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Caimmi D, Demoly P. Recommandations pour la prescription de l’immunothérapie allergénique et le suivi du patient — Questions développées et revue de la littérature. REVUE FRANÇAISE D'ALLERGOLOGIE 2021. [DOI: 10.1016/j.reval.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Rodrigues J, Kuruvilla ME, Vanijcharoenkarn K, Patel N, Hom MM, Wallace DV. The spectrum of allergic ocular diseases. Ann Allergy Asthma Immunol 2020; 126:240-254. [PMID: 33276116 DOI: 10.1016/j.anai.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this article is to review the pathophysiologic mechanisms, differential diagnosis, evaluation, and treatment of the various manifestations of ocular allergy, with an especial focus on immunoglobulin E (IgE)-mediated disease. DATA SOURCES A PubMed search was performed to include articles, using the search terms ocular allergy and allergic conjunctivitis. STUDY SELECTIONS Recent and relevant human studies in the English language pertaining to our topic of study were selected. Animal studies pertaining to pathophysiology of ocular allergy were also reviewed. We focused on clinical trials, practice guidelines, reviews, and systematic reviews. In addition, case reports were reviewed if they described rare clinical presentations, disease mechanisms, or novel therapies. RESULTS Ocular allergy encompasses both IgE- and non-IgE-mediated disease, and the clinical severity may range from mild to sight-threatening inflammation. A comprehensive treatment regimen including education, lifestyle measures, topical therapies, and even systemic interventions may be necessary for the effective management of ocular allergies, tailored according to symptom severity. CONCLUSION Ocular allergy is frequently encountered by allergists and eye-care specialists, and despite progressively increasing incidence, it often remains underdiagnosed and, hence, untreated.
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Affiliation(s)
- Jonathan Rodrigues
- Allergy & Immunology, Sanford Health, Bismarck, North Dakota; Department of Internal Medicine and Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota.
| | - Merin E Kuruvilla
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kristine Vanijcharoenkarn
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nikki Patel
- Allergy & Immunology, Sanford Health, Sioux Falls, South Dakota
| | | | - Dana V Wallace
- Allergy and Immunology, Nova Southeastern University, Davie, Florida
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Alba P, Moreno V, Arias-Irigoyen J, Antón M, Parra A, Gómez-Fernández MC, Madariaga B, Martínez A, Begoña L. Safety evaluation of a multiallergen immunotherapy treatment in polyallergic patients. APOLO observational study. Immunotherapy 2020; 12:75-87. [PMID: 31902260 DOI: 10.2217/imt-2019-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: Assessment of safety, tolerability and changes in global clinical impression with an multiallergen immunotherapy treatment without dilutional effect in polyallergic patients. Patients & methods: This observational prospective study included patients with allergic rhinitis-rhinoconjunctivitis with or without asthma between 5 and 60 years old receiving immunotherapy treatment with a mixture of two allergenic sources. All adverse events were recorded. Global clinical impression, tolerability subjective assessment and satisfaction were also assessed. Results: 130 patients were analyzed. Nine clinically relevant local adverse reactions were reported in six patients (4.6%). Six systemic reactions (grades 0-I) occurred in four patients (3.1%). Patients improved significantly in their global clinical impression. Good tolerability subjective assessment and satisfaction values were also observed. Conclusion: This multiallergen immunotherapy treatment without dilutional effect can be considered as a potential therapeutic alternative for polyallergic patients suffering from allergic rhinitis.
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Affiliation(s)
- Pilar Alba
- Hospital de Manises. Allergy Department, Manises, Valencia, Spain
| | | | | | - Mónica Antón
- Department of Allergy, Hospital Universitario del Vinalopó. Elche, Alicante, Spain
| | - Antonio Parra
- Department of Allergy, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Begoña Madariaga
- R&D Department, ROXALL Medicina España S.A., Zamudio, Bizkaia, Spain
| | - Alberto Martínez
- R&D Department, ROXALL Medicina España S.A., Zamudio, Bizkaia, Spain
| | - Leire Begoña
- R&D Department, ROXALL Medicina España S.A., Zamudio, Bizkaia, Spain
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Novak N, Buhl T, Pfaar O. Adherence During Early Allergen Immunotherapy and Strategies to Motivate and Support Patients. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10312545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Allergic rhinitis is one of the most common chronic inflammatory conditions, affecting up to 30% of people in Europe. Allergen immunotherapy (AIT) is the only treatment for allergic rhinitis and asthma that has a disease-modifying effect, and it is recommended in European guidelines for use in conjunction with patient education, specific allergen avoidance, and symptomatic pharmacotherapy. Reported AIT adherence rates vary widely but are often low in real-world settings. Factors known to affect adherence are patient, treatment, or physician-related, and vary between healthcare settings. Misconceptions or a lack of AIT knowledge among patients with regard to efficacy and side effects may contribute to high rates of discontinuation observed during the first year of AIT treatment. Interventions to improve patient adherence are multifaceted and should focus on patient education, particularly the provision of accurate information regarding adverse effects of AIT and when to expect an improvement in symptoms, patient-support programmes, and the use of regular eHealth reminders via a telephone call, text message, or social media. Serum-based biomarkers also have the potential to play a role in evaluating early response to AIT and in monitoring treatment adherence in clinical practice. In this review, the authors explore barriers to continuation with AIT and discuss initiatives to motivate and support patients through the challenging early months of treatment, prior to the onset of clinical effect and when side effects are most common, to encourage long-term adherence to therapy and achieve optimal patient outcomes.
