1
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Dohm L, Saha S, Fronhoffs K, Gieler U. [Mental disorders from climate and environmental changes using the example of dermatology]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:704-710. [PMID: 39117980 DOI: 10.1007/s00105-024-05396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Global climate and environmental changes impose a significant impact on human health by increasing prevalences of chronic and acute skin diseases. Climate-associated environmental changes can also trigger or intensify mental illnesses independently of a skin disease. AIM Discussion of the effects of the climate and environmental changes on dermatological diseases applying the biopsychosocial model. MATERIALS AND METHODS A selective literature search in the PubMed database and other sources was conducted. RESULTS The biopsychosocial model considers complex interactions between biological, psychological, and social factors. In view of the consequences of climate and environmental changes, an extension of the model is proposed for the first time in order to address new challenges. The modified presentation supports the understanding of the dynamics and underscores that in dermatological care not only direct health effects of climate and environmental changes have to be dealt with, but also with an increasing number of mental illnesses, which in turn are to be regarded as direct and indirect health effects. CONCLUSION Coping with the predicted increase in the burden of disease and the decline in the available labor force associated with demographic change poses a major challenge. In order to maintain the functionality of the healthcare system, the prompt implementation of resource-efficient, sustainable measures in all areas of society is essential. The integrative consideration of dermatological and psychological complaints in the context of climate and environmental changes requires the adaptation of content for the education, training, and continuing education of specialists.
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Affiliation(s)
- Lea Dohm
- Deutsche Allianz Klimawandel und Gesundheit e. V. (KLUG e. V.), Cuvrystr. 1, 10997, Berlin, Deutschland.
| | - Susanne Saha
- Arbeitsgemeinschaft Nachhaltigkeit in der Dermatologie (AGN) e. V., Guntramstr. 8, 79106, Freiburg, Deutschland.
| | - Kristina Fronhoffs
- Arbeitskreis Psychosomatische Dermatologie e. V., Rheinbach, Deutschland
| | - Uwe Gieler
- Psychodermatologie Univ. Hautklinik Gießen, Ärztlicher Direktor der Vitos-Klinik für Psychosomatik Gießen, Gießen, Deutschland
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2
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Ridolo E, Nicoletta F, Barone A, Ottoni M, Senna G, Canonica GW. Causes of Non-Adherence to Allergen-Specific Immunotherapy: A Foundation towards a Patient-Personalized Approach. J Pers Med 2023; 13:1206. [PMID: 37623457 PMCID: PMC10455852 DOI: 10.3390/jpm13081206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Allergen-specific immunotherapy (AIT) is the only disease-modifying therapy for allergic conditions, resulting in a long-lasting tolerance beyond the duration of the treatment. Due to the strong relationship between the effectiveness, its optimal duration (at least three years) and the observation of the correct administration protocol, appropriate adherence to the plan of treatment represents a critical factor for the therapeutical success of AIT. METHODS Analysis of studies about the rate of adherence in subcutaneous and sublingual immunotherapy, which are the main routes of administration of AIT. RESULTS There are different causes leading to a premature interruption of the therapy or to it being incorrectly carried out; the most reported include erroneous expectations of the effectiveness and the adverse effects, economic issues, inconvenience and unrelated clinical conditions. CONCLUSIONS An attentive analysis of the main causes of dropouts may be useful to improve the management of these patients and to develop new strategies for a personalized approach. These strategies should be dynamic, involving attentive communication between the physician and the patient about all the possible criticalities, especially in the initial phase of the therapy, and facilitating, as much as possible, access to healthcare providers over the course of the maintenance phase, including by exploiting technological tools.
