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Castro-Almarales RL, Ronquillo-Díaz M, Álvarez-Castelló M, Rodríguez-Canosa J, González-León M, Enríquez-Domínguez I, Navarro-Viltre BI, Mateo-Morejón M, Oliva-Díaz Y, Ramírez-González W, Cox L, Labrada-Rosado A. Subcutaneous allergen immunotherapy for asthma: A randomized, double-blind, placebo-controlled study with a standardized Blomia tropicalis vaccine. World Allergy Organ J 2020; 13:100098. [PMID: 32308779 PMCID: PMC7155230 DOI: 10.1016/j.waojou.2020.100098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sensitization to Blomia tropicalis (Bt) is very frequent in the tropics, and particularly in Cuba, being a significant cause of allergic asthma. Allergen immunotherapy (AIT) with Bt can be a therapeutic option, however, placebo-controlled clinical trials have not been reported. OBJECTIVE To assess the therapeutic effect and safety of AIT for asthma using a standardized allergen vaccine of B. tropicalis by subcutaneous route, in allergic asthmatic patients exposed and sensitized to this mite species. METHODS A double-blind, placebo-controlled Phase II trial was conducted in 35 adults (18 with treatment and 17 with placebo), with mild to moderate asthma, predominantly sensitized to Bt. AIT was administered subcutaneously in increasing doses from 4 to 6000 Biological Units using a locally manufactured standardized extract (BIOCEN, Cuba). Patient assessment was performed using symptom-medication score (SMS), peak expiratory flow and skin reactivity relative to Histamine as measured by skin prick test (SPT). RESULTS The 12-month treatment achieved a significant (p < 0.001) decrease of SMS. Symptom score showed only 41% (CI: 26-61) of placebo values, whereas medication was 34.5% (22.4%-63.3%). Treatment was regarded clinically effective in 67% of patients (OR 32; 95%CI: 17 to 102). The effect size on symptoms and medication was higher than has been reported with equivalent allergen dosages of D. pteronyssinus and D. siboney in Cuban asthmatic patients. Skin reactivity to Bt was also significantly reduced (p = 0.0001), increasing 148-fold the allergen threshold to elicit a positive skin test. This desensitization effect was specific to Bt and did not modify the reactivity to Dermatophagoides. The change of specific skin reactivity was significantly (p < 0.05) correlated to clinical improvement. All adverse events were local with a frequency of 2.4% of injections. CONCLUSIONS Subcutaneous AIT with Blomia tropicalis was effective and safe in asthmatic adults exposed and sensitized to this mite species in a tropical environment. TRIAL REGISTRATION Cuban Public Registry of Clinical Trials: RPCEC00000026 (WHO International Clinical Trial Registry Platform ICTRP).
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Key Words
- AIT, Allergen immunotherapy
- ALK, Denmark-based pharmaceutical company
- BIOCEN, National Center of Bioproducts
- BU, Biological Units
- BU/mL, Biological units per milliliter
- Blo t, Mayor allegen of Blomia tropicalis
- Blomia tropicalis
- Bt, Blomia tropicalis or B. tropicalis
- CECMED, Center for State Control of Drugs, Equipment and Medical Devices
- Ch10, Allergen specific reactivity calculated relative to the Histamine HC 10 mg/mL
- Clinical trial
- Dp or D, pteronyssinus: Dermatophagoides pteronyssinus
- Ds or D, siboney: Dermatophagoides siboney
- HDM SCIT, Immunotherpy Subcutaneous with allergens of House Dust Mite
- HDM, House Dust Mite
- OCI, Overall clinical improvement
- PEF, Peak Expiratory Flow
- SM, Symptom and Medication
- SMD, Standard Mean Difference
- Standardized allergen extract
- Subcutaneous immunotherapy
- VALERGEN-BT, Standardized allergen extract of Blomia tropicalis
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Affiliation(s)
- Raúl Lázaro Castro-Almarales
- Second Degree Specialist in Allergy and Integral General Medicine, Master in Transmissible Diseases, Auxiliary Professor, “General Calixto García” University Hospital, Havana University of Medical Science. Auxiliary Researcher, National Center of Bioproducts, Bejucal, Mayabeque, Cuba
| | - Mercedes Ronquillo-Díaz
- Second Degree Specialist in Allergy, Master in Occupational Health, Auxiliary Professor, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - Mirta Álvarez-Castelló
- Second Degree Specialist in Allergy, Auxiliary Professor and Researcher, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - José Rodríguez-Canosa
- Second Degree Specialist in Allergy, Master in Transmissible Diseases, Auxiliary Professor, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - Mayda González-León
- Second Degree Specialist in Integral General Medicine, Master in Natural and Traditional Medicine, Teaching Polyclinic “Pedro Fonseca Álvarez”, Havana, Cuba
