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Feng Y, Cao Y, Liu Y, Wang Q, He C, Hao J, Zhang K, HuangFu H. Clinical efficacy and safety of coseasonal initiation of Artemisia annua sublingual immunotherapy on patients with Artemisia-induced rhinoconjunctivitis. Am J Otolaryngol 2023; 44:103942. [PMID: 37352680 DOI: 10.1016/j.amjoto.2023.103942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/11/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE Patients with seasonal allergic rhinoconjunctivitis (SARC) might seek evaluation and treatment when symptoms appear during the pollen season. It is unclear whether coseasonal-initiated sublingual immunotherapy (SLIT) would be effective and safe for SARC. This study aims to identify the feasibility of initiating Artemisia annua SLIT during the pollen season. MATERIALS AND METHODS Sixty patients with Artemisia-induced SARC were equally recruited into the SLIT and control groups during the pollen season in 2021. The SLIT group was treated with standardized Artemisia annua SLIT drops using a modified dosing schedule combined with pharmacotherapy, while the control group only received pharmacotherapy. Diary cards for clinical symptoms, rescue medication use, and adverse events (AEs) were recorded during the pollen seasons. Objective measures, including average daily combined scores of medication and rhinoconjunctivitis symptoms (CSMRS), total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), and the score of visual analog scale (VAS) were calculated to evaluate the efficacy of SLIT. Safety was assessed through the occurrence and severity of AEs. RESULTS In total, 80.0 % (24/30) patients in the SLIT group and 86.67 % (26/30) patients in the control group completed the study. The severity of SARC, which was assessed by objective measures including CSMRS, TRSS, TMS, and VAS of the SLIT group and the control group, was generally at the same level during the 2021 pollen season, except for the medical consumption, which the score of TMS was slightly higher in the SLIT group. After one year of treatment, the scores of CSMRS, TRSS, and VAS in the SLIT group were significantly improved compared with the control group (all P < 0.001), and the difference in the TMS between the two groups disappeared (P > 0.05). Moreover, clinical improvement of the four objective measures was also observed in the SLIT group compared with the baseline value (P < 0.001). Overall, 9/24 patients in the SLIT group experienced mild local AEs, and two patients experienced mild systemic AEs during the SLIT period. CONCLUSIONS This controlled preliminary study identified that coseasonal-initiated Artemisia annua SLIT treatment for one year was generally safe and effective in improving the symptoms of SARC patients induced by Artemisia annua pollen.
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Affiliation(s)
- Yan Feng
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China
| | - Yingzi Cao
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Ying Liu
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China
| | - Qian Wang
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Chan He
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China
| | - Jianli Hao
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China
| | - Kejun Zhang
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China.
| | - Hui HuangFu
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China.
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Creticos PS, Bernstein DI, Casale TB, Lockey RF, Maloney J, Nolte H. Coseasonal Initiation of Allergen Immunotherapy: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:1194-1204.e4. [DOI: 10.1016/j.jaip.2016.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 05/16/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
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Tam H, Calderon MA, Manikam L, Nankervis H, García Núñez I, Williams HC, Durham S, Boyle RJ. Specific allergen immunotherapy for the treatment of atopic eczema. Cochrane Database Syst Rev 2016; 2:CD008774. [PMID: 26871981 PMCID: PMC8761476 DOI: 10.1002/14651858.cd008774.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Specific allergen immunotherapy (SIT) is a treatment that may improve disease severity in people with atopic eczema (AE) by inducing immune tolerance to the relevant allergen. A high quality systematic review has not previously assessed the efficacy and safety of this treatment. OBJECTIVES To assess the effects of specific allergen immunotherapy (SIT), including subcutaneous, sublingual, intradermal, and oral routes, compared with placebo or a standard treatment in people with atopic eczema. SEARCH METHODS We searched the following databases up to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 7, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), Web of Science™ (from 2005), the Global Resource of EczemA Trials (GREAT database), and five trials databases. We searched abstracts from recent European and North American allergy meetings and checked the references of included studies and review articles for further references to relevant trials. SELECTION CRITERIA Randomised controlled trials (RCTs) of specific allergen immunotherapy that used standardised allergen extracts in people with AE. DATA COLLECTION AND ANALYSIS Two authors independently undertook study selection, data extraction (including adverse effects), assessment of risk of bias, and analyses. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We identified 12 RCTs for inclusion in this review; the total number of participants was 733. The interventions included SIT in children and adults allergic to either house dust mite (10 trials), grass pollen, or other inhalant allergens (two trials). They were administered subcutaneously (six trials), sublingually (four trials), orally, or intradermally (two trials). Overall, the risk of bias was moderate, with high loss to follow up and lack of blinding as the main methodological concern.Our primary outcomes were 'Participant- or parent-reported global assessment of disease severity at the end of treatment'; 'Participant- or parent-reported specific symptoms of eczema, by subjective measures'; and 'Adverse events, such as acute episodes of asthma or anaphylaxis'. SCORing Atopic Dermatitis (SCORAD) is a means of measuring the effect of atopic dermatitis by area (A); intensity (B); and subjective measures (C), such as itch and sleeplessness, which we used.For 'Participant- or parent-reported global assessment of disease severity at the end of treatment', one trial (20 participants) found improvement in 7/9 participants (78%) treated with the SIT compared with 3/11 (27%) treated with the placebo (risk ratio (RR) 2.85, 95% confidence interval (CI) 1.02 to 7.96; P = 0.04). Another study (24 participants) found no difference: global disease severity improved in 8/13 participants (62%) treated with the SIT compared with 9/11 (81%) treated with the placebo (RR 0.75, 95% CI 0.45 to 1.26; P = 0.38). We did not perform meta-analysis because of high heterogeneity between these two studies. The quality of the evidence was low.For 'Participant- or parent-reported specific symptoms of eczema, by subjective measures', two trials (184 participants) did not find that the SIT improved SCORAD part C (mean difference (MD) -0.74, 95% CI -1.98 to 0.50) or sleep disturbance (MD -0.49, 95% CI -1.03 to 0.06) more than placebo. For SCORAD part C itch severity, these two trials (184 participants) did not find that the SIT improved itch (MD -0.24, 95% CI -1.00 to 0.52). One other non-blinded study (60 participants) found that the SIT reduced itch compared with no treatment (MD -4.20, 95% CI -3.69 to -4.71) and reduced the participants' overall symptoms (P < 0.01), but we could not pool these three studies due to high heterogeneity. The quality of the evidence was very low.Seven trials reported systemic adverse reactions: 18/282 participants (6.4%) treated with the SIT had a systemic reaction compared with 15/210 (7.1%) with no treatment (RR 0.78, 95% CI 0.41 to 1.49; the quality of the evidence was moderate). The same seven trials reported local adverse reactions: 90/280 participants (32.1%) treated with the SIT had a local reaction compared with 44/204 (21.6%) in the no treatment group (RR 1.27, 95% CI 0.89 to 1.81). As these had the same study limitations, we deemed the quality of the evidence to also be moderate.Of our secondary outcomes, there was a significant improvement in 'Investigator- or physician-rated global assessment of disease severity at the end of treatment' (six trials, 262 participants; RR 1.48, 95% CI 1.16 to 1.88). None of the studies reported our secondary outcome 'Parent- or participant-rated eczema severity assessed using a published scale', but two studies (n = 184), which have been mentioned above, used SCORAD part C, which we included as our primary outcome 'Participant- or parent-reported specific symptoms of eczema, by subjective measures'.Our findings were generally inconclusive because of the small number of studies. We were unable to determine by subgroup analyses a particular type of allergen or a particular age or level of disease severity where allergen immunotherapy was more successful. We were also unable to determine whether sublingual immunotherapy was associated with more local adverse reactions compared with subcutaneous immunotherapy. AUTHORS' CONCLUSIONS Overall, the quality of the evidence was low. The low quality was mainly due to the differing results between studies, lack of blinding in some studies, and relatively few studies reporting participant-centred outcome measures. We found limited evidence that SIT may be an effective treatment for people with AE. The treatments used in these trials were not associated with an increased risk of local or systemic reactions. Future studies should use high quality allergen formulations with a proven track record in other allergic conditions and should include participant-reported outcome measures.