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University of Bonn Medical Center, Bonn, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Georg-August University, Göttingen, Germany; Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen and University of Osnabrück, Osnabrück, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
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Liedtke JP, Mandl A, Köther J, Chwieralski J, Shah-Hosseini K, Raskopf E, Pieper-Fürst U, Allekotte S, Mösges R. RCAT reflects symptom control and quality of life in allergic rhinoconjunctivitis patients. Allergy 2018; 73:1101-1109. [PMID: 29159975 DOI: 10.1111/all.13362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Global Allergy and Asthma European Network (GA2 LEN) Taskforce has requested more data on correlations between various patient-reported outcomes (PROs) in clinical trials on allergy. We compared three tools-the Rhinitis Control Assessment Test (RCAT), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Rhinitis Total Symptom Score (RTSS)-to determine whether the RCAT alone is a sufficient primary outcome parameter in clinical trials on allergic rhinoconjunctivitis. METHODS In two double-blind, placebo-controlled immunotherapy studies, 33 patients allergic to grass pollen and 94 to birch pollen completed two questionnaires (RCAT and RQLQ) and kept their own symptom diary from which the RTSS was calculated. RESULTS Upon comparing RCAT and RQLQ results, we found strong correlations of r = -0.871 for grass pollen-allergic patients and r = -0.795 for birch pollen-allergic patients. The comparison between RCAT and RTSS results showed a strong correlation of r = -0.811 (grass pollen-allergic patients) and a moderate correlation of r = -0.539 (birch pollen-allergic patients). In the RCAT, 69.7% of grass pollen-allergic patients and 45.7% of birch pollen-allergic patients receiving guideline-concordant therapy were regarded as having insufficiently controlled symptoms. CONCLUSION The strong correlations suggest that the RCAT alone is equivalent to the RQLQ with respect to patients' symptom control and quality of life. Patients with uncontrolled symptoms can be identified using the RCAT. Hence, the physician can decide whether symptomatic therapy can be intensified or allergy immunotherapy should be administered.
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Affiliation(s)
- J.-P. Liedtke
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - A. Mandl
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - J. Köther
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - J. Chwieralski
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - K. Shah-Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - E. Raskopf
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - U. Pieper-Fürst
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - S. Allekotte
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - R. Mösges
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
- CRI - Clinical Research International Limited; Hamburg Germany
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Dhami S, Nurmatov U, Arasi S, Khan T, Asaria M, Zaman H, Agarwal A, Netuveli G, Roberts G, Pfaar O, Muraro A, Ansotegui IJ, Calderon M, Cingi C, Durham S, Wijk RG, Halken S, Hamelmann E, Hellings P, Jacobsen L, Knol E, Larenas‐Linnemann D, Lin S, Maggina P, Mösges R, Oude Elberink H, Pajno G, Panwankar R, Pastorello E, Penagos M, Pitsios C, Rotiroti G, Timmermans F, Tsilochristou O, Varga E, Schmidt‐Weber C, Wilkinson J, Williams A, Worm M, Zhang L, Sheikh A. Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis. Allergy 2017; 72:1597-1631. [PMID: 28493631 DOI: 10.1111/all.13201] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis. METHODS We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses. RESULTS We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores. CONCLUSIONS AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.
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Langzeit-Effektivität einerspezifischen subkutanen, MPL-adjuvantierten Kurzzeit-Immuntherapie über drei Therapie- und drei Nachbeobachtungsjahre – gemessen an der Lebensqualität. ALLERGO JOURNAL 2017. [DOI: 10.1007/s15007-017-1392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rabe U, Altengarten J, Benke E, Erdmann A, Erdmann AP, Fiedler G, Hofmann S, Jasch B, Kallien U, Knuppe-Andree S, Lüdcke HJ, Lohse K, Piller M. Long-term efficacy of specific subcutaneous, short-term MPL adjuvant immunotherapy over three treatment and three follow-up years, as measured by quality of life. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40629-017-0029-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chivato T, Álvarez-Calderón P, Panizo C, Abengozar R, Alías C, Al-Baech A, Arias-Irigoyen J, Caballero MJ, Conill L, de Miguel S, Laguna R, Martínez-Benazet J, Matoses F, Martínez-Alonso JC, Mendizábal L, Pérez-Carral C, Puerto C, Serra-Batllés J, Vélez A, Vicente J, de la Torre F. Clinical management, expectations, and satisfaction of patients with moderate to severe allergic rhinoconjunctivitis treated with SQ-standardized grass-allergen tablet under routine clinical practice conditions in Spain. Clin Mol Allergy 2017; 15:1. [PMID: 28096738 PMCID: PMC5234098 DOI: 10.1186/s12948-016-0057-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/18/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sublingual immunotherapy has been proven as a well-tolerated and effective treatment for allergic rhinitis. Within this type of treatment, GRAZAX® is the most documented product in terms of safety and efficacy. The objective of this study was to identify the patients' expectations and level of treatment satisfaction, as well as the clinical management of patients with moderate/severe allergic rhinoconjunctivitis treated with GRAZAX®. METHODS This was a non-interventional, observational, multi-centre, open-label study involving a total of 131 adult patients aged 18-66 years with confirmed diagnosis of grass-allergy and initiated treatment with GRAZAX® between June 2010 and April 2011. RESULTS In the pollen season after starting treatment, 56.6% of patients stated that their symptoms were much less/less intense, 86% needed less symptomatic medication for control of their symptoms, and 74.4% manifested to have improved (quite/a lot) as regards their allergic disease since treatment was initiated as compared with previous grass pollen season. The patient satisfaction with GRAZAX® was measured using a visual analogue scale (VAS) between 0 (minimum satisfaction) and 100 (maximum satisfaction) comprising five different items: effectiveness, tolerability, cost, convenience and overall satisfaction. The results obtained for each item were [mean (SD)]: 74.7 (18.1), 70.3 (36.1), 39.3 (25.8), 86.2 (12.6), 78.4 (15.8) respectively. The patient's level of satisfaction is highly influenced, especially in terms of assessment of effectiveness, tolerability and convenience, by the information provided by the specialist. CONCLUSIONS In summary, it can be concluded that improved communication leads to increased patient knowledge, greater patient compliance, and increased patient satisfaction.