| | - Irene Enríquez-Domínguez
- First Degree Specialist in Allergy and Integral General Medicine, Master in Child Integral Care, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana, Cuba
| | | | - Maytee Mateo-Morejón
- Master in Biotechnology, National Center of Bioproducts, Allergens Department, Bejucal, Mayabeque, Cuba
| | - Yunia Oliva-Díaz
- National Center of Bioproducts, Allergen Department, Bejucal, Mayabeque, Cuba
| | - Wendy Ramírez-González
- Master in Biochemistry, National Center of Bioproducts, Allergens Department, Bejucal, Mayabeque, Cuba
| | - Linda Cox
- Allergy & Asthma Center, Fort Lauderdale, Florida, USA
| | - Alexis Labrada-Rosado
- Full Researcher, Research and Development Director, National Center of Bioproducts, Bejucal, Mayabeque, Cuba
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Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, Sánchez-Borges M, Hossny E, García E, Rosario N, Ansotegui I, Puerta L, Sánchez J, Cardona V. Particularities of allergy in the Tropics. World Allergy Organ J 2016; 9:20. [PMID: 27386040 PMCID: PMC4924335 DOI: 10.1186/s40413-016-0110-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/25/2016] [Indexed: 12/27/2022] Open
Abstract
Allergic diseases are distributed worldwide and their risk factors and triggers vary according to geographical and socioeconomic conditions. Allergies are frequent in the Tropics but aspects of their prevalence, natural history, risk factors, sensitizers and triggers are not well defined and some are expected to be different from those in temperate zone countries. The aim of this review is to investigate if allergic diseases in the Tropics have particularities that deserve special attention for research and clinical practice. Such information will help to form a better understanding of the pathogenesis, diagnosis and management of allergic diseases in the Tropics. As expected, we found particularities in the Tropics that merit further study because they strongly affect the natural history of common allergic diseases; most of them related to climate conditions that favor permanent exposure to mite allergens, helminth infections and stinging insects. In addition, we detected several unmet needs in important areas which should be investigated and solved by collaborative efforts led by the emergent research groups on allergy from tropical countries.
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Affiliation(s)
- Luis Caraballo
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Josefina Zakzuk
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Bee Wah Lee
- />Khoo Teck Puat- National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- />Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nathalie Acevedo
- />Department of Medicine Solna, Karolinska Institutet, Translational Immunology Unit, Stockholm, Sweden
| | - Jian Yi Soh
- />Khoo Teck Puat- National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- />Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mario Sánchez-Borges
- />Allergy and Clinical Immunology Department, Centro Médico- Docente La Trinidad and Clínica El Avila, Caracas, Venezuela
| | - Elham Hossny
- />Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, Egypt
| | - Elizabeth García
- />Allergy Section, Fundación Santa Fe de Bogotá, Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Nelson Rosario
- />Federal University of Parana, Rua General Carneiro, Curitiba, Brazil
| | - Ignacio Ansotegui
- />Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bilbao, Spain
| | - Leonardo Puerta
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Jorge Sánchez
- />Department of Pediatrics, Graduate Program on Allergology, University of Antioquia, Medellín, Colombia
| | - Victoria Cardona
- />Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
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New Allergens of Relevance in Tropical Regions: The Impact of Ascaris lumbricoides Infections. World Allergy Organ J 2013; 4:77-84. [PMID: 23282442 PMCID: PMC3651106 DOI: 10.1097/wox.0b013e3182167e04] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
One of the many aspects of the relationships between parasite infections and allergic diseases is the possibility that allergens from parasites enhance the TH2 responses, especially IgE production, in allergic diseases such as asthma. In this review we discuss about the allergenic composition of the nematode Ascaris lumbricoides and their potential impact on allergy sensitization and asthma pathogenesis and prevalence in populations living in the tropics and naturally exposed to both, mite allergens and helminth infections.
