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Larenas-Linnemann D, Morfin-Maciel BM, Bedolla-Barajas M, López-Bago A, Navarrete Rodríguez EM, Mogica-Martínez MD, Gereda JE, Sarrazola Sanjuan M, Cano Pedroza RY, Cavallo MC, Romero Tapia SDJ, Jossen RA, Fuentes Pérez JM, Del Rio Navarro BE, Rodríguez Zagal E, Piraino Sosa PA, Huerta Villalobos YR, Chavez-Vereau P, García Imperial DA, Olivares Gómez M, Valle Rodríguez F, Zuñiga Reyes CO, Rodríguez-González M, Gallego Corella CI, Ivancevich JC, García Cruz MDLLH, Repka-Ramirez MS, Flores Morales ME, Fernández De Córdova Aguirre JC, Luna-Pech JA, Rivero Yeverino D, Martínez Guzmán E, Pérez Ortiz CE, Villa Médica L. Aeroallergen immunotherapy associated with reduced risk of severe COVID-19 in 1095 allergic patients. World Allergy Organ J 2023; 16:100779. [PMID: 37251811 PMCID: PMC10154540 DOI: 10.1016/j.waojou.2023.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/14/2023] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703-0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217-0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623-0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822-0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829-0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion In our registry AIT was associated with reduced COVID-19 severity.
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Affiliation(s)
| | | | | | - Ana López-Bago
- Facultad de medicina, Universidad Autónoma de México (UNAM), Mexico City, Mexico
| | | | | | | | | | | | - María Cecilia Cavallo
- Allergy and Clinical Immunology Department, Hospital San Martín, Paraná ER Argentina
| | | | | | - José Miguel Fuentes Pérez
- Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Blanca E Del Rio Navarro
- Hospital Infantil de México Federico Gómez, Servicio de Alergia e Inmunología Clínica, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | - María Susana Repka-Ramirez
- Allergy, Asthma and Immunology Department, Hospital de Clínicas-FCM, Universidad Nacional, Asunción, Paraguay
| | | | | | - Jorge A Luna-Pech
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico
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Baloh CH, Huffaker MF, Laidlaw T. Biomarkers and mechanisms of tolerance induction in food allergic patients drive new therapeutic approaches. Front Immunol 2022; 13:972103. [PMID: 36263023 PMCID: PMC9574092 DOI: 10.3389/fimmu.2022.972103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
Immunotherapy for food-allergic patients has been effective in inducing desensitization in some populations, but long-term tolerance has remained an elusive target. A challenge facing our field is how to differentiate immune markers that are impacted by immunotherapy from those that are critical biomarkers of tolerance. Data from recent clinical trials have identified several biomarkers and mechanisms for achieving tolerance. These biomarkers include younger age, lower food-specific IgE, lower food component-specific IgE, specific linear epitope profiles, and subsets of food-specific CD4+ T cells. Additional biomarkers under investigation for their relevance in tolerance induction include TCR repertoires, gastrointestinal and skin microbiome, and local tissue immunity. This mini-review highlights recent advances in understanding biomarkers and mechanisms of tolerance induction in food immunotherapy and how these are influencing clinical trial development.
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Affiliation(s)
- Carolyn H. Baloh
- Immune Tolerance Network, Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA, United States
- *Correspondence: Carolyn H. Baloh,
| | - Michelle F. Huffaker
- Immune Tolerance Network, University of California San Francisco, San Francisco, CA, United States
| | - Tanya Laidlaw
- Immune Tolerance Network, Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA, United States
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Zurmühl N, Schmitt A, Formentini U, Weiss J, Appel H, Debatin KM, Fabricius D. Differential uptake of three clinically relevant allergens by human plasmacytoid dendritic cells. Clin Mol Allergy 2021; 19:23. [PMID: 34789269 PMCID: PMC8597288 DOI: 10.1186/s12948-021-00163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Human plasmacytoid dendritic cells (pDC) have a dual role as interferon-producing and antigen-presenting cells. Their relevance for allergic diseases is controversial. and the impact of pDC on allergic immune responses is poorly understood. Methods This in vitro study on human pDC isolated from peripheral blood was designed to compare side by side the uptake of three clinically relevant representative allergens: fluorochrome-labeled house dust mite Der p 1, Bee venom extract from Apis mellifera (Api) and the food allergen OVA analyzed flow cytometry and confocal microscopy. Results We found that the internalization and its regulation by TLR9 ligation was significantly different between allergens in terms of time course and strength of uptake. Api and OVA uptake in pDC of healthy subjects was faster and reached higher levels than Der p 1 uptake. CpG ODN 2006 suppressed OVA uptake and to a lesser extent Der p 1, while Api internalization was not affected. All allergens colocalized with LAMP1 and EEA1, with Api being internalized particularly fast and reaching highest intracellular levels in pDC. Of note, we could not determine any specific differences in antigen uptake in allergic compared with healthy subjects. Conclusions To our knowledge this is the first study that directly compares uptake regulation of clinically relevant inhalative, injective and food allergens in pDC. Our findings may help to explain differences in the onset and severity of allergic reactions as well as in the efficiency of AIT. Supplementary Information The online version contains supplementary material available at 10.1186/s12948-021-00163-8.