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Affiliation(s)
- Erminia Ridolo
- Allergology Unit, Parma University Hospital, 43121 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | | | | | - Martina Ottoni
- Allergology Unit, Parma University Hospital, 43121 Parma, Italy
| | | | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
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3
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Izmailovich M, Semenova Y, Abdushukurova G, Mukhamejanova A, Dyussupova A, Faizova R, Gazaliyeva M, Akhvlediani L, Glushkova N, Kalmakhanov S, Bjørklund G. Molecular Aspects of Allergen-Specific Immunotherapy in Patients with Seasonal Allergic Rhinitis. Cells 2023; 12:383. [PMID: 36766723 PMCID: PMC9913438 DOI: 10.3390/cells12030383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
A systematic review and narrative synthesis of publications was undertaken to analyze the role of component-resolved diagnosis technology in identifying polysensitization for the provision of allergen-specific immunotherapy to patients with seasonal allergic rhinitis. A search of publications was carried out in electronic databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search helped to identify 568 publications, 12 of which were included in this review. Overall, 3302 patients were enrolled. The major finding was that component-resolved diagnostics change the choice of relevant allergens for allergen-specific immunotherapy in at least 50% of cases. Sensitization to allergen components differs with age, type of disease, and overall disease duration. Patients who had both bronchial asthma and allergic rhinitis were sensitized to a larger number of allergens than patients who had bronchial asthma alone.
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Affiliation(s)
- Marina Izmailovich
- Department of Internal Diseases, Karaganda Medical University, Karaganda 100008, Kazakhstan
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Gulzada Abdushukurova
- Department of Therapy, Faculty of Postgraduate Medical Education, Shymkent Medical Institute, Shymkent 160006, Kazakhstan
| | - Ainur Mukhamejanova
- Department of Family Medicine No 2, Astana Medical University, Nur-Sultan 010000, Kazakhstan
| | - Azhar Dyussupova
- Department of General Medical Practice of Semey City, Semey Medical University, Semey 071400, Kazakhstan
| | - Raida Faizova
- Department of General Medical Practice of Semey City, Semey Medical University, Semey 071400, Kazakhstan
| | - Meruert Gazaliyeva
- Vice-Rector for Clinical Work, Astana Medical University, Nur-Sultan 010000, Kazakhstan
| | - Leila Akhvlediani
- School of Medicine & Health Sciences, BAU International University Batumi, 6010 Batumi, Georgia
| | - Natalya Glushkova
- Department of Epidemiology, Biostatistics & Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty 050040, Kazakhstan
| | - Sundetgali Kalmakhanov
- Department Health Policy and Organization, Al-Farabi Kazakh National University, Almaty 050040, Kazakhstan
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), 8610 Mo i Rana, Norway
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4
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Thermography based skin allergic reaction recognition by convolutional neural networks. Sci Rep 2022; 12:2648. [PMID: 35173225 PMCID: PMC8850609 DOI: 10.1038/s41598-022-06460-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/31/2022] [Indexed: 01/15/2023] Open
Abstract
In this work we present an automated approach to allergy recognition based on neural networks. Allergic reaction classification is an important task in modern medicine. Currently it is done by humans, which has obvious drawbacks, such as subjectivity in the process. We propose an automated method to classify prick allergic reactions using correlated visible-spectrum and thermal images of a patient’s forearm. We test our model on a real-life dataset of 100 patients (1584 separate allergen injections). Our solution yields good results—0.98 ROC AUC; 0.97 AP; 93.6% accuracy. Additionally, we present a method to segment separate allergen injection areas from the image of the patient’s forearm (multiple injections per forearm). The proposed approach can possibly reduce the time of an examination, while taking into consideration more information than possible by human staff.
