two trials (184 participants) did not find that the SIT improved itch (MD -0.24, 95% CI -1.00 to 0.52). One other non-blinded study (60 participants) found that the SIT reduced itch compared with no treatment (MD -4.20, 95% CI -3.69 to -4.71) and reduced the participants' overall symptoms (P < 0.01), but we could not pool these three studies due to high heterogeneity. The quality of the evidence was very low.Seven trials reported systemic adverse reactions: 18/282 participants (6.4%) treated with the SIT had a systemic reaction compared with 15/210 (7.1%) with no treatment (RR 0.78, 95% CI 0.41 to 1.49; the quality of the evidence was moderate). The same seven trials reported local adverse reactions: 90/280 participants (32.1%) treated with the SIT had a local reaction compared with 44/204 (21.6%) in the no treatment group (RR 1.27, 95% CI 0.89 to 1.81). As these had the same study limitations, we deemed the quality of the evidence to also be moderate.Of our secondary outcomes, there was a significant improvement in 'Investigator- or physician-rated global assessment of disease severity at the end of treatment' (six trials, 262 participants; RR 1.48, 95% CI 1.16 to 1.88). None of the studies reported our secondary outcome 'Parent- or participant-rated eczema severity assessed using a published scale', but two studies (n = 184), which have been mentioned above, used SCORAD part C, which we included as our primary outcome 'Participant- or parent-reported specific symptoms of eczema, by subjective measures'.Our findings were generally inconclusive because of the small number of studies. We were unable to determine by subgroup analyses a particular type of allergen or a particular age or level of disease severity where allergen immunotherapy was more successful. We were also unable to determine whether sublingual immunotherapy was associated with more local adverse reactions compared with subcutaneous immunotherapy. AUTHORS' CONCLUSIONS Overall, the quality of the evidence was low. The low quality was mainly due to the differing results between studies, lack of blinding in some studies, and relatively few studies reporting participant-centred outcome measures. We found limited evidence that SIT may be an effective treatment for people with AE. The treatments used in these trials were not associated with an increased risk of local or systemic reactions. Future studies should use high quality allergen formulations with a proven track record in other allergic conditions and should include participant-reported outcome measures.
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Affiliation(s)
- Herman Tam
- Imperial College LondonSection of Paediatrics, Division of Infectious Diseases, Department of MedicineWright Fleming BuildingNorfolk PlaceLondonUKW2 1PG
| | - Moises A Calderon
- National Heart and Lung Institute, Imperial College LondonAllergy and Clinical Immunology, Section of Inflammation, Repair and DevelopmentLondonUKSW3 6LY
| | - Logan Manikam
- Imperial College LondonSection of Paediatrics, Division of Infectious Diseases, Department of MedicineWright Fleming BuildingNorfolk PlaceLondonUKW2 1PG
| | - Helen Nankervis
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Ignacio García Núñez
- Hospital Universitario Carlos HayaServicio de AlergologíaPlaza Del Hospital Civil S/NMálagaSpain29009
| | - Hywel C Williams
- The University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
| | - Stephen Durham
- National Heart and Lung Institute, Imperial College LondonAllergy and Clinical Immunology, Section of Inflammation, Repair and DevelopmentLondonUKSW3 6LY
| | - Robert J Boyle
- Imperial College LondonSection of Paediatrics, Division of Infectious Diseases, Department of MedicineWright Fleming BuildingNorfolk PlaceLondonUKW2 1PG
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Nguyen NT, Raskopf E, Shah-Hosseini K, Zadoyan G, Mösges R. A review of allergoid immunotherapy: is cat allergy a suitable target? Immunotherapy 2016; 8:331-49. [PMID: 26860435 DOI: 10.2217/imt.15.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
To modify the course of allergy, different types of specific allergen immunotherapy have been developed such as sublingual immunotherapy and subcutaneous immunotherapy with native allergens or subcutaneous immunotherapy with polymerized allergoids. However, the optimal specific immunotherapy, especially for cat allergy, remains undetermined. Few studies investigating immunotherapy in cat allergy have been published, and the risk of serious adverse reactions and systemic reactions has often been an important issue. Monomeric allergoids have lower allergenic potential while their immunogenicity remains constant, resulting in excellent safety with notable efficacy. Specific immunotherapy with monomeric allergoids could, therefore, be of high value, especially in cat allergy as well as other types of allergy, and bring relief to a great community of patients.
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Affiliation(s)
- Nhung T Nguyen
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Esther Raskopf
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Gregor Zadoyan
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Ralph Mösges
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
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15
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Kim JE, Kim HJ, Lew BL, Lee KH, Hong SP, Jang YH, Park KY, Seo SJ, Bae JM, Choi EH, Suhr KB, Lee SC, Ko HC, Park YL, Son SW, Seo YJ, Lee YW, Cho SH, Park CW, Roh JY. Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment. Ann Dermatol 2015; 27:578-92. [PMID: 26512172 PMCID: PMC4622892 DOI: 10.5021/ad.2015.27.5.578] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/12/2015] [Accepted: 08/16/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. OBJECTIVE We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. METHODS We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. RESULTS The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. CONCLUSION We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs.