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Affiliation(s)
- Noelle Zurmühl
- Department of Pediatrics, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Anna Schmitt
- Department of Pediatrics, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Ulrike Formentini
- Department of Pediatrics, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Johannes Weiss
- Department of Dermatology and Allergic Diseases, University Medical Center Ulm, Ulm, Germany
| | - Heike Appel
- Department of Otolaryngology, Ulm University, Ulm, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Dorit Fabricius
- Department of Pediatrics, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany.
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Tversky J, Lane AP, Azar A. Benralizumab effect on severe chronic rhinosinusitis with nasal polyps (CRSwNP): A randomized double-blind placebo-controlled trial. Clin Exp Allergy 2021; 51:836-844. [PMID: 33595845 DOI: 10.1111/cea.13852] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) can be a severe and debilitating disease associated with significant morbidity, loss of smell, sinus pressure and asthma exacerbations. Eosinophils play a role in the majority (85%) of patients. Benralizumab, an afucosylated monoclonal antibody directed against the IL-5 receptor, has powerful apoptotic effects on eosinophils. OBJECTIVE We sought to investigate the therapeutic benefit of inhibiting the IL-5 receptor using benralizumab to treat severe rhinosinusitis with nasal polyps. METHODS Patients with severe NP (defined by endoscopic grade 5 or more out of 8) with elevated eosinophils and a history of previous surgical or endoscopic polypectomy met entry criteria and were randomized in a double-blind fashion to receive 30 mg benralizumab SC or placebo. Endoscopic NP score was assessed at baseline and at treatment week 20. CT scan, SNOT-22 survey and UPSIT smell test score changes were also evaluated. RESULTS Thirty-three patients were screened, and twenty-four (n = 24) were enrolled in the study. Compared with baseline, benralizumab significantly improved NP score (-0.9 ± 0.2, P = 0.004) whereas placebo did not (-0.3 ± 0.3, P = 0.166). Benralizumab induced polyp size reduction compared with placebo did not reach statistical significance (P = 0.103). Five of 12 benralizumab-treated patients (42%) had improvements in all major outcomes (polyp score, CT, SNOT-22 and smell test) versus 2 out of 12 placebo (17%). The ratio of blood eosinophil count to allergen skin test positivity correlated with polyp reduction. CONCLUSION Benralizumab was well-tolerated and compared with baseline achieved a statistically significant reduction in nasal polyp size, sinus occupancy, symptoms and improved sensation of smell for most patients (83%).