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Affiliation(s)
- Herman Tam
- Imperial College LondonSection of Paediatrics, Division of Infectious Diseases, Department of MedicineWright Fleming BuildingNorfolk PlaceLondonUKW2 1PG
| | - Moises A Calderon
- National Heart and Lung Institute, Imperial College LondonAllergy and Clinical Immunology, Section of Inflammation, Repair and DevelopmentLondonUKSW3 6LY
| | - Logan Manikam
- Imperial College LondonSection of Paediatrics, Division of Infectious Diseases, Department of MedicineWright Fleming BuildingNorfolk PlaceLondonUKW2 1PG
| | - Helen Nankervis
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Ignacio García Núñez
- Hospital Universitario Carlos HayaServicio de AlergologíaPlaza Del Hospital Civil S/NMálagaSpain29009
| | - Hywel C Williams
- The University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
| | - Stephen Durham
- National Heart and Lung Institute, Imperial College LondonAllergy and Clinical Immunology, Section of Inflammation, Repair and DevelopmentLondonUKSW3 6LY
| | - Robert J Boyle
- Imperial College LondonSection of Paediatrics, Division of Infectious Diseases, Department of MedicineWright Fleming BuildingNorfolk PlaceLondonUKW2 1PG
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Ridolo E, Montagni M, Bonzano L, Senna G, Incorvaia C. Arguing the misconceptions in allergen-specific immunotherapy. Immunotherapy 2015; 6:587-95. [PMID: 24896627 DOI: 10.2217/imt.14.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Allergen immunotherapy (AIT) has a clear evidence of efficacy and safety, as shown by a number of meta-analyses. However, a number of issues limit the use of AIT, many of them being not actually supported by solid data from the literature. In particular, several contraindications to AIT deserve to be argued, being needed to accurately balance in single cases the benefits versus the disadvantages. This concerns comorbidities, such as autoimmune diseases and malignancies, concomitant drug treatments, particularly β-blockers and angiotensin-converting enzyme inhibitors, pregnancy, patient's age, the severity of asthma, allergen polysensitization and the period of starting the treatment. Another important aspect producing misconceptions on AIT is the quality of the allergen extracts, because currently a patient with respiratory allergy to a given source may be prescribed to treat his allergyby products with very different quality. Improving characterization and standardization of allergen extracts will pave the way to the general acknowledgment of AIT as an effective treatment.
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Affiliation(s)
- Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, 43100 Parma, Italy
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Frati F, Ridolo E, Fuiano N, Barberi S, Dell’Albani I, Landi M, Ricciardi L, Scala G, Incorvaia C. Safety of sublingual immunotherapy in children. Expert Opin Drug Saf 2014; 13:947-53. [DOI: 10.1517/14740338.2014.918949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Mun SJ, Shin JM, Han DH, Kim JW, Kim DY, Lee CH, Min YG, Rhee CS. Efficacy and safety of a once-daily sublingual immunotherapy without escalation regimen in house dust mite-induced allergic rhinitis. Int Forum Allergy Rhinol 2012; 3:177-83. [PMID: 23044892 DOI: 10.1002/alr.21098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 08/02/2012] [Accepted: 08/07/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND The conventional escalation regimen for sublingual immunotherapy (SLIT) in patients with allergic rhinitis has been proven to be safe and successful in reducing allergic symptoms. However, few studies compared the efficacy and safety between a conventional escalation regimen for SLIT and once-daily SLIT. The aim of the present study was to compare the efficacy and safety of once-daily SLIT without escalation (SLITsE) to conventional escalation therapy (SLITwE). METHODS This study was a nonrandomized open label observational study. In total, 153 patients suffering from allergic rhinitis symptoms and sensitized to the perennial house dust mite allergens Dermatophagoides pteronyssinus and Dermatophagoides farinae, were enrolled in this study from July 2008 to December 2009. The patients were divided into 2 groups, SLITwE and SLITsE. Each patient was followed with a diary card on which a symptom score, a rescue medication score, and adverse events were recorded. RESULTS All of the nasal symptoms, including rhinorrhea, sneezing, nasal obstruction, itching, and olfactory symptoms, defined as a total nasal symptom score, were reduced after 6 months in both groups (p < 0.05). The rescue medication score, defined as the sum of all of the allergy medications used, also decreased in both groups. Adverse events were similar in both groups, and no major adverse events, such as anaphylaxis, were reported. CONCLUSION Once-daily SLITsE was well tolerated and showed safe and comparable efficacy compared with a conventional SLITwE regimen.