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Affiliation(s)
- Tomás Chivato
- Decanato. Facultad de Medicina, Facultad de Medicina Universidad CEU San Pablo. Grupo Hospitales HM, Avda. Montepríncipe s/n, Boadilla del Monte, 28668 Madrid, Spain
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Horn A, Zeuner H, Wolf H, Schnitker J, Wüstenberg E. Health-Related Quality of Life During Routine Treatment with the SQ-Standardised Grass Allergy Immunotherapy Tablet: A Non-Interventional Observational Study. Clin Drug Investig 2016; 36:453-62. [PMID: 26979593 PMCID: PMC4891394 DOI: 10.1007/s40261-016-0388-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Allergy immunotherapy (AIT) with the SQ(®) grass sublingual immunotherapy (SLIT)-tablet has been shown to be efficacious, well-tolerated and to improve disease-specific health-related quality of life (HRQoL) in controlled clinical trials. The aim of our study was to investigate HRQoL in patients with allergic rhinoconjunctivitis routinely treated with the SLIT-tablet and taking symptomatic medication as needed compared with patients treated only with symptomatic medication. METHODS In a non-interventional, open-label study, patients treated with the SLIT-tablet were observed for about 12 months compared with patients only symptomatically treated. Patients assessed their HRQoL with the 12-Item Short Form Health Survey (SF-12) and the Rhinitis Quality of Life Questionnaire (RQLQ) in the grass pollen seasons (GPS) at baseline (GPS1, HRQoL1), after GPS1 (HRQoL2) and in the following GPS (GPS2, HRQoL3). Tolerability, compliance, symptoms and medication use were assessed in the SLIT-tablet group by the physician. RESULTS Overall, data were analysed in 576 patients. Mean differences (±SD) in overall scores for HRQoL3 versus HRQoL1 (186 patients) of SF-12 were +11.4 ± 16.8 (SLIT-tablet) and -3.4 ± 15.7 (symptomatic medication), (p < 0.0001), and of RQLQ -1.31 ± 1.07 and +0.10 ± 0.74 (p < 0.001), and for HRQoL3 versus HRQoL2 (238 patients) of SF-12 -1.6 ± 15.3 and -10.0 ± 14.1 (p = 0.0003), and of RQLQ +0.22 ± 1.29 and +1.24 ± 1.30 (p < 0.0001). Tolerability and adherence for the SLIT-tablet were comparable with data of other non-interventional studies. CONCLUSIONS Routine treatment with the SQ(®) grass SLIT-tablet resulted in clear improvements in disease-specific and general quality of life, while no improvements were observed in patients treated only symptomatically.
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Affiliation(s)
- Andreas Horn
- HNO Praxis am Neckar, 69120, Heidelberg, Germany
| | | | - Hendrik Wolf
- ALK-Abelló Arzneimittel GmbH, Clinical Development/Medical Department, Griegstrasse 75, Haus 25, 22763, Hamburg, Germany.
| | - Jörg Schnitker
- Institut für angewandte Statistik Dr. Jörg Schnitker GmbH, 33647, Bielefeld, Germany
| | - Eike Wüstenberg
- ALK-Abelló Arzneimittel GmbH, Clinical Development/Medical Department, Griegstrasse 75, Haus 25, 22763, Hamburg, Germany
- Clinic for Otolaryngology, Universitätsklinikum Carl Gustav Carus, 01307, Dresden, Germany
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Steveling EH, Lao-Araya M, Koulias C, Scadding G, Eifan A, James LK, Dumitru A, Penagos M, Calderón M, Andersen PS, Shamji M, Durham SR. Protocol for a randomised, double-blind, placebo-controlled study of grass allergen immunotherapy tablet for seasonal allergic rhinitis: time course of nasal, cutaneous and immunological outcomes. Clin Transl Allergy 2015; 5:43. [PMID: 26682038 PMCID: PMC4682243 DOI: 10.1186/s13601-015-0087-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/29/2015] [Indexed: 12/21/2022] Open
Abstract
Background Seasonal Allergic Rhinitis is characterised by inflammation of the nasal mucosa upon exposure to common aeroallergens, affecting up to 20–25 % of the population. For those patients whose symptoms are not controlled by standard medical treatment, allergen specific immunotherapy is a therapeutic alternative. Although several studies have shown changes in immunologic responses as well as long term tolerance following treatment with a sublingual allergy immunotherapy tablet, a detailed time course of the early mechanistic changes of local and systemic T and B cell responses and the effects on B cell repertoire in the nasal mucosa have not been fully examined. Methods/design This is a randomized, double-blind, single-centre, placebo controlled, two arm time course study based in the United Kingdom comparing sublingual allergy immunotherapy tablet (GRAZAX®, ALK-Abello Horsholm, Denmark) plus standard treatment with placebo plus standard treatment. Up to 50 moderate to severe grass pollen allergic participants will be enrolled to ensure randomisation of at least 44. Further, we shall enrol 20 non-atopic volunteers. Screening will be completed before eligible atopic participants are randomised to one of the two treatment arms in a 1 to 1 ratio. The primary endpoint will be the total nasal symptom score assessed over 60 min following grass pollen nasal allergen challenge after 12 months of treatment. Clinical assessments and/or mechanistic analyses on blood, nasal fluid, brushing and biopsies will be performed at baseline at 1, 2, 3, 4 (coinciding with the peak pollen season), 6 and 12 months of treatment. After 12 months of treatment, unblinding will take place. Those atopic participants receiving active treatment will continue therapy for another 12 months followed by a post treatment phase of 12 months. Assessments and collection of biologic samples from these participants will take place again at 24 and at 36 months from the start of treatment. The 20 healthy, non-atopic controls will undergo screening and one visit only coinciding with the 12 month visit for the atopic participants. Discussion The trial will end in April 2017. The trial is registered with ClinicalTrials.gov and the trial identifying number is NCT02005627. Trial registration: Primary Registry: ClinicalTrials.gov, Trial Identifying number: NCT02005627, Secondary identifying numbers: EudraCT number: 2013-003732-72 REC: 13/EM/0351, Imperial College London (Sponsor): 13IC0847, Protocol Version 6.0, Date: 16.05.2014 Electronic supplementary material The online version of this article (doi:10.1186/s13601-015-0087-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther Helen Steveling