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Affiliation(s)
- Jung Eun Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dermatology, Seoul Medical Center, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Ho Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Phil Hong
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Yong Hyun Jang
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Min Bae
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ki Beom Suhr
- Department of Dermatology, SA Dermatology Clinic, Daejeon, Korea
| | - Seung Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Chang Ko
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Young Jun Seo
- Department of Dermatology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Hyun Cho
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
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16
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Shershakova N, Bashkatova E, Babakhin A, Andreev S, Nikonova A, Shilovsky I, Kamyshnikov O, Buzuk A, Elisyutina O, Fedenko E, Khaitov M. Allergen-Specific Immunotherapy with Monomeric Allergoid in a Mouse Model of Atopic Dermatitis. PLoS One 2015; 10:e0135070. [PMID: 26275152 PMCID: PMC4537237 DOI: 10.1371/journal.pone.0135070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022] Open
Abstract
Atopic dermatitis (AD) is a widespread and difficult to treat allergic skin disease and is a tough challenge for healthcare. In this study, we investigated whether allergen-specific immunotherapy (ASIT) with a monomeric allergoid obtained by succinylation of ovalbumin (sOVA) is effective in a mouse model of atopic dermatitis. An experimental model of AD was reproduced by epicutaneous sensitization with ovalbumin (OVA). ASIT was performed with subcutaneous (SC) administration of increasing doses of OVA or sOVA. The levels of anti-OVA antibodies, as well as cytokines, were detected by ELISA. Skin samples from patch areas were taken for histologic examination. ASIT with either OVA or sOVA resulted in a reduction of both the anti-OVA IgE level and the IgG1/IgG2a ratio. Moreover, ASIT with sOVA increased the IFN-γ level in supernatants after splenocyte stimulation with OVA. Histologic analysis of skin samples from the sites of allergen application showed that ASIT improved the histologic picture by decreasing allergic inflammation in comparison with untreated mice. These data suggest that ASIT with a succinylated allergen represents promising approach for the treatment of AD.
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Affiliation(s)
- Nadezda Shershakova
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
- * E-mail: (MK); (NS); (SA)
| | - Elena Bashkatova
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Alexander Babakhin
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Sergey Andreev
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
- * E-mail: (MK); (NS); (SA)
| | - Alexandra Nikonova
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Igor Shilovsky
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Oleg Kamyshnikov
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Andrey Buzuk
- Faculty of Natural Sciences, Imperial College London, London, United Kingdom
| | - Olga Elisyutina
- Department of Skin Allergology and Immunopathology, National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Elena Fedenko
- Department of Skin Allergology and Immunopathology, National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Musa Khaitov
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
- * E-mail: (MK); (NS); (SA)
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17
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Liu L, Guo D, Liang Q, Ding S, Wu B, Zhang L, Li Q. The efficacy of sublingual immunotherapy withDermatophagoides farinaevaccine in a murine atopic dermatitis model. Clin Exp Allergy 2015; 45:815-22. [DOI: 10.1111/cea.12417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/29/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- L. Liu
- Department of Experimental Immunology; Zhejiang Wolwo Bio-Pharmaceutical Co., Ltd.; Shanghai China
| | - D. Guo
- Department of Experimental Immunology; Zhejiang Wolwo Bio-Pharmaceutical Co., Ltd.; Shanghai China
| | - Q. Liang
- Department of Experimental Immunology; Zhejiang Wolwo Bio-Pharmaceutical Co., Ltd.; Shanghai China
| | - S. Ding
- Department of Experimental Immunology; Zhejiang Wolwo Bio-Pharmaceutical Co., Ltd.; Shanghai China
| | - B. Wu
- Department of Experimental Immunology; Zhejiang Wolwo Bio-Pharmaceutical Co., Ltd.; Shanghai China
| | - L. Zhang
- Department of Experimental Immunology; Zhejiang Wolwo Bio-Pharmaceutical Co., Ltd.; Shanghai China
| | - Q. Li
- Department of Experimental Immunology; Zhejiang Wolwo Bio-Pharmaceutical Co., Ltd.; Shanghai China
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18
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Díez Zuluaga LS, Cardona Villa R, Restrepo Colorado MN, Sánchez Caraballo JM. Inmunoterapia con alérgenos, ¿cuándo y por qué? IATREIA 2014. [DOI: 10.17533/udea.iatreia.17755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
La inmunoterapia específica con alérgenos es el único tratamiento que modifica el curso natural de algunas enfermedades alérgicas como asma, rinitis, conjuntivitis, dermatitis atópica y alergia al veneno de himenópteros. Sin embargo, aún existe cierta controversia respecto a su seguridad y su utilidad clínica. En el presente artículo se presenta una revisión de los mecanismos moleculares, las indicaciones y contraindicaciones de dicha inmunoterapia, y se evalúan su seguridad y eficacia en cada una de estas enfermedades mediante casos ilustrativos y una breve revisión del tema.
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Lee J, Park CO, Lee KH. Specific immunotherapy in atopic dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 7:221-9. [PMID: 25749758 PMCID: PMC4397361 DOI: 10.4168/aair.2015.7.3.221] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/30/2014] [Accepted: 06/30/2014] [Indexed: 11/20/2022]
Abstract
Allergen specific immunotherapy (SIT) using house dust mite (HDM) extracts has been performed mainly with patients of asthma and allergic rhinitis. In the meanwhile, there has been a long debate on the efficacy of SIT in atopic dermatitis (AD) with only a few double-blind placebo-controlled trials. However, several randomized controlled trials of SIT in AD revealed significant improvement of clinical symptoms and also, positive result was shown by a following meta-analysis study of these trials. In order to predict and evaluate the treatment outcome, finding a biomarker that can predict treatment responses and treatment end-points is critical but it is very challenging at the same time due to the complexity of causes and mechanisms of AD. Other considerations including standardization of the easiest and safest treatment protocol and optimizing the treatment preparations should be studied as well. This review summarizes the basics of SIT in AD including the brief mechanisms, treatment methods and schedules, and also highlights the clinical efficacy of SIT in AD along with mild, controllable adverse reactions. Immunologic effects and studies of various biomarkers are also introduced and finally, future considerations with upcoming studies on SIT were discussed.