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5
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Wisgrill L, Fyhrquist N, Ndika J, Paalanen L, Berger A, Laatikainen T, Karisola P, Haahtela T, Alenius H. Bet v 1 triggers antiviral-type immune signaling in birch pollen allergic individuals. Clin Exp Allergy 2022; 52:929-941. [PMID: 35147263 PMCID: PMC9540660 DOI: 10.1111/cea.14108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
Background In allergic patients, clinical symptoms caused by pollen remind of symptoms triggered by viral respiratory infections, which are also the main cause of asthmatic exacerbations. In patients sensitized to birch pollen, Bet v 1 is the major symptom‐causing allergen. Immune mechanisms driving Bet v 1‐related responses of human blood cells have not been fully characterized. Objective To characterize the immune response to Bet v 1 in peripheral blood in patients allergic to birch pollen. Methods The peripheral blood mononuclear cells of birch‐allergic (n = 24) and non‐allergic (n = 47) adolescents were stimulated ex‐vivo followed by transcriptomic profiling. Systems‐biology approaches were employed to decipher disease‐relevant gene networks and deconvolution of associated cell populations. Results Solely in birch‐allergic patients, co‐expression analysis revealed activation of networks of innate immunity and antiviral signalling as the immediate response to Bet v 1 stimulation. Toll‐like receptors and signal transducer transcription were the main drivers of gene expression patterns. Macrophages and dendritic cells were the main cell subsets responding to Bet v 1. Conclusions and clinical relevance In birch‐pollen‐allergic patients, the activated innate immune networks seem to be, in part, the same as those activated during viral infections. This tendency of the immune system to read pollens as viruses may provide new insight to allergy prevention and treatment.
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Affiliation(s)
- Lukas Wisgrill
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nanna Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Human microbiome research program (HUMI), Medicum, University of Helsinki, Helsinki, Finland
| | - Joseph Ndika
- Human microbiome research program (HUMI), Medicum, University of Helsinki, Helsinki, Finland
| | - Laura Paalanen
- National Institute for Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Tiina Laatikainen
- National Institute for Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Piia Karisola
- Human microbiome research program (HUMI), Medicum, University of Helsinki, Helsinki, Finland
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Harri Alenius
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Human microbiome research program (HUMI), Medicum, University of Helsinki, Helsinki, Finland
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6
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El-Qutob D, Letrán A, Matheu V, Fernandez-Caldas E. Cancer: Still a contraindication for allergen immunotherapy?: Specific immunotherapy and cancer. World Allergy Organ J 2021; 14:100597. [PMID: 34786035 PMCID: PMC8526768 DOI: 10.1016/j.waojou.2021.100597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/19/2023] Open
Abstract
Allergen immunotherapy (AIT) is currently more than 100 years old. It is considered an evidence-based efficacious immune therapeutical treatment. It is at this time the only causative treatment for allergic respiratory and venom allergic diseases. Though clinical indications for AIT are well established, clinical contraindications to AIT differ among several guidelines. Regarding malignant neoplasia, traditionally, it has been considered as a relative or absolute contraindication with the concern that AIT might stimulate tumour growth even though pathogenic impact of AIT in cancer is not well understood. Furthermore, this contraindication is often based on observational case series, or case reports, with little real evidence-based data. Therefore, should cancer still be contemplated as an absolute contraindication for AIT?