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Affiliation(s)
- Jody Tversky
- The Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew P Lane
- The Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Antoine Azar
- The Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jones AC, Anderson D, Troy NM, Mallon D, Hartmann R, Serralha M, Holt B, Bosco A, Holt PG. Rewiring of gene networks underlying mite allergen-induced CD4 + Th-cell responses during immunotherapy. Allergy 2020; 75:2330-2341. [PMID: 32181882 DOI: 10.1111/all.14265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/23/2020] [Accepted: 02/10/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Multiple regulatory mechanisms have been identified employing conventional hypothesis-driven approaches as contributing to allergen-specific immunotherapy outcomes, but understanding of how these integrate to maintain immunological homeostasis is incomplete. OBJECTIVE To explore the potential for unbiased systems-level gene co-expression network analysis to advance understanding of immunotherapy mechanisms. METHODS We profiled genome-wide allergen-induced Th-cell responses prospectively during 24 months subcutaneous immunotherapy (SCIT) in 25 rhinitis, documenting changes in immunoinflammatory pathways and associated co-expression networks and their relationships to symptom scores out to 36 months. RESULTS Prior to immunotherapy, mite-induced Th-cell response networks involved multiple discrete co-expression modules including those related to Th2-, type1 IFN-, inflammation- and FOXP3/IL2-associated signalling. A signature comprising 109 genes correlated with symptom scores, and these mapped to cytokine signalling/T-cell activation-associated pathways, with upstream drivers including hallmark Th1/Th2- and inflammation-associated genes. Reanalysis after 3.5 months SCIT updosing detected minimal changes to pathway/upstream regulator profiles despite 32.5% symptom reduction; however, network analysis revealed underlying merging of FOXP3/IL2-with inflammation-and Th2-associated modules. By 12 months SCIT, symptoms had reduced by 41% without further significant changes to pathway/upstream regulator or network profiles. Continuing SCIT to 24 months stabilized symptoms at 47% of baseline, accompanied by upregulation of the type1 IFN-associated network module and its merging into the Th2/FOXP3/IL2/inflammation module. CONCLUSIONS Subcutaneous immunotherapy stimulates progressive integration of mite-induced Th cell-associated Th2-, FOXP3/IL2-, inflammation- and finally type1 IFN-signalling subnetworks, forming a single highly integrated co-expression network module, maximizing potential for stable homeostatic control of allergen-induced Th2 responses via cross-regulation. Th2-antagonistic type1 IFN signalling may play a key role in stabilizing clinical effects of SCIT.
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Affiliation(s)
- Anya C. Jones
- Telethon Kids Institute The University of Western Australia Perth WA Australia
| | - Denise Anderson
- Telethon Kids Institute The University of Western Australia Perth WA Australia
| | - Niamh M. Troy
- Telethon Kids Institute The University of Western Australia Perth WA Australia
- School of Medicine The University of Western Australia Perth WA Australia
| | - Dominic Mallon
- Department of Clinical Immunology Fiona Stanley Hospital Perth WA Australia
| | - Rochelle Hartmann
- Department of Clinical Immunology Fiona Stanley Hospital Perth WA Australia
| | - Michael Serralha
- Telethon Kids Institute The University of Western Australia Perth WA Australia
| | - Barbara Holt
- Telethon Kids Institute The University of Western Australia Perth WA Australia
| | - Anthony Bosco
- Telethon Kids Institute The University of Western Australia Perth WA Australia
| | - Patrick G. Holt
- Telethon Kids Institute The University of Western Australia Perth WA Australia
- Child Health Research Centre The University of Queensland Brisbane QLD Australia
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Gow DJ, Jackson H, Forsythe P, Gow AG, Mellanby RJ, Hume DA, Nuttall T. Measurement of serum macrophage migration inhibitory factor (MIF) and correlation with severity and pruritus scores in client owned dogs with atopic dermatitis. Vet Dermatol 2019; 30:115. [PMID: 30672038 DOI: 10.1111/vde.12721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory skin disease of dogs. Macrophage migration inhibitory factor (MIF) initiates pro-inflammatory cytokine release in human AD and serum concentrations are correlated with disease severity. HYPOTHESIS Canine serum MIF concentrations are increased in dogs with AD and correlate with clinical lesion and pruritus scores. ANIMALS Client owned dogs (n = 49) diagnosed with AD and 17 healthy, unaffected control dogs were used for the study. METHODS AND MATERIALS A commercially available MIF ELISA was optimized for the dog and serum from clinical cases used. Information regarding treatment, Canine Atopic Dermatitis Extent and Severity Index, (CADESI-4) and pruritus Visual Analog Scale (pVAS) were recorded for each dog at the time of serum collection. RESULTS Dogs with AD which had not received steroid therapy and those treated with oclacitinib had significantly elevated serum MIF concentrations compared to controls. Concentrations of MIF were not significantly different in AD dogs receiving steroids compared to controls. There was no significant correlation between MIF concentrations and clinical scores (CADESI-4 or pVAS). CONCLUSIONS AND CLINICAL IMPORTANCE Serum MIF concentrations are increased in dogs with AD and MIF might be a target for therapy.