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Mongkol Lao-Araya
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Christopher Koulias
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Guy Scadding
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Aarif Eifan
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Louisa K James
- Allergy and Clinical Immunology, Randall Division of Cell and Molecular Biophysics, King's College London, New Hunt's House, Guy's Campus, London, SE1 1UL UK
| | - Alina Dumitru
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Martin Penagos
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Moisés Calderón
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | | | - Mohamed Shamji
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Stephen R Durham
- Allergy and Clinical Immunology, Section Inflammation, Repair and Development, National Heart and Lung Institute (NHLI), Imperial College London, Dovehouse Street, London, SW3 6LY UK
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Scaparrotta A, Attanasi M, Petrosino MI, Di Filippo P, Di Pillo S, Chiarelli F. Critical appraisal of Timothy grass pollen extract GRAZAX in the management of allergic rhinitis. Drug Des Devel Ther 2015; 9:5897-909. [PMID: 26604688 PMCID: PMC4639524 DOI: 10.2147/dddt.s70432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Allergic rhinitis is one of the most common diseases of adult and pediatric age, associated with grass pollen (GP) allergy in >50% cases, with a consistent impact on quality of life of affected patients. A grass allergen tablet, containing standardized extract derived from Timothy grass (Phleum pratense) pollen and ~15 μg major allergen P. pratense (rPhl p 5), may be the future of allergen-specific immunotherapy (IT) for GP allergy. The aim of this review was to critically evaluate the role of Timothy GP extract IT for the management of allergic rhinitis. For this purpose, we have tried to analyze potential mechanisms of action at the basis of Timothy GP extract, we have reviewed efficacy studies to establish potential benefits and clinical response, and we have also evaluated safety and tolerability profiles and patient focus perspective, such as quality of life, satisfaction and acceptability, and compliance to this IT.
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Affiliation(s)
| | - Marina Attanasi
- Department of Pediatrics, University of Chieti, Chieti, Italy
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13
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Larsen JN, Broge L, Jacobi H. Allergy immunotherapy: the future of allergy treatment. Drug Discov Today 2015; 21:26-37. [PMID: 26327511 DOI: 10.1016/j.drudis.2015.07.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 06/24/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022]
Abstract
Allergic respiratory disease represents a significant and expanding health problem worldwide. Allergic symptoms, such as asthma and hay fever, cause sleep impairment and reduce school and work performance. The cost to society is substantial. Allergen avoidance and pharmacotherapy cannot control the disease. Only allergy immunotherapy has disease-modifying potential and should be included in optimal treatment strategies. Allergy immunotherapy was first administered as subcutaneous injections and has been practiced for the past 100 years or so. Recently, tablet-based sublingual allergy immunotherapy (SLIT) was introduced with comprehensive clinical documentation. SLIT tablets represent a more patient-friendly concept because they can be used for self-treatment at home.
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Leatherman BD, Khalid A, Lee S, McMains K, Peltier J, Platt MP, Stachler RJ, Toskala E, Tropper G, Venkatraman G, Lin SY. Dosing of sublingual immunotherapy for allergic rhinitis: evidence-based review with recommendations. Int Forum Allergy Rhinol 2015; 5:773-83. [PMID: 26097218 DOI: 10.1002/alr.21561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/27/2015] [Accepted: 05/02/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since the mid 1980s, the clinical use of sublingual immunotherapy (SLIT) has dramatically increased. However, 1 of the primary barriers to providing SLIT is lack of a published dosing recommendations. The purpose of this work is to provide a range of effective SLIT dosing based upon a rigorous review of the existing evidence base. An appendix with SLIT dosing recommendations is also included. METHODS A comprehensive search of the past 25 years of the medical literature using PubMed was performed for specific antigens. Inclusion criteria for articles included: randomized, placebo-controlled studies of SLIT, studies with clinical allergic rhinitis outcomes, and dosing units available to determine the micrograms per month of major allergen administered. The extracted data was used to compile a range of effective SLIT dosing for individual antigens. RESULTS Seventy-five articles met the inclusion criteria, providing a range of effective dosing for some allergens. There was commonly a wide range in doses for particular antigens between the individual studies. For some antigens, there was significant overlap in dosage amount between studies showing efficacy and lack of efficacy. Clinical trials meeting inclusion criteria are not available for many allergens. CONCLUSION This study provided a comprehensive review of the published sublingual dosing ranges for specific antigens. The review provided a range of effective sublingual doses for some allergens, whereas for other allergens there was insufficient published data to determine specific doses. Recommendations for SLIT dosing were produced based on the data revealed in the review and expert opinion.