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Affiliation(s)
- David El-Qutob
- Allergy Unit, University Hospital of La Plana, Vila-real, Spain
- Corresponding author
| | - Antonio Letrán
- Allergy Unit, Hospital HLA Jerez Puerta del Sur, Jerez de la Frontera, Cádiz, Spain
| | - Victor Matheu
- Service of Allergology, University Hospital of Canarias, Spain
| | - Enrique Fernandez-Caldas
- Inmunotek SL, Alcalá de Henares, Madrid, Spain
- University of South Florida College of Medicine, Tampa, Florida, USA
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7
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Dastmalchi M. Elusive partners: a review of the auxiliary proteins guiding metabolic flux in flavonoid biosynthesis. THE PLANT JOURNAL : FOR CELL AND MOLECULAR BIOLOGY 2021; 108:314-329. [PMID: 34318549 DOI: 10.1111/tpj.15446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
Flavonoids are specialized metabolites widely distributed across the plant kingdom. They are involved in the growth and survival of plants, conferring the ability to filter ultra-violet rays, conduct symbiotic partnerships, and respond to stress. While many branches of flavonoid biosynthesis have been resolved, recent discoveries suggest missing auxiliary components. These overlooked elements can guide metabolic flux, enhance production, mediate stereoselectivity, transport intermediates, and exert regulatory functions. This review describes several families of auxiliary proteins from across the plant kingdom, including examples from specialized metabolism. In flavonoid biosynthesis, we discuss the example of chalcone isomerase-like (CHIL) proteins and their non-catalytic role. CHILs mediate the cyclization of tetraketides, forming the chalcone scaffold by interacting with chalcone synthase (CHS). Loss of CHIL activity leads to derailment of the CHS-catalyzed reaction and a loss of pigmentation in fruits and flowers. Similarly, members of the pathogenesis-related 10 (PR10) protein family have been found to differentially bind flavonoid intermediates, guiding the composition of anthocyanins. This role comes within a larger body of PR10 involvement in specialized metabolism, from outright catalysis (e.g., (S)-norcoclaurine synthesis) to controlling stereochemistry (e.g., enhancing cis-trans cyclization in catnip). Both CHILs and PR10s hail from larger families of ligand-binding proteins with a spectrum of activity, complicating the characterization of their enigmatic roles. Strategies for the discovery of auxiliary proteins are discussed, as well as mechanistic models for their function. Targeting such unanticipated components will be crucial in manipulating plants or engineering microbial systems for natural product synthesis.
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Affiliation(s)
- Mehran Dastmalchi
- Department of Plant Science, McGill University, Sainte-Anne-de-Bellevue, Québec, H9X 3V9, Canada
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8
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Hossenbaccus L, Ellis AK. The use of nasal allergen vs allergen exposure chambers to evaluate allergen immunotherapy. Expert Rev Clin Immunol 2021; 17:461-470. [PMID: 33729907 DOI: 10.1080/1744666x.2021.1905523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Allergen-specific immunotherapy (AIT) is the only disease-modifying treatment option for allergic rhinitis (AR) patients with persistent moderate-severe AR for whom traditional pharmacotherapies are ineffective. The nasal allergen challenge (NAC) and allergen exposure chamber (AEC) are two translational models of AR that can be used to investigate the properties, safety, and efficacy of AIT. AREAS COVERED Peer-reviewed, human-centered articles utilizing AEC or NAC models to investigate AIT between 2010 and 2020 were curated from PubMed, EMBASE, and OVID Medline databases. AECs have been used to evaluate traditional subcutaneous and sublingual administrations of AIT, including cross-protective effects and different dosing regimens. More recently, the effectiveness of novel AIT formulations has been evaluated. NACs are another model used to study AIT, including using novel intralymphatic routes of administration. It is an especially powerful and versatile tool to determine if basic science and animal model findings are clinically translatable. EXPERT OPINION The AEC and NAC models both produce clinically relevant and reproducible results. AECs are more effective for studying many participants but are limited because they require a specialized facility. As more AIT therapies and new formulations are developed over time, the versatility of the NAC will be especially useful.