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Affiliation(s)
- Debbie J Gow
- R(D)SVS and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Edinburgh, EH25 9RG, Scotland, UK
| | - Hilary Jackson
- The Dermatology Referral Service Ltd, 528 Paisley Road West, Glasgow, G51 1RN, Scotland, UK
| | - Peter Forsythe
- The Dermatology Referral Service Ltd, 528 Paisley Road West, Glasgow, G51 1RN, Scotland, UK
| | - Adam G Gow
- R(D)SVS and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Edinburgh, EH25 9RG, Scotland, UK
| | - Richard J Mellanby
- R(D)SVS and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Edinburgh, EH25 9RG, Scotland, UK
| | - David A Hume
- R(D)SVS and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Edinburgh, EH25 9RG, Scotland, UK
- Mater Research Institute, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Tim Nuttall
- R(D)SVS and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Edinburgh, EH25 9RG, Scotland, UK
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Sousa L, Martín-Sierra C, Pereira C, Loureiro G, Tavares B, Pedreiro S, Martinho A, Paiva A. Subcutaneous immunotherapy induces alterations in monocytes and dendritic cells homeostasis in allergic rhinitis patients. Allergy Asthma Clin Immunol 2018; 14:45. [PMID: 30459816 PMCID: PMC6236941 DOI: 10.1186/s13223-018-0271-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023] Open
Abstract
Background Specific subcutaneous immunotherapy (SCIT) can achieve long-term remission in patients with allergic rhinitis (AR) through complex and still unknown mechanisms. The aim of this study is to evaluate the effect of SCIT over CD16+ and CD16− monocytes, myeloid (mDCs) and plasmacytoid dendritic cells (pDCs) in patients with AR, comparatively to pharmacological standard treatment (non-SIT). Methods The relative frequency and absolute number of monocytes and DC subsets, the frequency of these cells producing TNFα after in vitro stimulation with Dermatophagoides pteronyssinus (Dpt) extract, and the expression levels of receptor-bound IgE or IgG were assessed by flow cytometry, in peripheral blood samples from 23 healthy individuals (HG) and 43 participants with AR mono-sensitized to Dpt; 10 with non-SIT treatment and 33 under SCIT, just before (SCIT-T0) and 4 h after administration (SCIT-T4). Moreover, IFNα mRNA expression was evaluated in purified pDCs, by qRT-PCR. Results After SCIT administration we observed a strong decrease of circulating pDCs, although accompanied by higher levels of IFNα mRNA expression, and an increase of circulating CD16+ monocytes. AR participants under SCIT exhibited a higher expression of receptor-bound IgE in all cell populations that expressed the high affinity receptor for IgE (FcεRI) and a higher frequency of CD16+ monocytes producing TNFα. Conversely, we observed a decrease in the frequency of mDCs producing TNFα in AR under SCIT, similar to the observed in the control group. Conclusions SCIT seems to induce numeric, phenotypic, and functional changes in circulating monocytes and dendritic cells, contributing at least in part to the well described immunological alterations induced by this type of immunotherapy.
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Affiliation(s)
- Letícia Sousa
- 1Stemlab, S.A, Biocant Park, Núcleo 4, Lote 2, Cantanhede, Portugal
| | - Carmen Martín-Sierra
- 2Flow Cytometry Unit, Clinical Pathology Service, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Ed. S. Jerónimo, 3° piso, 30001-301 Coimbra, Portugal
| | - Celso Pereira
- 3Immunoallergology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Graça Loureiro
- 3Immunoallergology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Beatriz Tavares
- 3Immunoallergology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Susana Pedreiro
- 2Flow Cytometry Unit, Clinical Pathology Service, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Ed. S. Jerónimo, 3° piso, 30001-301 Coimbra, Portugal
| | - António Martinho
- Portuguese Institute of Blood and Transplantation, Coimbra, Portugal
| | - Artur Paiva
- 2Flow Cytometry Unit, Clinical Pathology Service, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Ed. S. Jerónimo, 3° piso, 30001-301 Coimbra, Portugal.,5CIMAGO-Center of Investigation on Environment Genetics and Oncobiology, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Jordakieva G, Jensen-Jarolim E. The impact of allergen exposure and specific immunotherapy on circulating blood cells in allergic rhinitis. World Allergy Organ J 2018; 11:19. [PMID: 30128065 PMCID: PMC6092783 DOI: 10.1186/s40413-018-0197-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/10/2018] [Indexed: 12/21/2022] Open
Abstract
Allergic rhinitis (AR) is an IgE-mediated inflammatory disease of the nasal mucosa with well described local immune responses during allergen exposure. The frequent association of AR with general extra-nasal symptoms and other allergic conditions, such as conjunctivitis and asthma, however, support a more systemic disease impact. In addition to acute elevation of soluble inflammatory mediators in periphery blood, a growing number of studies have reported changes in circulating blood cells after specific nasal allergen challenge or environmental allergen exposure. These findings imply an involvement of specific blood leukocyte subsets, thrombocytes and recently, erythrocytes. This review summarizes the circulating blood cell dynamics associated with allergen exposure in AR subjects reported so far. Additionally, the impact of therapy, particularly allergen-specific immunotherapy (AIT), the only currently available causal treatment reducing AR-related symptoms, is further considered in this context.
