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Yang W, Wang W, Ji Y, Pan H. Efficacy and safety of subcutaneous and sublingual allergen immunotherapy in the treatment of asthma in children: a systematic review and meta-analysis. J Asthma 2024:1-10. [PMID: 39132908 DOI: 10.1080/02770903.2024.2391441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/22/2024] [Accepted: 08/08/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Asthma is a common chronic condition in children globally. Allergen-specific immunotherapy, such as subcutaneous (SCIT) and sublingual (SLIT) therapies, are promising by increasing allergen tolerance. This meta-analysis compares the efficacy and safety of SLIT and SCIT in pediatric asthma. METHODS We searched PubMed, Cochrane Library, and Embase for randomized controlled trials and case-control studies comparing SLIT and SCIT in asthmatic children. Meta-analysis was conducted using random-effects models with calculations via R software version 4.3.2 and RevMan version 5.4. Study quality and bias risk were assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. RESULTS The literature search yielded a total of 1787 records, with 7 studies meeting the inclusion criteria after screening and assessments. There was no significant difference in the Total Asthma Symptoms Score between SLIT and SCIT (mean difference -0.05 [95% CI: -0.21; 0.10]). However, asthma improvement rates were higher in the SLIT group (risk ratio 0.77 [95% CI: 0.64; 0.93]). FEV1 improvement showed no significant difference (mean difference -1.60 [95% CI: -6.27; 3.08]). Adverse events were similar between the treatments (risk ratio 0.56 [95% CI: 0.11; 2.82]). CONCLUSIONS SLIT and SCIT were generally similarly effective and safe for treating pediatric asthma. SLIT may be preferred due to its noninvasive administration. More research is needed on long-term effects and tailored treatment approaches.
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Affiliation(s)
- Wenwen Yang
- Department of Pediatric, XianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hangzhou Medical College, Taizhou, China
| | - Weijie Wang
- Department of Pediatric, XianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hangzhou Medical College, Taizhou, China
| | - Yishu Ji
- Department of Pediatric, XianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hangzhou Medical College, Taizhou, China
| | - Huisong Pan
- Department of Pediatric, XianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hangzhou Medical College, Taizhou, China
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Drechsler Y, Dong C, Clark DE, Kaur G. Canine Atopic Dermatitis: Prevalence, Impact, and Management Strategies. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2024; 15:15-29. [PMID: 38371487 PMCID: PMC10874193 DOI: 10.2147/vmrr.s412570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/26/2024] [Indexed: 02/20/2024]
Abstract
Atopic dermatitis (AD) is a common inflammatory and pruritic allergic skin disease in humans and dogs worldwide. The pathogenesis of AD is multifactorial, immunologically complex, and may involve genetic factors, epidermal barrier dysfunction, microbiome changes, immune dysregulation, and allergic sensitization. Across species, prevalence of AD is on the rise. At present, there is no cure for canine AD (CAD). The treatment for CAD is multifaceted and aimed at controlling the pruritus, associated inflammation, and infections, repairing the skin barrier function, and dietary management. This review presents data on prevalence, impact, and complex immunological interactions in AD with a focus on subsequent management of the disease in the canine population. A multimodal approach for management of CAD to address varying clinical signs and responses to therapies is discussed.