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Affiliation(s)
- Lubnaa Hossenbaccus
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada.,Allergy Research Unit, Kingston Health Sciences Centre - KGH Site, Kingston, Canada
| | - Anne K Ellis
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada.,Allergy Research Unit, Kingston Health Sciences Centre - KGH Site, Kingston, Canada.,Department of Medicine, Queen's University, Kingston, Canada
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9
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Incorvaia C, Al‐Ahmad M, Ansotegui IJ, Arasi S, Bachert C, Bos C, Bousquet J, Bozek A, Caimmi D, Calderón MA, Casale T, Custovic A, De Blay F, Demoly P, Devillier P, Didier A, Fiocchi A, Fox AT, Gevaert P, Gomez M, Heffler E, Ilina N, Irani C, Jutel M, Karagiannis E, Klimek L, Kuna P, O'Hehir R, Kurbacheva O, Matricardi PM, Morais‐Almeida M, Mosges R, Novak N, Okamoto Y, Panzner P, Papadopoulos NG, Park H, Passalacqua G, Pawankar R, Pfaar O, Schmid‐Grendelmeier P, Scurati S, Tortajada‐Girbés M, Vidal C, Virchow JC, Wahn U, Worm M, Zieglmayer P, Canonica GW. Personalized medicine for allergy treatment: Allergen immunotherapy still a unique and unmatched model. Allergy 2021; 76:1041-1052. [PMID: 32869882 DOI: 10.1111/all.14575] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/17/2022]
Abstract
The introduction of personalized medicine (PM) has been a milestone in the history of medical therapy, because it has revolutionized the previous approach of treating the disease with that of treating the patient. It is known today that diseases can occur in different genetic variants, making specific treatments of proven efficacy necessary for a given endotype. Allergic diseases are particularly suitable for PM, because they meet the therapeutic success requirements, including a known molecular mechanism of the disease, a diagnostic tool for such disease, and a treatment blocking the mechanism. The stakes of PM in allergic patients are molecular diagnostics, to detect specific IgE to single-allergen molecules and to distinguish the causative molecules from those merely cross-reactive, pursuit of patient's treatable traits addressing genetic, phenotypic, and psychosocial features, and omics, such as proteomics, epi-genomics, metabolomics, and breathomics, to forecast patient's responsiveness to therapies, to detect biomarker and mediators, and to verify the disease control. This new approach has already improved the precision of allergy diagnosis and is likely to significantly increase, through the higher performance achieved with the personalized treatment, the effectiveness of allergen immunotherapy by enhancing its already known and unique characteristics of treatment that acts on the causes.
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Affiliation(s)
| | - Mona Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Kuwait
- Drug Allergy Unit Department of Allergy Al‐Rashed Allergy Center Kuwait
| | | | - Stefania Arasi
- Department of Allergy Bambino Gesu' Childrens' Hospital IRCCS Rome Italy
| | - Claus Bachert
- Upper Airways Research Laboratory ENT Dept Ghent University Hospital Ghent Belgium
- Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Catherine Bos
- Stallergenes Greer Medical Affairs Department Antony France
| | - Jean Bousquet
- University Hospital Montpellier France – MACVIA‐France Montpellier France
| | - Andrzéj Bozek
- Clinical Department of Internal Disease, Dermatology and Allergology Medical University of Silesia Katowice Poland
| | - Davide Caimmi
- Department of Pulmonology and Addictology Arnaud de Villeneuve Hospital Montpellier University Montpellier France
| | - Moises A. Calderón
- Imperial College London – National Heart and Lung Institute Royal Brompton Hospital NHS London UK
| | - Thomas Casale
- Division of Allergy/Immunology University of South Florida Tampa FL USA
| | - Adnan Custovic
- Centre for Respiratory Medicine and Allergy Institute of Inflammation and Repair University of Manchester and University Hospital of South Manchester Manchester UK
| | - Frédéric De Blay
- Allergy Division Chest Diseases Department Strasbourg University Hospital Strasbourg France
| | - Pascal Demoly
- Department of Pulmonology and Addictology Arnaud de Villeneuve Hospital Montpellier University Montpellier France
- Sorbonne Université UMR‐S 1136 INSERM IPLESP EPAR Team Paris France
| | - Philippe Devillier
- Laboratoire de Recherche en Pharmacologie Respiratoire Pôle des Maladies des Voies Respiratoires Hôpital Foch Université Paris‐Saclay Suresnes France
| | - Alain Didier