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Affiliation(s)
- Bryan D Leatherman
- Coastal Sinus and Allergy Center, Gulfport, MS.,Coastal Ear Nose and Throat Associates, Gulfport, MS
| | | | - Stella Lee
- Department of Otolaryngology-Head and Neck Surgery, Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kevin McMains
- Otolaryngology, South Texas Veterans Health Care System, San Antonio, TX
| | | | - Michael P Platt
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA
| | | | - Elina Toskala
- Department of Otolaryngology-Head and Neck Surgery, Temple University, School of Medicine, Philadelphia, PA
| | - Guy Tropper
- Avant Garde Medical Care, Boucherville, QC, Canada
| | | | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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16
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Pfaar O, Demoly P, Gerth van Wijk R, Bonini S, Bousquet J, Canonica GW, Durham SR, Jacobsen L, Malling HJ, Mösges R, Papadopoulos NG, Rak S, Rodriguez del Rio P, Valovirta E, Wahn U, Calderon MA. Recommendations for the standardization of clinical outcomes used in allergen immunotherapy trials for allergic rhinoconjunctivitis: an EAACI Position Paper. Allergy 2014; 69:854-67. [PMID: 24761804 DOI: 10.1111/all.12383] [Citation(s) in RCA: 309] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Allergen immunotherapy (AIT) has been thoroughly documented in randomized controlled trials (RCTs). It is the only immune-modifying and causal treatment available for patients suffering from IgE-mediated diseases such as allergic rhinoconjunctivitis, allergic asthma and insect sting allergy. However, there is a high degree of clinical and methodological heterogeneity among the endpoints in clinical studies on AIT, for both subcutaneous and sublingual immunotherapy (SCIT and SLIT). At present, there are no commonly accepted standards for defining the optimal outcome parameters to be used for both primary and secondary endpoints. METHODS As elaborated by a Task Force (TF) of the European Academy of Allergy and Clinical Immunology (EAACI) Immunotherapy Interest Group, this Position Paper evaluates the currently used outcome parameters in different RCTs and also aims to provide recommendations for the optimal endpoints in future AIT trials for allergic rhinoconjunctivitis. RESULTS Based on a thorough literature review, the TF members have outlined recommendations for nine domains of clinical outcome measures. As the primary outcome, the TF recommends a homogeneous combined symptom and medication score (CSMS) as a simple and standardized method that balances both symptoms and the need for antiallergic medication in an equally weighted manner. All outcomes, grouped into nine domains, are reviewed. CONCLUSION A standardized and globally harmonized method for analysing the clinical efficacy of AIT products in RCTs is required. The EAACI TF highlights the CSMS as the primary endpoint for future RCTs in AIT for allergic rhinoconjunctivitis.
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Affiliation(s)
- O. Pfaar
- Center for Rhinology and Allergology Wiesbaden; Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital Mannheim; Mannheim Germany
| | - P. Demoly
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
- Sorbonne Universités; UPMC Paris 06, UMR-S 1136, IPLESP; Equipe EPAR; Paris France
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam the Netherlands
| | - S. Bonini
- Second University of Naples and Institute of Translational Pharmacology; Italian National Research Council (IFT-CNR); Rome Italy
| | - J. Bousquet
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
- 1018, Respiratory and Environmental Epidemiology Team; INSERM; CESP Centre for research in Epidemiology and Population Health; Villejuif France
| | - G. W. Canonica
- Respiratory Diseases & Allergy Clinic; University of Genova; IRCCS AOU San Martino; Genova Italy
| | - S. R. Durham
- Section of Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College; London UK
| | - L. Jacobsen
- ALC, Allergy Learning and Consulting; Copenhagen Denmark
| | - H. J. Malling
- Allergy Clinic; University Hospital Gentofte; Copenhagen Denmark
| | - R. Mösges
- Institute of Medical Statistics; Informatics and Epidemiology (IMSIE); University of Cologne; Cologne Germany
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Centre for Paediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - S. Rak
- Department of Respiratory Medicine and Allergology; Sahlgrenska University Hospital; Goteborg Sweden
| | | | - E. Valovirta
- Department of Clinical Allergology and Pulmonary Diseases; University of Turku; Finland
- Suomen Terveystalo Allergy Clinic; Turku Finland
| | - U. Wahn
- Department for Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
| | - M. A. Calderon
- Section of Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College; London UK
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Poole CD, Bannister CA, Andreasen JN, Andersen JS, Currie CJ. Estimation of health-related utility (EQ-5D index) in subjects with seasonal allergic rhinoconjunctivitis to evaluate health gain associated with sublingual grass allergen immunotherapy. Health Qual Life Outcomes 2014; 12:99. [PMID: 24927639 PMCID: PMC4094440 DOI: 10.1186/1477-7525-12-99] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Grass allergen immunotherapy (AIT) reduces symptom severity in seasonal allergic rhinoconjunctivitis (ARC) but its impact on general health-related utility has not been characterised for the purposes of economic evaluation. The aim of this study was to model the preferred measure of utility, EQ-5D index, from symptom severity and estimate incremental quality adjusted life years (QALYs) associated with SQ-standardised grass immunotherapy tablet (GRAZAX®, 75,000 SQ-T/2,800 BAU, ALK, Denmark). Methods Data were analysed from five consecutive pollen seasons in a randomised placebo controlled trial of GRAZAX®. Binomial and Gaussian mixed effects modelling related weekly EQ-5D index score to daily symptom and medication scores (DSS & DMS respectively). In turn, daily EQ-5D index was estimated from ARC symptoms and medication use. Results DSS and DMS were the principal predictors of ‘perfect’ health (EQ-5D = 1.000; binomial) and ‘imperfect’ health (EQ-5D < 1.000; Gaussian). Each unit increase in DSS and DMS reduced the odds of ‘perfect’ health (EQ-5D = 1.000) by 27% and 16% respectively, and reduced ‘imperfect’ health by 0.17 and 0.13, respectively. Gender remained the only other significant main fixed effect (Male odds ratio [OR] = 1.82). Incremental estimated EQ-5D index utility for GRAZAX® was observed from day -30 to day +70 of the pooled pollen season; mean daily utility for GRAZAX® = 0.938 units (95%CI 0.932-0.943) vs. 0.914 (0.907-0.921) for placebo, an incremental difference of 0.0238 (p < 0.001). This translates into an incremental 0.0324 Quality Adjusted Life Years over the five year study period. Conclusions ARC symptoms and medication use are the main predictors of EQ-5D index. The incremental QALYs observed for GRAZAX® may not fully describe the health benefits of this treatment, suggesting that economic modelling may be conservative.
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Affiliation(s)
| | | | | | | | - Craig J Currie
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales, UK.