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Affiliation(s)
- Yvonne Drechsler
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA
| | - Charli Dong
- Animal Dermatology Clinic, Pasadena, CA, USA
| | - David E Clark
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA
| | - Gagandeep Kaur
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA
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Figo DD, Cordeiro Macedo PR, Gadermaier G, Remuzgo C, Castro FFM, Kalil J, Galvão CES, Santos KS. IgE and IgG4 Epitopes of Dermatophagoides and Blomia Allergens before and after Sublingual Immunotherapy. Int J Mol Sci 2023; 24:ijms24044173. [PMID: 36835585 PMCID: PMC9958541 DOI: 10.3390/ijms24044173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
Sublingual immunotherapy (SLIT) is used worldwide to treat house dust mites (HDM) allergy. Epitope specific immunotherapy with peptide vaccines is used far less, but it is of great interest in the treatment of allergic reactions, as it precludes the drawbacks of allergen extracts. The ideal peptide candidates would bind to IgG, blocking IgE-binding. To better elucidate IgE and IgG4 epitope profiles during SLIT, sequences of main allergens, Der p 1, 2, 5, 7, 10, 23 and Blo t 5, 6, 12, 13, were included in a 15-mer peptide microarray and tested against pooled sera from 10 patients pre- and post-1-year SLIT. All allergens were recognized to some extent by at least one antibody isotype and peptide diversity was higher post-1-year SLIT for both antibodies. IgE recognition diversity varied among allergens and timepoints without a clear tendency. Der p 10, a minor allergen in temperate regions, was the molecule with more IgE-peptides and might be a major allergen in populations highly exposed to helminths and cockroaches, such as Brazil. SLIT-induced IgG4 epitopes were directed against several, but not all, IgE-binding regions. We selected a set of peptides that recognized only IgG4 or were able to induce increased ratios of IgG4:IgE after one year of treatment and might be potential targets for vaccines.
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Affiliation(s)
- Daniele Danella Figo
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
| | - Priscilla Rios Cordeiro Macedo
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Servico de Imunologia Clinica e Alergia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Gabriele Gadermaier
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, 5020 Salzburg, Austria
| | - Cesar Remuzgo
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
| | - Fábio Fernandes Morato Castro
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Servico de Imunologia Clinica e Alergia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
- Instituto Nacional de Ciencia e Tecnologia de Investigação em Imunologia (iii-INCT), Sao Paulo 05403-900, Brazil
| | - Jorge Kalil
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Instituto Nacional de Ciencia e Tecnologia de Investigação em Imunologia (iii-INCT), Sao Paulo 05403-900, Brazil
| | - Clovis Eduardo Santos Galvão
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Servico de Imunologia Clinica e Alergia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Keity Souza Santos
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Instituto Nacional de Ciencia e Tecnologia de Investigação em Imunologia (iii-INCT), Sao Paulo 05403-900, Brazil
- Correspondence:
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Abdullah B, Pawankar R, Abdul Latiff AH, Woo KCK, Wüstenberg E, Khalid MAF, Xiang YZ, Husain S, Mohammad N, Md Shukri N. Malaysian Society of Allergy and Immunology Consensus Statement on Sublingual Immunotherapy in Allergic Rhinitis. J Clin Med 2023; 12:jcm12031151. [PMID: 36769797 PMCID: PMC9918058 DOI: 10.3390/jcm12031151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 02/04/2023] Open
Abstract
Allergic rhinitis (AR) is an IgE-mediated inflammatory disease of the upper airway. AR affects the patients' quality of life, is a known risk factor for asthma and a socio-economic burden. Allergen-specific immunotherapy (AIT), comprising sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT), involves administering increasing doses of the causative allergen to induce clinical and immunologic tolerance to the allergens. It is the only currently available treatment for AR that has been proven to induce disease-modifying effects (i.e., long-term remission of allergic symptoms or potential prevention of asthma and new sensitizations). Although AIT is conventionally recommended for patients who are non-responsive to symptom-relieving pharmacotherapy, it is presently recommended as a first-line treatment for patients with moderate to severe AR who prefer a treatment with the potential for long-term remission. In light of the relatively recent implementation of AIT in Malaysia, guidelines on its appropriate indication and application are important to attain optimal outcomes. This consensus statement was developed by an expert group formed by the Malaysian Society of Allergy and Immunology to provide evidence-based recommendations for the practice of AIT in Malaysia. Patient and product selection, choice of AIT, and strategy towards an effective treatment outcome in AIT are presented.