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Vergara C, Jiménez S, Acevedo N, Martínez B, Mercado D, Gusmão L, Rafaels N, Hand T, Barnes KC, Caraballo L. Association of G-protein-coupled receptor 154 with asthma and total IgE in a population of the Caribbean coast of Colombia. Clin Exp Allergy 2009; 39:1558-68. [PMID: 19624525 DOI: 10.1111/j.1365-2222.2009.03311.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND G protein-coupled receptor 154 was described as an asthma susceptibility gene by positional cloning. It has been subsequently associated with asthma and other inflammatory diseases in several populations with different ethnic origin. Replication of associations adds reliability to these findings. OBJECTIVE To analyze the association of G protein-coupled receptor 154 with asthma and total and mite-specific IgE levels in a population of the Caribbean Coast of Colombia. METHODS We genotyped seven single nucleotide proteins (SNPs) in GPR154 in 475 asthmatics, 394 controls and 116 families from Cartagena, Colombia using either SnaPshot or TaqMan. Total and specific IgE against Blomia tropicalis and Dermatophagoides pteronyssinus were determined by ELISA. Hardy-Weinberg equilibrium was assessed and case-control and family-based analyses were performed to evaluate the association between the SNPs and their haplotypes and asthma and IgE. Association analyses in the case-control dataset were corrected by population stratification using 52 ancestry informative markers. RESULTS Allelic distribution was similar to that described in other populations. Two SNPs were associated with the same direction of the effect in both datasets. Allele A of Hopo546333 was protective for asthma (case-control OR: 0.42; 95% CI: 0.17-0.99, P=0.042; P=0.043; families Z score=-2,236; P=0.025). Similarly, allele C of rs740347 conferred low risk for asthma (OR: 0.44; 95% CI: 0.28-0.70, P=0.00017; Pc=0.00037) and total IgE (OR: 0.29; 95% CI: 0.09-0.88, P=0.015; Pc=0.030) in the case-control study and families (Z score=-3.207, P=0.0013; Z score=-3.182, P=0.0014, respectively). Haplotype CCAGGT was associated with total IgE (OR: 1.76; 95% CI: 1.14-2.71, P=0.006, Pc=0.007) in the case-controls group and CGCGGT with both phenotypes (P=0.044 and P=0.032, respectively) in families. Neither SNPs nor haplotypes were associated with levels of mite-specific IgE. CONCLUSIONS Our findings in a sample of asthmatics from Colombia suggest a relevant role of G protein-coupled receptor 154 in the pathogenesis of asthma and allergy.
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Affiliation(s)
- C Vergara
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
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Martínez B, Barrios K, Vergara C, Mercado D, Jiménez S, Gusmão L, Caraballo L. A NOS1 gene polymorphism associated with asthma and specific immunoglobulin E response to mite allergens in a Colombian population. Int Arch Allergy Immunol 2007; 144:105-13. [PMID: 17536218 DOI: 10.1159/000103221] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 03/14/2007] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nitric oxide (NO) is involved in asthma pathogenesis and is synthesized by three isoforms of NO synthase, one of them encoded by NOS1 gene. The CA-repeat and the C5266T SNP in NOS1 exon 29 have been associated with asthma and IgE levels. We thought to test the association of asthma and asthma-related phenotypes with the exon 29 CA-repeat and the C5266T SNP in a Colombian population sample. METHODS The CA-repeat and the C5266T SNP were genotyped in 167 asthmatics and 166 controls using PCR-based fragment length polymorphism and TaqMan assay. We also determined total and mite-specific IgE against Blomia tropicalis and Dermatophagoides pteronyssinus. RESULTS Three new CA-repeat alleles, 14, 23 and 24 repeats were detected. Allele comprising 16 repeats was associated with asthma (OR: 1.90 (CI 1.22-2.97, p(c) = 0.028) and low total (p(c) = 0.02) and specific IgE to B. tropicalis (p(c) < 0.0001) and D. pteronyssinus (p(c) < 0.0001). We found no association of the C5266T SNP and asthma or IgE levels. CONCLUSION NOS1 exon 29 CA-repeat may be a risk factor for asthma susceptibility and mite specific IgE response in a Colombian population.