- Respiratory Disease Dept Larrey Hospital University Hospital of Toulouse Paul Sabatier University Toulouse France
| | - Alessandro Fiocchi
- Department of Allergy Bambino Gesu' Childrens' Hospital IRCCS Rome Italy
| | - Adam T. Fox
- Department of Paediatric Allergy Guy's & St Thomas' Hospitals NHS Foundation Trust London UK
| | - Philippe Gevaert
- Upper Airways Research Laboratory ENT Dept Ghent University Hospital Ghent Belgium
| | | | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy – Humanitas Clinical and Research Center IRCCS Rozzano Italy
- Department of Biomedical Science Humanitas University Pieve Emanuele Italy
| | - Natalia Ilina
- Federal Institute of Immunology of Russia Moscow Russia
| | - Carla Irani
- Department of Internal Medicine and Clinical Immunology Faculty of Medicine Hotel Dieu de France Hospital Saint Joseph University Beirut Lebanon
| | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wrocław Poland
| | | | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland
| | - Robin O'Hehir
- Alfred Hospital and Monash University Melbourne Australia
| | - Oxana Kurbacheva
- National Research Center – Institute of Immunology Federal Medical‐Biological Agency of Russia Moscow Russia
| | - Paolo M. Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | - Mario Morais‐Almeida
- Immunoallergy Department of CUF‐Descobertas Hospital Lisbon Portugal
- CUF‐Infante Santo Hospital Lisbon Portugal
| | - Ralph Mosges
- Faculty of Medicine Institute of Medical Statistics and Computational Biology University of Cologne Cologne Germany
- CRI – Clinical Research International Ltd. Cologne Germany
| | - Natalija Novak
- Department of Dermatology and Allergy University Hospital Bonn Bonn Germany
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital "P&A Kyriakou" University of Athens Athens Greece
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Ospedale Policlino San Martino – University of Genoa Genoa Italy
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | | | - Silvia Scurati
- Stallergenes Greer Medical Affairs Department Antony France
| | - Miguel Tortajada‐Girbés
- Pediatric Pulmonology and Allergy Unit Department of Pediatrics Dr. Peset University Hospital Valencia Spain
- Department of Pediatrics, Obstetrics and Gynecology University of Valencia Valencia Spain
- IVI Foundation Valencia Spain
| | - Carmen Vidal
- Allergy Service Complejo Hospitalario Universitario de Santiago Santiago de Compostela Spain
| | - J. Christian Virchow
- Department of Pneumology/Intensive Care Medicine University of Rostock Rostock Germany
| | - Ulrich Wahn
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | - Margitta Worm
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | | | - Giorgio W. Canonica
- Personalized Medicine, Asthma & Allergy – Humanitas Clinical and Research Center IRCCS Rozzano Italy
- Department of Biomedical Science Humanitas University Pieve Emanuele Italy
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10
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Cox L. Pharmacoeconomics of allergy immunotherapy versus pharmacotherapy. Expert Rev Clin Immunol 2021; 17:255-268. [PMID: 33645387 DOI: 10.1080/1744666x.2021.1886079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: The purpose of this review is to evaluate the cost-effectiveness of allergy immunotherapy (AIT) in the treatment of allergic rhinitis, asthma, and other allergic conditions.Area covered: An extensive search of the PubMed and Medline database (January 1996 up to June of 2020) was conducted using the search terms allergy immunotherapy, pharmacoeconomics, cost-effectiveness, allergic rhinitis, and asthma. Studies were included if they included information on the economics of AIT in comparison to pharmacotherapy in the treatment of allergic rhinitis or asthma either as actual costs or based on theoretical models. Systematic reviews were included if they included information about the cost-effectiveness of AIT.Most clinical trials found significant cost-savings with AIT. The cost-effective time-point ranged from a few months to several years after treatment initiation.. Cost savings were demonstrated as early as 3 months after treatment initiation and were as great as 80% less than SDT in some studies.Expert opinion: There is strong evidence in the collective literature that AIT is cost-effective as compared to SDT alone. The magnitude of AIT's cost-effectiveness is likely underestimated because most of the studies considered during treatment costs and not AIT's long-term benefits or preventive/prophylactic effects or its impact on co-morbid conditions.