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Affiliation(s)
- Jungsoo Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ook Park
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Hoon Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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20
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Zhong H, Deng X, Song Z, Darsow U, Chen W, Chen S, Luo N, Hao F. Immunological changes after ASIT in AD allergen-specific immunotherapy and their potential correlation with clinical response in patients with atopic dermatitis patients sensitized to house dust mite. J Eur Acad Dermatol Venereol 2014; 29:1318-24. [PMID: 25376542 DOI: 10.1111/jdv.12813] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Allergen-specific immunotherapy (ASIT) is the main treatment for inducing long-term immunological and clinical tolerance in patients with IgE-mediated allergic diseases. Recent open-label and controlled studies on the efficacy of ASIT in patients with atopic dermatitis (AD) have provided promising results. However, data about possible relationship between the improvement of clinical symptoms and changes of serum cytokines are limited. METHODS Seventy-nine patients with moderate to severe AD sensitized to house dust mite (HDM) were enrolled. Fifty-eight patients were treated with ASIT and 11 controls received only symptomatic treatment. The disease activity in AD patients was evaluated by using the patient-oriented eczema measure (POEM) system. Serum interleukin (IL)-4, IL-10, interferon (IFN)-γ, transforming growth factor (TGF) β1, total IgE, HDM-specific IgE (s-IgE) and HDM-specific IgG4 (s-IgG4) were measured before and after 2 years of therapy. RESULTS The mean patient-oriented eczema measure system (POEM) score of AD patients with ASIT significantly decreased after 2 years of treatment, compared to that in patients without ASIT. After ASIT, the serum levels of IL-10, TGF-β1, IFN-γ and s-IgG4 increased, while the level of IL-4 decreased. The change in the POEM score was negatively correlated with changes of serum concentration of TGF-β1, s-IgG4 and IFN-γ. Furthermore, s-IgG4 levels were positively correlated with changes in the IL-10 levels. No correlation between POEM score and serum IL-10 or IL-4 was observed. CONCLUSION Clinical symptoms and the quality of life of AD with HDM sensitization could be improved after 2 years of ASIT. Changes in serum IL-10, TGF-β1, s-IgG4 and IFN-γ might be considered as biomarkers to assist clinical evaluation of the therapeutic effects of ASIT in patients with AD.
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Affiliation(s)
- H Zhong
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - X Deng
- Department of Dermatology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Z Song
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - U Darsow
- Department of Dermatology and Allergy, Technische Universitaet Muenchen, Munich, Germany
| | - W Chen
- Department of Dermatology and Allergy, Technische Universitaet Muenchen, Munich, Germany
| | - S Chen
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - N Luo
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - F Hao
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing, China
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21
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Plötz SG, Wiesender M, Todorova A, Ring J. What is new in atopic dermatitis/eczema? Expert Opin Emerg Drugs 2014; 19:441-58. [DOI: 10.1517/14728214.2014.953927] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol 2014; 71:1218-33. [PMID: 25264237 DOI: 10.1016/j.jaad.2014.08.038] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/06/2014] [Accepted: 08/22/2014] [Indexed: 01/27/2023]
Abstract
Atopic dermatitis is a common, chronic inflammatory dermatosis that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this final section, treatments for flare prevention and adjunctive and complementary therapies and approaches are reviewed. Suggestions on use are given based on available evidence.
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23
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Vrtala S, Huber H, Thomas WR. Recombinant house dust mite allergens. Methods 2014; 66:67-74. [PMID: 23911838 PMCID: PMC4582397 DOI: 10.1016/j.ymeth.2013.07.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 07/12/2013] [Accepted: 07/15/2013] [Indexed: 01/07/2023] Open
Abstract
House dust mites (HDM) are a globally important source of allergen responsible for the sensitization of more than 50% of allergic patients. Specific immunotherapy with HDM extracts is effective but allergen extracts cannot be fully standardized and severe side-effects can occur during the protracted course of treatment. The introduction of molecular biological techniques into allergy research allowed the indentification of more than 20 groups of HDM allergens. Recombinant HDM allergens can be produced in defined concentrations and consistent quality and allow the development of vaccines for HDM allergy with reduced allergenic activity and retained immunogenicity. The immunotherapy trials in pollen allergic patients with recombinant pollen allergens/hypoallergenic allergen derivatives have shown that this treatment is effective and indicated that recombinant HDM vaccines might improve immunotherapy of HDM allergic patients. Here we report the steps for the development of vaccines for HDM allergy. After selection of the most prevalent HDM species, the panel of allergens to be included into a therapeutic vaccine for HDM allergy needs to be determined. HDM allergens with high IgE-binding frequency and clinical relevance will be modified into hypoallergenic variants and evaluated for their allergenic activity and immunogenicity. Derivatives with reduced allergenic activity but with retained immunogenicity would be good candidates for a HDM vaccine for safe and efficient immunotherapy.
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Affiliation(s)
- Susanne Vrtala
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Hans Huber
- Biomay AG, Lazarettgasse 19. 1090 Vienna, Austria
| | - Wayne R Thomas
- Center for Child Health Research, University of Western Australia, Telethon Institute of Child Health Research, West Perth, Australia.