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Abstract
Allergic diseases have continued to increase throughout the developed world. Subcutaneous immunotherapy has been a mainstay of treatment for allergic rhinitis and asthma, however, some patients are precluded from treatment. On the other hand, in the case of food allergy, treatments simply do not exist. Oral and sublingual immunotherapy, with its superior safety and ease of administration, offers an alternative for patients with allergic rhinitis and asthma and has also been promising as a potential treatment for food allergy. The review summarizes significant advances from the past year including further data on the effectiveness of existing treatments, preliminary data on novel treatments, and further understanding of the mechanisms of these new therapies.
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Affiliation(s)
- Edwin H Kim
- University of North Carolina at Chapel Hill, 2144 Genome Sciences Bldg, CB #7231, Chapel Hill, NC 27599-7231, 919-962-4409 (office), 919-962-4730 (fax)
| | - Wesley Burks
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 MacNider Bldg, CB#7220, Chapel Hill, NC 27599-7220, 919-966-1505 (office), 919-966-7299 (fax)
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Aasbjerg K, Torp-Pedersen C, Vaag A, Backer V. Treating allergic rhinitis with depot-steroid injections increase risk of osteoporosis and diabetes. Respir Med 2013; 107:1852-8. [PMID: 24090789 DOI: 10.1016/j.rmed.2013.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND In Denmark, 23% of the adult population have allergic rhinitis. We have previously demonstrated that a majority of hay fever patients are treated with depot-steroid injections in violation of the guidelines. It has been hypothesised that 1-2 annual depot-steroid injections are not harmful to the patient. OBJECTIVES Investigate if the depot-steroid treatment of allergic rhinitis instead of immunotherapy increases risk of steroid-related diseases. METHODS A retrospective study based on Danish National Registries 1995-2011 covering diagnoses, medications, as well as clinical outcomes. The main analysis was time dependent poisson regression models with results presented as rate ratios (RR), and incidence per 1000 patient years. Steroid use was defined as minimum one injection during April-July for at least three consecutive years. Treatment with specific immunotherapy against grass, birch or both was used as non-steroid control group. Relative risk of adverse outcomes such as osteoporosis, infections, diabetes and/or tendon rupture was investigated. RESULTS We identified 47,382 individuals with rhinitis; 55.8% treated with steroids, 37.6% with immunotherapy, and 6.7% with both. No significant differences in infections or tendon rupture were observed. For steroid treatment RR of diabetes was 1.5 (95% CI: 1.3-1.8; P < 0.001), incidence 3.9 (95% CI: 3.5-4.3), and RR of osteoporosis was 1.2 (95% CI: 1.0-1.5; P = 0.023), incidence 2.8 (95% CI: 2.5-3.1). Risk of diabetes culminated within the first two years of treatment start. CONCLUSIONS Compared to immunotherapy regular use of depot-steroid injections to treat allergic rhinitis is associated with increased risk of being diagnosed with diabetes and osteoporosis. CLINICAL IMPLICATIONS Treating seasonal allergic rhinitis with depot-steroid injections should be abandoned and replaced with immunotherapy, as annual depot-steroid treatment is associated with increased risk of diabetes and osteoporosis.
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Affiliation(s)
- Kristian Aasbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
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Leonardi A, Bogacka E, Fauquert JL, Kowalski ML, Groblewska A, Jedrzejczak-Czechowicz M, Doan S, Marmouz F, Demoly P, Delgado L. Ocular allergy: recognizing and diagnosing hypersensitivity disorders of the ocular surface. Allergy 2012; 67:1327-37. [PMID: 22947083 DOI: 10.1111/all.12009] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 12/28/2022]
Abstract
Ocular allergy includes several clinically different conditions that can be considered as hypersensitivity disorders of the ocular surface. The classification of these conditions is complex, and their epidemiology has not been adequately studied because of the lack of unequivocal nomenclature. Ocular allergy symptoms are often, but not always, associated with other allergic manifestations, mostly rhinitis. However, specific ocular allergic diseases need to be recognized and managed by a team that includes both an ophthalmologist and an allergist. The diagnosis of ocular allergy is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when the identification of the specific allergic sensitization is required for patient management. The aims of this Task Force Report are (i) to unify the nomenclature and classification of ocular allergy, by combining the ophthalmology and allergy Allergic Rhinitis and its Impact on Asthma criteria; (ii) to describe current methods of diagnosis; (iii) to summarize the therapeutic options for the management of ocular allergic inflammation.
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Affiliation(s)
- A. Leonardi
- Department of Neuroscience; Ophthalmology Unit; University of Padua; Padua; Italy
| | - E. Bogacka
- Department of Internal Medicine, Allergy and Geriatrics; Medical Academy of Wrocław; Wrocław; Poland
| | - J. L. Fauquert
- Unité d'Allergologie de l'enfant; CHU Estaing; Clermont-Ferrand; France
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Łódź; Poland
| | - A. Groblewska
- Department of Ophthalmology; Polish Mother's Memorial Hospital; Łódź; Poland
| | | | - S. Doan
- Hopital Bichat and Fondation A. de Rothschild; Paris; France
| | - F. Marmouz
- Pole sanitaire du Vexin; Pontoise; France
| | - P. Demoly
- Inserm U454 - IFR3; hôpital Arnaud-de-Villeneuve; Montpellier; France
| | - L. Delgado
- Faculty of Medicine; Department of Immunology; University of Porto; Porto; Portugal
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Rønborg SM, Svendsen UG, Micheelsen JS, Ytte L, Andreasen JN, Ehlers L. Budget impact analysis of two immunotherapy products for treatment of grass pollen-induced allergic rhinoconjunctivitis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2012; 4:253-60. [PMID: 23166443 PMCID: PMC3500916 DOI: 10.2147/ceor.s34832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Grass pollen-induced allergic rhinoconjunctivitis constitutes a large burden for society. Up to 20% of European and United States (US) populations suffer from respiratory allergies, including grass pollen-induced allergic rhinoconjunctivitis. The majority of patients are treated with symptomatic medications; however, a large proportion remains uncontrolled despite use of such treatments. Specific immunotherapy is the only treatment documented to target the underlying cause of the disease, leading to a sustained effect after completion of treatment. The aim of this study was to compare the economic consequences of treating patients suffering from allergic rhinoconjunctivitis with either a grass allergy immunotherapy tablet (AIT) or subcutaneous immunotherapy (SCIT). METHODS A budget impact analysis was applied comparing SQ-standardized grass AIT (Grazax(®); Phleum pratense, 75,000 SQ-T/2,800 BAU; ALK, Denmark) with SCIT (Alutard(®); P. pratense, 100,000 SQ-U/mL; ALK, Denmark). Budget impact analysis included health care utilization measured in physical units based on systematic literature reviews, guidelines, and expert opinions, as well as valuation in unit costs based on drug tariffs, physician fees, and wage statistics. Budget impact analysis was conducted from a Danish health care perspective. RESULTS Treating patients suffering from allergic rhinoconjunctivitis with grass AIT instead of grass SCIT resulted in a total reduction in treatment costs of €1291 per patient during a treatment course. This cost saving implies that approximately 40% more patients could be treated with grass AIT per year without influencing the cost of treatment. CONCLUSION Budget impact analysis showed that grass AIT is a cost-saving alternative to SCIT when treating patients with grass pollen-induced allergic rhinoconjunctivitis.