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Affiliation(s)
- Galateja Jordakieva
- 1Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Spitalgasse 23, Vienna, 1090 Austria
| | - Erika Jensen-Jarolim
- 2Department of Pathophysiology and Allergy Research, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria.,The interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, University of Vienna, Veterinaerplatz 1, Vienna, 1210 Austria.,AllergyCare, Allergy Diagnosis and Study Center Vienna, Vienna, Austria
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Virtanen T. Immunotherapy for pet allergies. Hum Vaccin Immunother 2018; 14:807-814. [PMID: 29182437 PMCID: PMC5893203 DOI: 10.1080/21645515.2017.1409315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/27/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022] Open
Abstract
Allergic diseases compose a serious challenge for modern societies. Their individual, medical and economical burden is large. As humans spend most of their time indoors, exposure to indoor allergens is a significant contributor to the development of allergic sensitization and respiratory allergies, such as allergic rhinoconjunctivitis and asthma. One important source of indoor allergens are pets, in particular cats and dogs. Allergens from these and other mammals spread effectively and they are encountered widely in public places. If patient education, allergen avoidance and pharmacotherapy do not suffice for controlling the symptoms of pet allergy, allergen immunotherapy can be a treatment option. Current information on allergen immunotherapy in pet allergy suggests that it can be effective in reducing allergic symptoms. However, the low number of high-quality randomized controlled trials of allergen immunotherapy in pet allergy warrants for further investigations.
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Affiliation(s)
- Tuomas Virtanen
- University of Eastern Finland, School of Medicine, Institute of Clinical Medicine, Department of Clinical Microbiology, Kuopio, Finland
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Immunomodulatory Effects of Adjuvants CPG, MPLA, and BCG on the Derp2-Induced Acute Asthma at Early Life in an Animal Model of BALB/c Mice. Inflammation 2017; 40:259-274. [PMID: 27896542 DOI: 10.1007/s10753-016-0476-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Th1- and Treg cell-related immune responses play key roles in the modulation of Th2 cell-related allergic disorders. The aim was to evaluate the effects of CPG, MPLA, and BCG on the number of Th1-, Th2-, and Treg cell-related parameters in an animal model of asthma. BALB/c mice were divided into five groups and immunized subcutaneously (SC) on days 1, 15, and 22 with allergen Derp2. Three groups of mice were pretreated SC on days 0, 14, and 21 with CPG, CPG + MPLA, or CPG + BCG. All mice were then challenged intranasally with Derp2 on days 28-37. Blood samples were collected from the retro-orbital sinus, on days 0, 23, and 40. The serum levels of IL-4, IFN-γ, IgE, and IgG2a were measured using ELISA technique. The blood number of Th1 and Treg cells was determined using flow cytometry. At the sensitization phase, the number of Th1 and the serum levels of IFN-γ and IgG2a were significantly increased in the Derp2-sensitized group pretreated with CPG plus MPLA, and the number of Treg cells was significantly elevated in Derp2-sensitized mice pretreated with CPG or CPG plus MPLA as compared with that in Derp2-sensitized control mice. At the challenge phase, the number of Th1 was significantly elevated in Derp2-sensitized mice pretreated with CPG plus MPLA, CPG plus BCG, or CPG; the count of Treg cells was significantly increased in Derp2-sensitized mice pretreated with CPG plus BCG group; and the levels of IFN-γ and IgG2a were significantly enhanced in the Derp2-sensitized group pretreated with CPG plus MPLA in comparison with those in Derp2-sensitized control mice. The scores of inflammation and mucus secretion in the lung were significantly decreased in the Derp2-sensitized group pretreated with CPG, BCG, and CPG plus MPLA in comparison with those in the Derp2-sensitized control group. These results showed that BCG, MPLA, and CPG modulate Th1-, Th2-, and Treg-related parameters and ameliorate lung inflammatory parameters in a mouse model of asthma.