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Viney JM, Andrew DP, Phillips RM, Meiser A, Patel P, Lennartz-Walker M, Cousins DJ, Barton NP, Hall DA, Pease JE. Distinct conformations of the chemokine receptor CCR4 with implications for its targeting in allergy. THE JOURNAL OF IMMUNOLOGY 2014; 192:3419-27. [PMID: 24563252 DOI: 10.4049/jimmunol.1300232] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CC chemokine receptor 4 (CCR4) is expressed by Th2 and regulatory T cells and directs their migration along gradients of the chemokines CCL17 and CCL22. Both chemokines and receptor are upregulated in allergic disease, making CCR4 a therapeutic target for the treatment of allergy. We set out to assess the mechanisms underlying a previous report that CCL22 is a dominant ligand of CCR4, which may have implications for its therapeutic targeting. Human T cells expressing endogenous CCR4 and transfectants engineered to express CCR4 were assessed for receptor function, using assays of calcium release, chemotaxis, receptor endocytosis, and ligand binding. Despite the two ligands having equal potency in calcium flux and chemotaxis assays, CCL22 showed dominance in both receptor endocytosis assays and heterologous competitive binding assays. Using two different CCR4-specific Abs, we showed that CCR4 exists in at least two distinct conformations, which are differentially activated by ligand. A major population is activated by both CCL17 and CCL22, whereas a minor population is activated only by CCL22. Mutation of a single C-terminal residue K310 within a putative CCR4 antagonist binding site ablated activation of CCR4 by CCL17, but not by CCL22, despite having no effect on the binding of either ligand. We conclude that CCL17 and CCL22 are conformationally selective ligands of CCR4 and interact with the receptor by substantially different mechanisms. This finding suggests that the selective blockade of CCR4 in allergy may be feasible when one CCR4 ligand dominates, allowing the inhibition of Th2 signaling via one ligand while sparing regulatory T cell recruitment via another.
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Affiliation(s)
- Jonathan M Viney
- Leukocyte Biology Section, Medical Research Council-Asthma UK Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute Division, Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
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Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, Novak N, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol 2013; 131:295-9.e1-27. [PMID: 23374261 DOI: 10.1016/j.jaci.2012.12.672] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Atopic dermatitis: a practice parameter update 2012." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available online at http://www.jcaai.org.
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Hur GY, Kim TB, Han MY, Nahm DH, Park JW. A survey of the prescription patterns of allergen immunotherapy in Korea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 5:277-82. [PMID: 24003383 PMCID: PMC3756173 DOI: 10.4168/aair.2013.5.5.277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/31/2012] [Indexed: 11/25/2022]
Abstract
Purpose Allergen immunotherapy (AIT) has been used as a curative and specific treatment of allergic diseases. However, no data on the prescription patterns of AIT in Korea is available. Therefore, we surveyed the prescription patterns of AIT by allergy specialists in Korea. Methods We emailed a questionnaire on AIT prescription patterns to the 690 members of the Korean Academy of Asthma, Allergy and Clinical Immunology with clinical practice experience. All returned answers were evaluated. Results The response rate was 21.0%. Only 69.0% of the respondents performed AIT in practice. Hindrance factors for performing AIT in the practice included a lack of facilities (21%), lack of practical experience during their subspecialty or postgraduate educational training programs (15.8%), no need for AIT because of sufficient pharmacotherapy (14.5%), insufficient economic profits (14.5%), and risks for adverse reactions (13.2%). Ninety-two allergy specialists (82%) performed AIT subcutaneously subcutaneous immunotherapy (SCIT) and 20 allergy specialists (18%) performed it sublingually sublingual immunotherapy (SLIT). Only 8 specialists performed both SCIT and SLIT. The allergens used for SCIT were house dust mites (98.9%), pollens (72.8%), and animal dander (23.9%). SLIT was prescribed only for house dust mites. Twenty-eight physicians (30.4%) observed anaphylactic reactions during SCIT. Eight physicians (40.0%) who prescribed SLIT observed adverse reactions, including local reactions, but none of them observed anaphylactic reactions. Conclusions In this survey, 69.0% of the respondents performed AIT in clinical practice. SCIT prescription is more popular than SLIT. The Lack of facilities and clinical education is a critical barrier to performing AIT. Therefore, proper clinical education of AIT is necessary for Korean allergists.
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Affiliation(s)
- Gyu-Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Kim J, Lee S, Woo SY, Han Y, Lee JH, Lee IY, Lim IS, Choi ES, Choi BW, Cheong HK, Lee SI, Ahn K. The indoor level of house dust mite allergen is associated with severity of atopic dermatitis in children. J Korean Med Sci 2013; 28:74-9. [PMID: 23341715 PMCID: PMC3546108 DOI: 10.3346/jkms.2013.28.1.74] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/11/2012] [Indexed: 11/22/2022] Open
Abstract
We attempted to investigate the correlation between the severity of atopic dermatitis (AD) in children and the indoor level of house dust mite (HDM) allergens. Ninety-five patients (31.1 ± 19.5 months of age) with AD were enrolled in this study, and serum specific IgE against Dermatophagoides pteronyssinus and D. farinae was measured. The severity of AD was assessed using the visual analogue scale on the same day of house dust collection. Living rooms and mattresses where the child usually slept were vacuumed for 2 minutes and concentrations of Der f 1 were measured by enzyme-linked immunosorbent assay. The skin symptoms were more severe in patients with Der f 1 concentrations in living room > 2 µg/g dust than ≤ 2 µg/g dust (P = 0.018). This difference was noted in AD patients without sensitization to HDM (P = 0.004), but not in patients with sensitization. There was no difference in symptom severity according to Der f 1 concentrations in mattresses (P = 0.062). The severity of skin symptoms is associated with indoor concentrations of HDM in children with AD, and it is likely to act as nonspecific irritants as well as allergens in AD skin lesions.