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Affiliation(s)
- Steen M Rønborg
- The Pulmonology and Allergy Clinic of Copenhagen, Copenhagen
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Therapeutic effects and biomarkers in sublingual immunotherapy: a review. J Allergy (Cairo) 2012; 2012:381737. [PMID: 22500184 PMCID: PMC3303629 DOI: 10.1155/2012/381737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 11/15/2011] [Indexed: 02/08/2023] Open
Abstract
Immunotherapy is considered to be the only curative treatment for allergic diseases such as pollinosis, perennial rhinitis, asthma, and food allergy. The sublingual route is widely applied for immunotherapy for allergy, instead of the conventional administration by subcutaneous route. A recent meta-analysis of sublingual immunotherapy (SLIT) has shown that this approach is safe, has positive clinical effects, and provides prolonged therapeutic effects after discontinuation of treatment. However, the mechanism of SLIT and associated biomarkers are not fully understood. Biomarkers that change after or during SLIT have been reported and may be useful for response monitoring or as prognostic indicators for SLIT. In this review, we focus on the safety, therapeutic effects, including prolonged effects after treatment, and new methods of SLIT. We also discuss response monitoring and prognostic biomarkers for SLIT. Finally, we discuss immunological mechanisms of SLIT with a focus on oral dendritic cells and facilitated antigen presentation.
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Durham SR, Emminger W, Kapp A, de Monchy JGR, Rak S, Scadding GK, Wurtzen PA, Andersen JS, Tholstrup B, Riis B, Dahl R. SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol 2012; 129:717-725.e5. [PMID: 22285278 DOI: 10.1016/j.jaci.2011.12.973] [Citation(s) in RCA: 359] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 11/30/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The main aim of specific immunotherapy is sustained effect due to changes in the immune system that can be demonstrated only in long-term trials. OBJECTIVE To investigate sustained efficacy and disease modification in a 5-year double-blind, placebo-controlled trial, including 2 years of blinded follow-up after completion of a 3-year period of treatment, with the SQ-standardized grass allergy immunotherapy tablet, Grazax (Phleum pratense 75,000 SQ-T/2,800 BAU,(∗) ALK, Denmark) or placebo. METHODS A randomized, double-blind, placebo-controlled, multinational, phase III trial included adults with a history of moderate-to-severe grass pollen-induced allergic rhinoconjunctivitis, with or without asthma, inadequately controlled by symptomatic medications. Two hundred thirty-eight participants completed the trial. End points included rhinoconjunctivitis symptom and medication scores, combined scores, asthma symptom and medication scores, quality of life, days with severe symptoms, immunologic end points, and safety parameters. RESULTS The mean rhinoconjunctivitis daily symptom score was reduced by 25% to 36% (P ≤ .004) in the grass allergy immunotherapy tablet group compared with the placebo group over the 5 grass pollen seasons covered by the trial. The rhinoconjunctivitis DMS was reduced by 20% to 45% (P ≤ .022 for seasons 1-4; P = .114 for season 5), and the weighted rhinoconjunctivitis combined score was reduced by 27% to 41% (P ≤ .003) in favor of active treatment. The percentage of days with severe symptoms during the peak grass pollen exposure was in all seasons lower in the active group than in the placebo group, with relative differences of 49% to 63% (P ≤ .0001). Efficacy was supported by long-lasting significant effects on the allergen-specific antibody response. No safety issues were identified. CONCLUSION The results confirm disease modification by SQ-standardized grass allergy immunotherapy tablet in addition to effective symptomatic treatment of allergic rhinoconjunctivitis.
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Affiliation(s)
- Stephen R Durham
- Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, United Kingdom.