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Affiliation(s)
- Linda Cox
- Department of Medicine, Associate Professor of Medicine Nova Southeastern University, Ft. Lauderdale, Florida, USA
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11
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Gál Z, Gézsi A, Semsei ÁF, Nagy A, Sultész M, Csoma Z, Tamási L, Gálffy G, Szalai C. Investigation of circulating lncRNAs as potential biomarkers in chronic respiratory diseases. J Transl Med 2020; 18:422. [PMID: 33168013 PMCID: PMC7653503 DOI: 10.1186/s12967-020-02581-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In the present study the blood expression level of inflammatory response and autoimmunity associated long non-coding RNAs (lncRNAs) were compared in patients with different chronic respiratory diseases and investigated whether they could be used as biomarkers in these diseases. METHODS In the discovery cohort, the gene expression level of 84 lncRNAs were measured in the blood of 24 adult patients including healthy controls and patients with asthma and COPD. In the replication cohort the expression of 6 selected lncRNAs were measured in 163 subjects including healthy controls and adults with allergic rhinitis, asthma, COPD and children with asthma. It was evaluated whether these lncRNAs can be used as diagnostic biomarkers for any studied disease. With systems biology analysis the biological functions of the selected lncRNAs were predicted. RESULTS In the discovery cohort, the mean expression of 27 lncRNAs showed nominally significant differences in at least one comparison. OIP5-AS1, HNRNPU, RP11-325K4.3, JPX, RP11-282O18.3, MZF1-AS1 were selected for measurement in the replication cohort. Three lncRNAs (HNRNPU, RP11-325K4.3, JPX) expressed significantly higher in healthy children than in adult controls. All the mean expression level of the 6 lncRNAs differed significantly between adult allergic rhinitis patients and controls. RP11-325K4.3, HNRNPU and OIP5-AS1 expressed higher in allergic asthma than in non-allergic asthma. COPD and asthma differed in the expression of RP11-325K4.3 from each other. In examining of the lncRNAs as biomarkers the weighted accuracy (WA) values were especially high in the comparison of healthy controls and patients with allergic rhinitis. OIP5-AS1 and JPX achieved 0.98 and 0.9 WA values, respectively, and the combination of the selected lncRNAs also resulted in a high performance (WA = 0.98). Altogether, OIP5-AS1 had the highest discriminative power in case of three out of six comparisons. CONCLUSION Differences were detected in the expression of circulating lncRNAs in chronic respiratory diseases. Some of these differences might be utilized as biomarkers and also suggest a possible role of these lncRNAs in the pathomechanism of these diseases. The lncRNAs and the associated pathways are potential therapeutic targets in these diseases, but naturally additional studies are needed for the confirmation of these results.
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Affiliation(s)
- Zsófia Gál
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - András Gézsi
- Department of Measurements and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary
- MTA-SE Immune-Proteogenomics Extracellular Vesicle Research Group, Semmelweis University, Budapest, Hungary
| | - Ágnes F Semsei
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | | | | | - Zsuzsanna Csoma
- National Korányi Institute of TB and Pulmonology, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Csaba Szalai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary.
- Heim Pál Children's Hospital, Budapest, Hungary.