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Gorelik M, Frischmeyer-Guerrerio PA. Innate and adaptive dendritic cell responses to immunotherapy. Curr Opin Allergy Clin Immunol 2016; 15:575-80. [PMID: 26509662 DOI: 10.1097/aci.0000000000000213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW In allergic disease, dendritic cells play a critical role in orchestrating immune responses to innate stimuli and promoting the formation of T helper 2 (TH2) effector versus T-regulatory cells. Here, we review recent advances in our understanding of how current forms of immunotherapy modulate dendritic cell responses. (Figure is included in full-text article.) RECENT FINDINGS Sublingual immunotherapy (SLIT) and oral immunotherapy (OIT) for peanut allergy alter the expression of costimulatory molecules on dendritic cells, which leads to reduced expression of TH2 effector cytokines in an antigen-nonspecific manner. SLIT and OIT also modulate dendritic cell innate immune responses to Toll-like receptor agonists, including enhanced production of interferon α and reduced expression of proinflammatory cytokines that may serve to promote the development of tolerance. Dendritic cells isolated from patients post-OIT promoted hypomethylation of the FOXP3 locus in effector T cells. Reduced methylation of the FOXP3 locus has been associated with more persistent clinical desensitization following OIT. Recent studies have additionally highlighted a role for B cells in inducing tolerogenic dendritic cell populations and T-regulatory cells during immunotherapy. Epicutaneous immunotherapy may also elicit immunosuppressive populations of cutaneous dendritic cells, although in some cases, antigen exposure through the skin can lead to sensitization. Finally, efforts have focused on identifying pharmacologic and/or antigen-independent strategies of altering dendritic cell function to enhance the immunosuppressive effects of immunotherapy. SUMMARY Dendritic cells are a critical target of immunotherapy. Alterations in both adaptive and innate immunity likely underlie the immunosuppressive effects of this treatment.
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Affiliation(s)
- Mark Gorelik
- aDepartment of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore bLaboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
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Frischmeyer-Guerrerio PA, Keet CA, Guerrerio AL, Chichester KL, Bieneman AP, Hamilton RG, Wood RA, Schroeder JT. Modulation of dendritic cell innate and adaptive immune functions by oral and sublingual immunotherapy. Clin Immunol 2014; 155:47-59. [PMID: 25173802 DOI: 10.1016/j.clim.2014.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/16/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
Sublingual (SLIT) and oral immunotherapy (OIT) are promising treatments for food allergy, but underlying mechanisms are poorly understood. Dendritic cells (DCs) induce and maintain Th2-type allergen-specific T cells, and also regulate innate immunity through their expression of Toll-like receptors (TLRs). We examined how SLIT and OIT influenced DC innate and adaptive immune responses in children with IgE-mediated cow's milk (CM) allergy. SLIT, but not OIT, decreased TLR-induced IL-6 secretion by myeloid DCs (mDCs). SLIT and OIT altered mDC IL-10 secretion, a potent inhibitor of FcεRI-dependent pro-inflammatory responses. OIT uniquely augmented IFN-α and decreased IL-6 secretion by plasmacytoid DCs (pDCs), which was associated with reduced TLR-induced IL-13 release in pDC-T cell co-cultures. Both SLIT and OIT decreased Th2 cytokine secretion to CM in pDC-T, but not mDC-T, co-cultures. Therefore, SLIT and OIT exert unique effects on DC-driven innate and adaptive immune responses, which may inhibit allergic inflammation and promote tolerance.