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Valovirta E, Berstad AKH, de Blic J, Bufe A, Eng P, Halken S, Ojeda P, Roberts G, Tommerup L, Varga EM, Winnergard I. Design and recruitment for the GAP trial, investigating the preventive effect on asthma development of an SQ-standardized grass allergy immunotherapy tablet in children with grass pollen-induced allergic rhinoconjunctivitis. Clin Ther 2011; 33:1537-46. [PMID: 21999887 DOI: 10.1016/j.clinthera.2011.09.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/13/2011] [Accepted: 09/13/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Allergic rhinoconjunctivitis is a risk factor for asthma development. Treating the underlying allergy may represent an attractive method of asthma prevention. No regulatory guidance exists in this area, and, to our knowledge, no clinical investigations meeting modern regulatory standards have been published. OBJECTIVE The objective of this publication is to describe the rationale behind the design of and report on the recruitment for the ongoing pediatric Grazax Asthma Prevention (GAP) trial. METHODS The trial was designed for assessment of the preventive effect of an SQ-standardized grass allergy immunotherapy tablet (AIT) on asthma development, both during treatment and after the end of treatment. (The standardized quality [SQ] procedure is a standardization procedure comprising 3 components: total potency, major allergen content, and assessment of extract complexity.) The trial design was discussed with several European Competent Authorities. RESULTS The GAP trial is a multinational, parallel-group, double-blind, placebo-controlled randomized trial. Main eligibility criteria were age of 5 to 12 years, grass pollen-induced allergic rhinoconjunctivitis, no asthma, and no overlapping symptomatic allergies. The children have been randomized 1:1 to receive the grass AIT or placebo once daily for 3 years, followed by a blinded observational period of 2 years. Asthma is assessed by the investigators according to specific diagnostic criteria, used at screening visits before randomization to exclude children with existing asthma, and evaluated at least half-yearly during the trial. Seven months of screening resulted in 812 randomized children at 101 centers in 11 countries. CONCLUSIONS To our knowledge, the GAP trial represents the first double-blind, placebo-controlled randomized trial to assess the preventive effect of allergen-specific immunotherapy on asthma development. A total of 812 children were successfully recruited into the trial. EudraCT number: 2009-011235-12.
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Allergic rhinitis and asthma: celebrating 100 years of immunotherapy. Curr Opin Immunol 2011; 23:808-13. [PMID: 21862303 DOI: 10.1016/j.coi.2011.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 07/22/2011] [Indexed: 11/24/2022]
Abstract
Since Noon first described allergen immunotherapy a century ago the basic premise of subcutaneous injections (SCIT) of relevant aeroallergens to induce clinical tolerance has remained true [1]. Indeed, allergen immunotherapy did not change dramatically over the first 75 years, but over the past 25 years there have been a number of important advancements leading to newer approaches and novel formulations. Here we review the top 50 articles published in the past 2 years on allergens, environmental control, and immunotherapy for asthma and allergic rhinitis and the use of immunomodulators in allergic disease.
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Pfaar O, Kleine-Tebbe J, Hörmann K, Klimek L. Allergen-specific immunotherapy: which outcome measures are useful in monitoring clinical trials? Immunol Allergy Clin North Am 2011; 31:289-309, x. [PMID: 21530821 DOI: 10.1016/j.iac.2011.02.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Various clinical outcome measures are commonly applied in clinical trials on specific immunotherapy for allergic rhinoconjunctivitis with or without asthma to provide evidence of its clinical efficacy. These "primary endpoints" measure clinical symptoms as well as the use for concomitant medication. "Secondary outcome endpoints" are represented by health-related quality of life (HRQoL), "well-days," provocation-tests, in vitro tests and others. This article reviews different methods assessing the clinical outcome of trials on both subcutaneous and sublingual immunotherapy, and highlights potential advantages and drawbacks of each method.
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Affiliation(s)
- O Pfaar
- Center for Rhinology and Allergology Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, An den Quellen 10, 65183 Wiesbaden, Germany.
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Bousquet J, Schünemann HJ, Bousquet PJ, Bachert C, Canonica GW, Casale TB, Demoly P, Durham S, Carlsen KH, Malling HJ, Passalacqua G, Simons FER, Anto J, Baena-Cagnani CE, Bergmann KC, Bieber T, Briggs AH, Brozek J, Calderon MA, Dahl R, Devillier P, Gerth van Wijk R, Howarth P, Larenas D, Papadopoulos NG, Schmid-Grendelmeier P, Zuberbier T. How to design and evaluate randomized controlled trials in immunotherapy for allergic rhinitis: an ARIA-GA(2) LEN statement. Allergy 2011; 66:765-74. [PMID: 21496059 DOI: 10.1111/j.1398-9995.2011.02590.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Specific immunotherapy (SIT) is one of the treatments for allergic rhinitis. However, for allergists, nonspecialists, regulators, payers, and patients, there remain gaps in understanding the evaluation of randomized controlled trials (RCTs). Although treating the same diseases, RCTs in SIT and pharmacotherapy should be considered separately for several reasons, as developed in this study. These include the severity and persistence of allergic rhinitis in the patients enrolled in the study, the problem of the placebo, allergen exposure (in particular pollen and mite), the analysis and reporting of the study, the level of symptoms of placebo-treated patients, the clinical relevance of the efficacy of SIT, the need for a validated combined symptom-medication score, the differences between children and adults and pharmacoeconomic analyses. This statement reviews issues raised by the interpretation of RCTs in sublingual immunotherapy. It is not possible to directly extrapolate the rules or parameters used in medication RCTs to SIT. It also provides some suggestions for the research that will be needed. Interestingly, some of the research questions can be approached with the available data obtained from large RCTs.
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MESH Headings
- Administration, Sublingual
- Adolescent
- Adult
- Allergens/administration & dosage
- Allergens/immunology
- Animals
- Child
- Child, Preschool
- Desensitization, Immunologic/methods
- Humans
- Injections, Subcutaneous
- Mites/immunology
- Pollen/immunology
- Quality of Life
- Randomized Controlled Trials as Topic/methods
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/physiopathology
- Rhinitis, Allergic, Seasonal/therapy
- Severity of Illness Index
- Treatment Outcome
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Affiliation(s)
- Jean Bousquet
- University Hospital, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:269-73. [PMID: 21516010 DOI: 10.1097/aci.0b013e3283473da8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blaiss M, Maloney J, Nolte H, Gawchik S, Yao R, Skoner DP. Efficacy and safety of timothy grass allergy immunotherapy tablets in North American children and adolescents. J Allergy Clin Immunol 2011; 127:64-71, 71.e1-4. [DOI: 10.1016/j.jaci.2010.11.034] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/24/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
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