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Affiliation(s)
- Sue Jean Mun
- Department of Otorhinolaryngology, Seoul National University Hospital College of Medicine, Seoul, Korea
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Walker SM, Durham SR, Till SJ, Roberts G, Corrigan CJ, Leech SC, Krishna MT, Rajakulasingham RK, Williams A, Chantrell J, Dixon L, Frew AJ, Nasser SM. Immunotherapy for allergic rhinitis. Clin Exp Allergy 2011; 41:1177-200. [DOI: 10.1111/j.1365-2222.2011.03794.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Frati F, Scurati S, Puccinelli P, David M, Hilaire C, Capecce M, Marcucci F, Incorvaia C. Development of a sublingual allergy vaccine for grass pollinosis. Drug Des Devel Ther 2010; 4:99-105. [PMID: 20689696 PMCID: PMC2915534 DOI: 10.2147/dddt.s10044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Indexed: 11/23/2022] Open
Abstract
Grass pollen is a very common cause of allergic rhinitis and asthma. The only treatment targeting the underlying causes of allergy is immunotherapy (IT). Sublingual immunotherapy (SLIT) has been introduced to solve the problem of systemic reactions to subcutaneous IT (SCIT). This article evaluates the characteristics of the allergen extract, Staloral, in terms of practical administration, effectiveness, safety, and mechanism of action. Efficacy data were obtained from double-blind, placebo-controlled studies using Staloral in patients sensitized to grass pollen, while practical administration, cost-effectiveness, and mechanism of action data were provided by well designed studies. The efficacy and safety of Staloral, as demonstrated by review of published studies which used doses up to 1125 times those administered with SCIT, shows that this allergen extract has optimal characteristics for treating patients with seasonal allergies due to grass pollens. The main mechanism of action is the interaction between dendritic cells of the oral mucosa and the subsequent tolerance induced in T-cells.
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Affiliation(s)
- Franco Frati
- Medical and Scientific Department, Stallergenes, Milan, Italy
- University Department of Medical and Surgical Specialties and Public Health, Perugia, Italy
| | - Silvia Scurati
- Medical and Scientific Department, Stallergenes, Milan, Italy
| | | | | | | | | | - Francesco Marcucci
- University Department of Medical and Surgical Specialties and Public Health, Perugia, Italy
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Mohapatra SS, Qazi M, Hellermann G. Immunotherapy for allergies and asthma: present and future. Curr Opin Pharmacol 2010; 10:276-88. [PMID: 20573547 DOI: 10.1016/j.coph.2010.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/18/2010] [Accepted: 05/29/2010] [Indexed: 02/04/2023]
Abstract
Allergen immunotherapy (IT) is a proven approach for treating allergic rhinitis and allergic asthma that has been practiced since 1911 and has undergone significant development in the past two decades. As currently practiced, IT involves subcutaneous or sublingual administration of allergens, both methods of which have been extensively investigated. In addition to allergen IT, a number of additional nonspecific IT approaches are being used or are in phase II/phase III clinical trials, which may be available in clinics within the next one to three years. Such therapies include anti-IgE antibodies and the soluble IL-4 receptor. Other experimental IT approaches are at the preclinical research stage and may proceed to clinical trials and the clinic within the next five to ten years. This review discusses the pros and cons of recent developments in both currently practiced and experimental IT approaches.
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Affiliation(s)
- Shyam S Mohapatra
- Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, FL, USA.
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Current world literature. Curr Opin Allergy Clin Immunol 2010; 10:87-92. [PMID: 20026987 DOI: 10.1097/aci.0b013e3283355458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sieber J, Köberlein J, Mösges R. Sublingual immunotherapy in daily medical practice: effectiveness of different treatment schedules - IPD meta-analysis. Curr Med Res Opin 2010; 26:925-32. [PMID: 20163297 DOI: 10.1185/03007991003659483] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the effectiveness of perennial and co-seasonal high-dose sublingual immunotherapy (SLIT) treatments as well as ultra-rush and classical titrations in a real-world setting for pollen allergens. METHODS An individual patient data (IPD) meta-analysis was performed of three open, prospective observational studies on high-dose SLIT using IR-standardised allergen extracts in patients with allergic rhinitis with and without asthma. RESULTS In total, 1052 patients aged 24.9 years (mean) were treated with SLIT and included in this IPD meta-analysis. Individual studies and total data pool analyses revealed consistent improvements in rhinoconjunctivitis symptom scores. Stratified analyses revealed consistent improvements in symptomatic score and medication score regardless of the type of sensitisation and type of treatment. Ultra-rush titration resulted in considerably more pronounced improvement in symptom scores than classical titration, possibly due to better compliance of patients receiving that supervised titration. Adverse events occurred in 24% of patients during titration and in 18% of patients during maintenance treatment. The vast majority of events (89% and 87%) were mild-to-moderate, predominantly local symptoms in the oral cavity. There were no differences detected between the study titration or treatment schedules. No serious adverse reactions were reported. Nearly all patients (88%) decided to continue SLIT after completion of the studies. CONCLUSION High-dose SLIT with seasonal allergens given as co-seasonal or perennial treatment appears to be effective and well-tolerated in daily medical practice. Improved compliance under ultra-rush titration and seasonal SLIT treatment may further enhance effectiveness. Randomised controlled trials are requested for the further evaluation of these findings.