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Affiliation(s)
- Pamela A Frischmeyer-Guerrerio
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Corinne A Keet
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Anthony L Guerrerio
- Division of Gastroenterology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kristin L Chichester
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Anja P Bieneman
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Robert G Hamilton
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Robert A Wood
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - John T Schroeder
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Aryan Z, Holgate ST, Radzioch D, Rezaei N. A new era of targeting the ancient gatekeepers of the immune system: toll-like agonists in the treatment of allergic rhinitis and asthma. Int Arch Allergy Immunol 2014; 164:46-63. [PMID: 24853609 DOI: 10.1159/000362553] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Toll-like receptors (TLR) belong to a large family of pattern recognition receptors known as the ancient 'gatekeepers' of the immune system. TLRs are located at the first line of defense against invading pathogens as well as aeroallergens, making them interesting targets to modulate the natural history of respiratory allergy. Agonists of TLRs have been widely employed in therapeutic or prophylactic preparations useful for asthma/allergic rhinitis (AR) patients. MPL® (a TLR4 agonist) and the CpG oligodeoxynucleotide of 1018 ISS, a TLR9 agonist, show strong immunogenicity effects that make them appropriate adjuvants for allergy vaccines. Targeting the TLRs can enhance the efficacy of specific allergen immunotherapy, currently the only available 'curative' treatment for respiratory allergies. In addition, intranasal administration of AZD8848 (a TLR7 agonist) and VTX-1463 (a TLR8 agonist) as stand-alone therapeutics have revealed efficacy in the relief of the symptoms of AR patients. No anaphylaxis has been so far reported with such compounds targeting TLRs, with the most common adverse effects being transient and local irritation (e.g. redness, swelling and pruritus). Many other compounds that target TLRs have been found to suppress airway inflammation, eosinophilia and airway hyper-responsiveness in various animal models of allergic inflammation. Indeed, in the future a wide variability of TLR agonists and even antagonists that exhibit anti-asthma/AR effects are likely to emerge.
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Affiliation(s)
- Zahra Aryan
- Molecular Immunology Research Center and Department of Immunology, School of Medicine, Tehran, Iran
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Frischmeyer-Guerrerio PA, Schroeder JT. Cellular immune response parameters that influence IgE sensitization. J Immunol Methods 2012; 383:21-9. [PMID: 22245389 DOI: 10.1016/j.jim.2011.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/07/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
Abstract
In vitro basophil responses have long been used in mechanistic studies to help assess the human allergic diathesis, particularly during therapeutic intervention. Recent evidence points to the use of dendritic cells (DCs) in also being valuable in evaluating therapies aimed at lessening disease through immunomodulation. This review article therefore takes a look at some of the recent advances in old and new assays employing both basophils and DCs, with the added perception that the responses mediated by two cell types are insightful towards understanding immune cell mechanisms underlying allergic disease.
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Affiliation(s)
- Pamela A Frischmeyer-Guerrerio
- The Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins Children's Hospital, Johns Hopkins University, USA
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Lange NE, Zhou X, Lasky-Su J, Himes BE, Lazarus R, Soto-Quirós M, Avila L, Celedón JC, Hawrylowicz CM, Raby BA, Litonjua AA. Comprehensive genetic assessment of a functional TLR9 promoter polymorphism: no replicable association with asthma or asthma-related phenotypes. BMC MEDICAL GENETICS 2011; 12:26. [PMID: 21324137 PMCID: PMC3048492 DOI: 10.1186/1471-2350-12-26] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 02/15/2011] [Indexed: 12/27/2022]
Abstract
Background Prior studies suggest a role for a variant (rs5743836) in the promoter of toll-like receptor 9 (TLR9) in asthma and other inflammatory diseases. We performed detailed genetic association studies of the functional variant rs5743836 with asthma susceptibility and asthma-related phenotypes in three independent cohorts. Methods rs5743836 was genotyped in two family-based cohorts of children with asthma and a case-control study of adult asthmatics. Association analyses were performed using chi square, family-based and population-based testing. A luciferase assay was performed to investigate whether rs5743836 genotype influences TLR9 promoter activity. Results Contrary to prior reports, rs5743836 was not associated with asthma in any of the three cohorts. Marginally significant associations were found with FEV1 and FVC (p = 0.003 and p = 0.008, respectively) in one of the family-based cohorts, but these associations were not significant after correcting for multiple comparisons. Higher promoter activity of the CC genotype was demonstrated by luciferase assay, confirming the functional importance of this variant. Conclusion Although rs5743836 confers regulatory effects on TLR9 transcription, this variant does not appear to be an important asthma-susceptibility locus.
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Affiliation(s)
- Nancy E Lange
- Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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