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Affiliation(s)
- B Martínez
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
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FERRÁNDIZ R, CASAS R, DREBORG S. Purification and IgE binding capacity of Der s 3, a major allergen from Dermatophagoides siboney. Clin Exp Allergy 2006. [DOI: 10.1111/j.1365-2222.1997.tb01199.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pires MC, Calux MJF, Mori JC, Montealegre F. Reactivity of anti-Blomia tropicalis IgG and IgE in patients with atopic dermatitis. Clin Exp Dermatol 2002; 27:309-13. [PMID: 12139678 DOI: 10.1046/j.1365-2230.2002.01029.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with atopic dermatitis (AD) commonly develop antibodies of subclasses IgG and IgE to house dust mites, such as Dermatophagoides pteronyssinus and D. farinae. The domestic mite Blomia tropicalis is prevalent in Brazil and can cause the exacerbation of AD. The objectives of this study were to assess skin reactivity to B. tropicalis extracts of AD patients and a control group of nonallergic subjects, and to determine the in vitro reactivity of anti-B. tropicalis IgG and IgE in the serum of AD patients and a control group of nonallergic individuals. Subjects were 36 patients with confirmed AD and the controls were 25 nonallergic individuals. Skin sensitivity to B. tropicalis extracts was tested by the prick-test, and anti-B. tropicalis IgG reactivity in the serum was detected by the Western blot. Anti-B. tropicalis IgE reactivity in the serum was measured by RAST. Patients with AD reacted 7.12 times more often to extracts from B. tropicalis than the control group. A positive association was observed between the presence of anti-B. tropicalis IgG and IgE and AD. AD patients showed a high degree of sensitization to B. tropicalis; it can thus be considered a risk factor for the development of AD exacerbations in patients exposed to this mite species.
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Affiliation(s)
- M C Pires
- Hospital do Servidor Público Estadual de São Paulo, Complexo Hospitalar Padre Bento de Guarulhos, Faculdade de Medicina da Universidade de São Paulo, Rua Diana 183, 63, 05019-000 São Paulo, Brazil.
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García-Robaina JC, Eraso E, Martínez J, Martínez A, de la Torre Morin F, Hernández-Nieto L, Pineda-Algorta J, Guisantes J. Sensitization to Blomia kulagini in a general population of a subtropical region of Spain (Canary Islands). Allergy 1997; 52:727-31. [PMID: 9265987 DOI: 10.1111/j.1398-9995.1997.tb01229.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Blomia genus has been described as allergenic in man. The present study aimed to assess the prevalence of B. kulagini sensitization in a large population of allergic subjects without occupational exposure in a subtropical region (Canary Islands, Spain). Secondarily, a new standardized B. kulagini extract was evaluated. The study population comprised 207 patients. RAST for B. kulagini was positive in 76.2% of patients, and 47 of them were selected for the biologic standardization. When the prick test was performed with the nonstandardized extracts, results were positive in 76.6%, whereas when the test was repeated with the standardized extract, sensitivity rose to 95.7%. The conjunctival provocation test was positive in 78.3% of 46 evaluated patients. The bronchial provocation test was positive in 18 sensitized patients and negative in five controls. In conclusion, B. kulagini is an important cause of sensitization among the occupationally unexposed population of the studied area and should be included in allergy diagnostic tests. For reliable prick tests, the use of standardized extracts is mandatory.
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Affiliation(s)
- J C García-Robaina
- Allergy Unit, Complejo Hospitalario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
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