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Affiliation(s)
- Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Sangwoon Lee
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Sook-young Woo
- Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Korea
| | - Youngshin Han
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Jung Hyun Lee
- Department of Pediatrics, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - In-Yong Lee
- Department of Environmental Medical Biology, Yonsei University College of Medicine, Seoul, Korea
| | - In-Seok Lim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eung-Sang Choi
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byoung-Whi Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Sang-Il Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
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Affiliation(s)
- Kenny Y Kwong
- Division of Allergy-Immunology, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, N-25, Torrance, CA 90509, USA.
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Cox L, Calderón M, Pfaar O. Subcutaneous allergen immunotherapy for allergic disease: examining efficacy, safety and cost-effectiveness of current and novel formulations. Immunotherapy 2012; 4:601-16. [PMID: 22788128 DOI: 10.2217/imt.12.36] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Subcutaneous immunotherapy (SCIT) is a unique therapy for allergic disease because it provides symptomatic relief while modifying the allergic disease by targeting the underlying immunological mechanism. Its efficacy and safety have been established in the treatment of asthma, allergic rhinitis/rhinoconjunctivitis and stinging insect hypersensitivity in numerous controlled clinical trials. This review evaluates a spectrum of clinical factors, ranging from efficacy to cost-effectiveness, which should be considered in evaluating SCIT. The evidence for SCIT safety and efficacy for these conditions is reviewed in an evaluation of the systematic reviews and meta-analyses. The evidence for the persistent and preventive effects of SCIT is also examined. An overview of the SCIT outcomes measures utilized in clinical trials is presented. The cost-effectiveness of SCIT compared with conventional medication treatment, novel indications and formulations for SCIT are also explored in this review.
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Affiliation(s)
- Linda Cox
- Department of Medicine, Nova Southeastern University, 5333 North Dixie Highway, Fort Lauderdale, FL 33334, USA.
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31
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Novak N, Bieber T, Hoffmann M, Fölster-Holst R, Homey B, Werfel T, Sager A, Zuberbier T. Efficacy and safety of subcutaneous allergen-specific immunotherapy with depigmented polymerized mite extract in atopic dermatitis. J Allergy Clin Immunol 2012; 130:925-31.e4. [DOI: 10.1016/j.jaci.2012.08.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/31/2012] [Accepted: 08/02/2012] [Indexed: 02/07/2023]
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Abstract
HDM allergy is associated with asthma, allergic rhinitis and atopic dermatitis. In many countries childhood asthma is predominantly found in HDM-allergic children with their probability of developing disease being proportional to their IgE antibody titers and the early development of Th2 responses. While the pathogenesis is complex and increasingly linked to infection the immunologically-based allergen immunotherapy and anti-IgE antibody therapy are highly beneficial. Immunotherapy could be a short-term treatment providing lifelong relief but the current regimens depend on repeated administration of allergen over years. Immunological investigations point to a contribution of responses outside the Th2 pathway and multiple potential but unproven control mechanisms. Over half of the IgE antibodies are directed to the group 1 and 2 allergens with most of remainder to the group 4, 5, 7 and 21 allergens. This hierarchy found in high and low responders provides a platform for introducing defined allergens into immunotherapy and defined reagents for investigation.
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Affiliation(s)
- Wayne R Thomas
- Centre for Child Health Research, University of Western Australia. wayne @ichr.uwa.edu.au
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33
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Moingeon P, Mascarell L. Novel routes for allergen immunotherapy: safety, efficacy and mode of action. Immunotherapy 2012; 4:201-12. [PMID: 22339462 DOI: 10.2217/imt.11.171] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Allergen immunotherapy is the only curative treatment of IgE-mediated type I respiratory allergies. Subcutaneous immunotherapy (SCIT) is used as a reference therapy and has transformed allergic treatments; it improves symptoms (asthma and rhinitis) as well as the quality of life of patients. SCIT requires repetitive administration and carries the risk of severe systemic adverse effects, including anaphylaxis. Sublingual immunotherapy is now a valid noninvasive alternative to SCIT, as a safe and efficacious treatment for respiratory allergies. In this article, we compare various routes of allergen immunotherapy, including SCIT and sublingual immunotherapy, as well as more exploratory routes currently under investigation (i.e., intralymphatic, epicutaneous, intranasal and oral). We discuss their respective advantages, as well as their foreseen modes of action.
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Affiliation(s)
- Philippe Moingeon
- Stallergenes SA, Département Scientifique, 6 rue Alexis de Tocqueville, 92160 Antony, France
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34
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Sánchez Caraballo JM, Cardona Villa R. Clinical and immunological changes of immunotherapy in patients with atopic dermatitis: randomized controlled trial. ISRN ALLERGY 2012; 2012:183983. [PMID: 23724240 PMCID: PMC3658480 DOI: 10.5402/2012/183983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 01/10/2012] [Indexed: 12/03/2022]
Abstract
Background. Immunotherapy has proven to be an useful tool in the management of allergic respiratory diseases; however, little has been studied in atopic dermatitis. Objective. To evaluate the clinical and immunological impact of immunotherapy with mites allergen extracts in atopic dermatitis. Methods. Patients with atopic dermatitis were assigned with computer-generated randomization to either of the following groups: (a) controls received only topical treatment with steroids and/or tacrolimus and (b) actively treated patients received topical treatment plus immunotherapy. Levels of serum total IgE, mites-specific IgE and IgG4 were assessed at study start and after one year of immunotherapy. Results. 31 patients in the active group and 29 in the control group completed the study. Symptoms and medication scores were significantly reduced in the active group after six months. Three patients in the control group showed new sensitizations to mites, while 3 patients in the active group showed neosensitization to shrimp with negative oral food challenge. We observed significant increase of mites-specific IgG4 levels in active group. Conclusion. Specific allergen immunotherapy induced a tolerogenic IgG4 response to mite allergens associated with favorable clinical effects in atopic dermatitis patients.