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Affiliation(s)
- Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Correspondence: or ; Tel.: +60-9-7676416
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
| | | | - Kent Chee Keen Woo
- Allergy & Immunology, Gleneagles Hospital, Jalan Ampang, Kuala Lumpur 50450, Malaysia
| | - Eike Wüstenberg
- ALK-Abelló Arzneimittel GmbH, 22763 Hamburg, Germany
- Department of Otorhinolaryngology-Head and Neck Surgery, Dresden University, 01307 Dresden, Germany
| | - Mohamad Azizul Fitri Khalid
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Sultanah Bahiyah, Alor Setar 05460, Malaysia
| | - Yeoh Zhi Xiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Sultanah Bahiyah, Alor Setar 05460, Malaysia
| | - Salina Husain
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nurashikin Mohammad
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Norasnieda Md Shukri
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
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Ellis AK, Frankish CW, O'Hehir RE, Armstrong K, Steacy L, Larché M, Hafner RP. Treatment with grass allergen peptides improves symptoms of grass pollen–induced allergic rhinoconjunctivitis. J Allergy Clin Immunol 2017; 140:486-496. [DOI: 10.1016/j.jaci.2016.11.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 11/03/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022]
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Saporta D. Sublingual Immunotherapy: A Useful Tool for the Allergist in Private Practice. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9323804. [PMID: 27340673 PMCID: PMC4906203 DOI: 10.1155/2016/9323804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/09/2016] [Indexed: 01/06/2023]
Abstract
This is a review of the author's experience with Sublingual Immunotherapy in a private office setting. Sublingual Immunotherapy should be considered by any allergy practitioner as a useful tool. Sublingual Immunotherapy is safe while at the same time it is effective. It enables the practitioner to treat asthmatics and young children without the concerns implicit with allergy injections.
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Affiliation(s)
- Diego Saporta
- Private Practice, 470 North Avenue, Elizabeth, NJ 07208, USA
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Nguyen NT, Raskopf E, Shah-Hosseini K, Zadoyan G, Mösges R. A review of allergoid immunotherapy: is cat allergy a suitable target? Immunotherapy 2016; 8:331-49. [PMID: 26860435 DOI: 10.2217/imt.15.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
To modify the course of allergy, different types of specific allergen immunotherapy have been developed such as sublingual immunotherapy and subcutaneous immunotherapy with native allergens or subcutaneous immunotherapy with polymerized allergoids. However, the optimal specific immunotherapy, especially for cat allergy, remains undetermined. Few studies investigating immunotherapy in cat allergy have been published, and the risk of serious adverse reactions and systemic reactions has often been an important issue. Monomeric allergoids have lower allergenic potential while their immunogenicity remains constant, resulting in excellent safety with notable efficacy. Specific immunotherapy with monomeric allergoids could, therefore, be of high value, especially in cat allergy as well as other types of allergy, and bring relief to a great community of patients.
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Affiliation(s)
- Nhung T Nguyen
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Esther Raskopf
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Gregor Zadoyan
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Ralph Mösges
- Institute of Medical Statistics, Informatics & Epidemiology (IMSIE), Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
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Pleskovic N, Bartholow A, Gentile DA, Skoner DP. The Future of Sublingual Immunotherapy in the United States. Curr Allergy Asthma Rep 2015; 15:44. [PMID: 26149585 DOI: 10.1007/s11882-015-0545-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sublingual immunotherapy (SLIT) is a safe and effective treatment for allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC). The Food and Drug Administration (FDA) in the USA has approved three SLIT tablets for the treatment of AR and ARC in relation to pollen. Specifically, Grastek® and Oralair® are two formulations approved to treat patients suffering with AR/ARC to grass pollen, and Ragwitek™ is a formulation approved to treat patients suffering with AR/ARC to ragweed pollen. Although these approvals provide support for physicians to prescribe SLIT, barriers to prescribing SLIT still remain such as FDA approval for additional formulations, a standard dose and dosing schedule, and cost/insurance coverage. In order to further support the use of SLIT, research is currently being conducted to expand the indication for SLIT to other common comorbidities to AR/ARC. For example, allergic asthma, food allergies, and atopic dermatitis are other diseases which are being explored. The future of SLIT in the USA is unknown; however, education will be necessary for both providers and patients.
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Affiliation(s)
- Nicole Pleskovic
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA, USA,
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9
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Passalacqua G, Canonica GW. Sublingual immunotherapy: focus on tablets. Ann Allergy Asthma Immunol 2015; 115:4-9. [PMID: 26123419 DOI: 10.1016/j.anai.2015.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/25/2015] [Accepted: 03/30/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa, Italy.
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