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Incorvaia C, Mauro M. Do indications to sublingual immunotherapy need to be revised? J Allergy Clin Immunol 2010; 125:277; author reply 277-8. [PMID: 20109757 DOI: 10.1016/j.jaci.2009.10.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 10/08/2009] [Indexed: 11/17/2022]
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Frati F, Scurati S, Puccinelli P, Justicia JL, Adamec T, Sieber HJ, Ras L, David M, Marcucci F, Incorvaia C. Development of an allergen extract for sublingual immunotherapy--evaluation of Staloral. Expert Opin Biol Ther 2009; 9:1207-15. [PMID: 19601728 DOI: 10.1517/14712590903146869] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Specific immunotherapy (IT) is an effective treatment for rhinitis and asthma caused by aeroallergens sensitization. Sublingual IT (SLIT) was introduced to solve the problem of systemic reactions to subcutaneous IT (SCIT) and developed to represent an actual treatment option. It is now generally accepted that allergen doses much higher than those administered by SCIT must be used to achieve clinical efficacy on allergic symptoms. OBJECTIVE To evaluate the characteristics of Staloral, an allergen extract produced by Stallergenes (Antony, France) in terms of practical administration, efficacy, safety and mechanism of action. METHODS Data were obtained from 20 double-blind, placebo-controlled studies using Staloral in patients sensitized to pollens and house-dust mites, and also from open studies concerning practical administration and the mechanism of action. RESULTS/CONCLUSION Efficacy and safety of Staloral, as demonstrated by the revision of the studies, which used doses up to 1125 times those administered with SCIT, are very satisfactory and confer to this allergen extract optimal characteristics for treating patients with seasonal allergies due to pollens or with perennial symptoms induced by dust mites. The main mechanism of action is the interaction with dendritic cells of the oral mucosa and the subsequent tolerance induced in T cells.
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Affiliation(s)
- Franco Frati
- Scientific and Medical Department, Stallergenes Italia, Milan, Italy.
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Marseglia GL, Incorvaia C, La Rosa M, Frati F, Marcucci F. Sublingual immunotherapy in children: facts and needs. Ital J Pediatr 2009; 35:31. [PMID: 19852795 PMCID: PMC2772839 DOI: 10.1186/1824-7288-35-31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 10/23/2009] [Indexed: 02/07/2023] Open
Abstract
Allergen specific immunotherapy (SIT) is the practice of administering gradually increasing doses of the specific causative allergen to reduce the clinical reactivity of allergic subjects, and is the only treatment targeting the causes of hypersensitivity and not only the symptoms, as done by drugs. The traditional, subcutaneous immunotherapy (SCIT) was burdened by the problem of systemic reactions which may be sometimes severe and - though very rarely - even fatal. This was the background to develop non injections routes for SIT and particularly sublingual immunotherapy (SLIT), that emerged as a real treatment option for respiratory allergy. A number of studies was conducted to evaluate efficacy and safety of SLIT, the first meta-analysis - including 22 placebo-controlled trials - concluded for positive results in both issues, but the number of studies on children was too low to draw definite conclusions. Since then, many other studies became available and make possible to analyze SLIT in children in its well defined aspects as well as in sides still requiring more solid data.
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Affiliation(s)
- Gian Luigi Marseglia
- Department of Paediatrics - Foundations IRCCS Policlinico San Matteo, University of Pavia, Italy.
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