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Affiliation(s)
- Jorge Mario Sánchez Caraballo
- Group of Clinical and Experimental Allergy, University of Antioquia, Medellin, Colombia ; Foundation for the Development of Medical and Biological Sciences (FUNDEMEB), Cartagena, Colombia ; Institute for Immunological Research, University of Cartagena, Cartagena, Colombia ; IPS Universitaria Sede Ambulatoria, Universidad de Antioquia Carrera 51A No. 62-42, Medellin, Colombia
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Weller K, Soost S, Worm M, Maurer M, Zuberbier T. Atopic dermatitis and allergic rhinitis--do co-effects in therapy exist? J Dtsch Dermatol Ges 2012; 10:221-36; quiz 238-9. [PMID: 22304462 DOI: 10.1111/j.1610-0387.2011.07885.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atopic dermatitis and allergic rhinitis frequently appear together in the same patients. The pathogenesis of both disorders is complex and still incompletely understood. Nevertheless, pathophysiological overlaps suggest the existence of potential therapeutic co-effects. While data pointing towards a positive effect of allergen elimination for both diseases is still limited, there is now increasing evidence showing beneficial effects of specific immunotherapy in patients suffering from atopic dermatitis and additional type I allergies. H(1)-antihistamines were also found to exert moderate positive effects on the symptoms of atopic dermatitis in single studies. In summary, a limited therapeutic co-effect of the above mentioned treatment options can be expected in case of the parallel existence of atopic dermatitis and allergic rhinitis in the same patient. More studies on this issue during the next years are desirable. In addition, a better understanding of the pathophysiology should have a positive impact on the treatment of atopic manifestations such as atopic dermatitis and allergic rhinitis.
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Affiliation(s)
- Karsten Weller
- Allergy Center Charité, Department of Dermatology, Venereology and Allergology, Charité-University Medicine, Charitéplatz 1, Berlin, Germany.
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36
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Hsu J, Saltoun CA, Avila PC. Advances in upper airway diseases and allergen immunotherapy in 2011. J Allergy Clin Immunol 2012; 129:646-52. [PMID: 22305680 DOI: 10.1016/j.jaci.2012.01.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 10/14/2022]
Abstract
The purpose of this review is to highlight recently published important articles on upper airway diseases and allergen immunotherapy. We review articles on rhinitis, sinusitis, conjunctivitis, and immunotherapy. New insights into epidemiology, pathophysiology, diagnosis, and therapy are described for each of the above diseases.
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Affiliation(s)
- Joy Hsu
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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37
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Darsow U, Forer I, Ring J. Allergen-specific immunotherapy in atopic eczema. Curr Allergy Asthma Rep 2011; 11:277-83. [PMID: 21461718 DOI: 10.1007/s11882-011-0194-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aeroallergens are relevant eliciting factors of allergic rhinoconjunctivitis and bronchial asthma but also of atopic eczema. The use of allergen-specific immunotherapy as in respiratory atopic diseases is controversial in patients with atopic eczema, but refined diagnostic methods to characterize subgroups of patients with relevant allergies and the results of smaller controlled studies give rise to new approaches in this field. This article reviews the theoretical problems and practical results associated with allergen-specific immunotherapy in atopic eczema.
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Affiliation(s)
- Ulf Darsow
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Biedersteiner Strasse 29, 80802, München, Germany.
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38
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Belderbos ME, Knol EF, Houben ML, Bleek GM, Wilbrink B, Kimpen JLL, Rovers M, Bont L. Low neonatal Toll-like receptor 4-mediated interleukin-10 production is associated with subsequent atopic dermatitis. Clin Exp Allergy 2011; 42:66-75. [DOI: 10.1111/j.1365-2222.2011.03857.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 07/17/2011] [Accepted: 07/18/2011] [Indexed: 01/17/2023]
Affiliation(s)
- M. E. Belderbos
- Department of Pediatrics; University Medical Center Utrecht; Utrecht; The Netherlands
| | - E. F. Knol
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - M. L. Houben
- Department of Pediatrics; University Medical Center Utrecht; Utrecht; The Netherlands
| | - G. M. Bleek
- Department of Pediatrics; University Medical Center Utrecht; Utrecht; The Netherlands
| | - B. Wilbrink
- Laboratory of Infectious Diseases and Perinatal Screening; National Institute of Public Health and the Environment; Bilthoven; The Netherlands
| | - J. L. L. Kimpen
- Department of Pediatrics; University Medical Center Utrecht; Utrecht; The Netherlands
| | - M. Rovers
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht; The Netherlands
| | - L. Bont
- Department of Pediatrics; University Medical Center Utrecht; Utrecht; The Netherlands
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Passalacqua G, Compalati E, Canonica GW. Sublingual immunotherapy: other indications. Immunol Allergy Clin North Am 2011; 31:279-87, ix. [PMID: 21530820 DOI: 10.1016/j.iac.2011.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sublingual immunotherapy (SLIT) represents a significant advance and it seems particularly suitable in pediatric patients. There are favorable results for food allergy in controlled trials. For latex allergy, the results of several trials are encouraging. For atopic dermatitis, previous experience with subcutaneous immunotherapy and some earlier trials suggest the possible application of SLIT in children with mild to moderate dermatitis and sensitization to dust mite, but this recommendation is considered insufficiently evidence based. In hymenoptera allergy, the only trial available is a proof-of-concept study in large local reactions that needs to be confirmed in well-controlled studies.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine, University of Genoa, Padiglione Maragliano, Largo R. Benzi 10, Genoa 16132, Italy
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Abstract
Recently, important novel insights into the complex pathophysiology of atopic dermatitis (AD) have been gained. However, in most cases the therapy of AD is limited to base line therapy with emollients combined with symptomatic, rather general immunosuppressive treatment approaches of the flare-ups. Latest research findings together with experiences from daily clinical practice, which support the concept that a combination of general disease features together with specific trigger factors in the individual patients drive the disease, might be helpful for a subclassification of patients with AD based on the most relevant pathophysiologic modifications. Subclassification of patients with AD seems indispensable to introduce rationale-based, individualized treatment approaches of AD, which target specific modified pathways. In this review, we provide an overview about a selection of pathophysiologic pathways, which hold promise to represent targets of such therapeutic approaches in the near future.
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany.
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Ozdemir C, Kucuksezer UC, Akdis M, Akdis CA. Specific immunotherapy and turning off the T cell: how does it work? Ann Allergy Asthma Immunol 2011; 107:381-92. [PMID: 22018608 DOI: 10.1016/j.anai.2011.05.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/08/2011] [Accepted: 05/17/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine T-regulatory (Treg) cell functions in allergic immune responses and their roles during allergen specific immunotherapy based on recent developments and current understanding of immune regulation. DATA SOURCES PubMed search of English-language articles regarding Treg cells and allergen specific immunotherapy. STUDY SELECTION Articles on the subject matter were selected and reviewed. RESULTS Allergen specific immunotherapy is the ultimate treatment modality targeting the immunopathogenic mechanisms of allergic disorders. A diminished allergen-specific T-cell proliferation and suppressed secretion of T(H)1- and T(H)2-type cytokines are the characteristic hallmarks. In addition, Treg cells inhibit the development of allergen-specific T(H)2 and T(H)1 cell responses and therefore exert key roles in healthy immune response to allergens. Treg cells potently suppress IgE production and directly or indirectly control the activity of effector cells of allergic inflammation, such as eosinophils, basophils, and mast cells. CONCLUSION As advancements in the field of allergen specific immunotherapy ensue, they may provide novel progression of more rational and safer approaches for the prevention and treatment of allergic disorders. Currently, the Treg cell field is an open research area to increase our understanding in mechanisms of peripheral tolerance to allergens.
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Affiliation(s)
- Cevdet Ozdemir
- Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
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Vakirlis E, Lazaridou E, Tzellos TG, Gerou S, Chatzidimitriou D, Ioannides D. Investigation of cytokine levels and their association with SCORAD index in adults with acute atopic dermatitis. J Eur Acad Dermatol Venereol 2011; 25:409-16. [PMID: 21371129 DOI: 10.1111/j.1468-3083.2010.03800.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease with increasing frequency over the last decades, especially in adults. Cytokines orchestrate atopic skin inflammation. Objectives The aim of this study was to compare serum levels of cytokines in adult patients with acute AD (AD1) with other groups of AD patients and controls and investigate the possible association between such cytokines and disease severity. METHODS We measured cytokine levels using flow cytometry in 21 adult patients with acute AD, 12 adults with chronic AD, 10 children with acute AD and 10 healthy adults. RESULTS Flow cytometry analysis of cytokines revealed that interleukin 10 (IL-10), IL-6, interferon γ (IFN-γ) and IL-4 levels were significantly decreased in AD1 group compared with controls, whereas IL-2 and tumour necrosis factor (TNF) did not differ. Comparison of AD1 group with adults chronic phase group showed that IgE, eosinophil and IL-2 levels remained unaltered, whereas IL-10, IL-6, IFN-γ, IL-4 and TNF were significantly decreased. SCORAD and IgE levels were significantly increased, IL-10, IL-6 and IFN-γ were decreased and TNF, IL-2, IL-4 and eosinophil levels remained unchanged in AD1 group compared with children acute phase group. Within AD1 group correlation analysis revealed that IgE and TNF levels were significantly associated with AD severity. Coefficient of determination analysis revealed that TNF and IgE levels could explain 49.14% and 35.28% of the variance of SCORAD. CONCLUSIONS These data indicate that serum IgE and TNF levels correlate with AD severity and that serum cytokines are downregulated in AD1 group. Further studies are clearly needed to elucidate cytokines' role in adults with AD.
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Affiliation(s)
- E Vakirlis
- Departments of Dermatology and Venereology Microbiology, School of Medicine, Aristotle University of Thessaloniki, Greece.
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Pajno GB, Finegold I. SIT beyond respiratory diseases. Ann Allergy Asthma Immunol 2011; 107:395-400. [PMID: 22018609 DOI: 10.1016/j.anai.2011.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 04/23/2011] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The goal was to assess the effectiveness of specific immunotherapy (SIT) in reduction of symptoms and medication score in patients with immunoglobulin E (IgE) mediated extrinsic form of atopic dermatitis (AD); and to assess the effectiveness of oral immunotherapy (OIT) as "active" treatment to achieving tolerance for food(s) in patients with IgE mediated food allergy. DATA SOURCES Computerized bibliographic searches of MEDLINE (1998-2010) were supplemented by hand searches of reference lists. Studies were included if they were double-blind randomized controlled trials comparing subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT) or OIT with placebo. However uncontrolled studies and case reports were also included. STUDY SELECTIONS Thirty-two studies were analyzed. Because of the high heterogeneity of the AD studied only results of 2 placebo controlled studies 1-SCIT and 1-SLIT respectively were comparable. Among OIT studies: 4 carried out with control groups were analyzed. RESULTS From 36% to 92% of patients treated with OIT reached tolerance to cow's milk or egg; a rate of 8% to 53% reached partial tolerance. The patients had either clinical history of severe systemic reactions to foods: anaphylaxis, or mild to moderate reactions. Regarding SIT for AD: 72% of patients treated with house dust mite SCIT and 54% treated with SLIT had a significant improvement of SCORAD-Index. CONCLUSIONS This review found that OIT with cow's milk or egg is effective in achieving full tolerance or partial tolerance in the majority of patients with IgE mediated food allergy. SIT may represent an additional therapeutic tool for the treatment of extrinsic AD in properly selected patients.
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Affiliation(s)
- Giovanni B Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Italy.
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Novak N, Thaci D, Hoffmann M, Fölster-Holst R, Biedermann T, Homey B, Schaekel K, Stefan JA, Werfel T, Bieber T, Sager A, Zuberbier T. Subcutaneous immunotherapy with a depigmented polymerized birch pollen extract--a new therapeutic option for patients with atopic dermatitis. Int Arch Allergy Immunol 2011; 155:252-6. [PMID: 21293143 DOI: 10.1159/000320058] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 08/06/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Birch pollen is an important outdoor allergen able to aggravate symptoms in atopic dermatitis (AD). Specific immunotherapy (SIT), an established procedure for allergic airway diseases, might also represent an attractive therapeutic option for the causal treatment of allergen-triggered cutaneous symptoms in these patients. Studies with house dust mite SIT have already shown beneficial effects in AD patients, whereas the safety and efficacy of SIT with birch pollen extract in AD patients have not been studied so far. The aim of this study was to evaluate for the first time the safety and efficacy of SIT with a depigmented polymerized birch pollen extract in AD patients. METHODS Fifty-five adult patients with moderate-to-severe AD and clinically relevant sensitization to birch pollen received SIT for 12 weeks. SIT was continued during birch pollen season. The assessment of safety, the total SCORAD value, and the Dermatology Life Quality Index (DLQI) were evaluated. RESULTS The median total SCORAD value was reduced by 34% (p < 0.001) during the course of treatment and the mean DLQI improved by 49% (p < 0.001) despite strong simultaneous birch pollen exposure. Eight patients (14.5%) developed systemic reactions and 19 patients (34.5%) developed local reactions which were of mild intensity in most cases. No patient discontinued the study prematurely due to adverse drug reactions. Coseasonal treatment was well tolerated. CONCLUSION SIT with a depigmented polymerized birch pollen extract leads to significant improvement of the SCORAD value and the DLQI in patients suffering from moderate-to-severe AD sensitized to birch pollen.
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany.
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Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, Nelson M, Weber R, Bernstein DI, Blessing-Moore J, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D. Allergen immunotherapy: A practice parameter third update. J Allergy Clin Immunol 2011; 127:S1-55. [DOI: 10.1016/j.jaci.2010.09.034] [Citation(s) in RCA: 597] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 09/23/2010] [Indexed: 10/18/2022]
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Calderon MA, Boyle RJ, Nankervis H, García Núñez I, Williams HC, Durham S. Specific allergen immunotherapy for the treatment of atopic eczema. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2010; 101:585-599. [DOI: 10.1016/j.ad.2010.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 03/07/2010] [Accepted: 03/30/2010] [Indexed: 12/20/2022] Open
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Abstract
IMPORTANCE OF THE FIELD Atopic eczema (AE) is a chronic relapsing inflammatory skin condition and one of the most common, potentially debilitating diseases with increasing incidence. AREAS COVERED IN THIS REVIEW The complex etiology of AE with multiple systemic and local immunologic and inflammatory responses and interactions between susceptibility genes and environmental factors leading to defects in skin barrier function and eczematous skin lesions is presented. Knowledge of pathogenesis is important for understanding the more innovative treatment approaches discussed. WHAT THE READER WILL GAIN Basic therapy consists of hydrating topical treatment and avoidance of specific and unspecific provocation factors. For acute eczematous skin lesions, anti-inflammatory treatment consists mainly of topical glucocorticoids and topical calcineurin inhibitors (tacrolimus and pimecrolimus). Microbial colonization and superinfection may induce skin exacerbation, which can be treated by either topical or systemic antimicrobial treatment. Systemic anti-inflammatory therapy is limited to severe cases and consists of systemic steroids, cyclosporine A or mycophenolate mofetil. Novel anti-inflammatory concepts that go beyond corticosteroids are in the early phases of development. There are targeted therapeutic approaches, such as cytokine and chemokine modulators and it remains to be investigated how effective they will be and what side effects they may carry. TAKE HOME MESSAGE Existing treatment modalities such as barrier repair therapy, topical immunosuppressive agents, antiseptic treatment as well as systemic treatment options are discussed. The review aims to summarize the most recent findings of more innovative treatment approaches such as modulation of cytokines or chemokines, modulation of T-cell responses or anti-IgE therapy.
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