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12
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Papadopoulos NG. Current Grand Challenges in Allergy. FRONTIERS IN ALLERGY 2020; 1:547654. [PMID: 35386930 PMCID: PMC8974771 DOI: 10.3389/falgy.2020.547654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/24/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, United Kingdom.,Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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13
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Vogelberg C, Brüggenjürgen B, Richter H, Jutel M. Real-World Adherence and Evidence of Subcutaneous and Sublingual Immunotherapy in Grass and Tree Pollen-Induced Allergic Rhinitis and Asthma. Patient Prefer Adherence 2020; 14:817-827. [PMID: 32494127 PMCID: PMC7231771 DOI: 10.2147/ppa.s242957] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Allergen immunotherapy (AIT), when continued for 3 years, is the only disease-modifying treatment for AR and asthma. Adherence is a key to ensure effectiveness, and poor adherence is a contraindication for AIT. The objective of this study was to evaluate real-world adherence to AIT with subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) preparations in patients allergic to grass or tree pollen. The impact of AIT on the consumption of asthma and rhinitis medication was also analyzed. PATIENTS AND METHODS In this retrospective cohort analysis of a German longitudinal prescription database, the adherence of a grass and tree pollen allergoid was examined and compared to two sublingual AIT tablets/drops. Patients receiving grass or tree allergen-specific immunotherapy prescriptions were compared with non-AIT patients receiving symptomatic allergic rhinitis (AR) and asthma prescriptions. The study endpoints included therapy adherence, AR progression, and asthma progression. Multivariate regression analyses were used to estimate the effects of SCIT or SLIT, adjusting for variables related to demographics and prescriptions. RESULTS SCIT adherence was 60.1-61.8% at 2 years and 35.0-37.5% at 3 years for the two allergens. SLIT adherence was distinctly lower (29.5-36.5% and 9.6-18.2%, respectively). Adherence in children was higher compared to adolescents or adults. All products were highly efficacious at reducing symptomatic AR medication consumption. SCIT also reduced asthma medication use for both allergens, whereas for SLIT these results were significant only for grasses but not trees. CONCLUSION Subcutaneous AIT in a real-world setting achieved significantly higher adherence rates compared to sublingual administration. SCIT reduced the use of rhinitis and asthma medication significantly for both allergens, while SLIT reduced the use of rhinitis medication for both allergens and the use of asthma medication for grasses only.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
- Correspondence: Christian Vogelberg University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, Dresden01307, GermanyTel +49 351 458-5699Fax +49 351 458-4334 Email
| | - Bernd Brüggenjürgen
- Institute for Health Economics, Steinbeis University Berlin, Berlin, Germany
| | | | - Marek Jutel
- All-MED Medical Research Institute, Warsaw, Poland
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
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14
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Yamada Y, Kidoguchi M, Yata A, Nakamura T, Yoshida H, Kato Y, Masuko H, Hizawa N, Fujieda S, Noguchi E, Miura K. High-Yield Production of the Major Birch Pollen Allergen Bet v 1 With Allergen Immunogenicity in Nicotiana benthamiana. FRONTIERS IN PLANT SCIENCE 2020; 11:344. [PMID: 32300351 PMCID: PMC7142267 DOI: 10.3389/fpls.2020.00344] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/09/2020] [Indexed: 05/13/2023]
Abstract
Type I allergy is an immunological disorder triggered by allergens and causes significant health problems. The major allergen of birch pollen is Bet v 1, which belongs to the pathogen-related protein 10 (PR-10) family. Here, we established a rapid and robust method for the production of Bet v 1 in Nicotiana benthamiana leaves, with binding activity to allergic patients' IgE. The Bet v 1 allergen was expressed in N. benthamiana using a strong agroinfiltration-based transient protein expression system, which consists of a deconstructed geminiviral vector system with a double terminator. Five days post-infiltration, the allergen concentration in N. benthamiana leaves was 1.2 mg/g of fresh mass, being this the maximum yield of Bet v 1 in plants reported up to now. A part of plant-derived Bet v 1 was glycosylated. Bet v 1 purified from N. benthamiana or Brevibacillus brevis was used to carry out enzyme-linked immunoassays; both recombinant allergens were found to have comparable binding properties to the IgE of allergic patients. These results suggest that our plant expression system allows rapid and robust production of the allergen, which keeps the immunogenicity.
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Affiliation(s)
- Yuki Yamada
- Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
| | - Masanori Kidoguchi
- Department of Medical Genetics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Division of Otorhinolaryngology and Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Akira Yata
- Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
| | - Takako Nakamura
- Department of Medical Genetics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideki Yoshida
- Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
- Tsukuba-Plant Innovation Research Center, University of Tsukuba, Tsukuba, Japan
| | - Yukinori Kato
- Division of Otorhinolaryngology and Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Hironori Masuko
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuyuki Hizawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shigeharu Fujieda
- Division of Otorhinolaryngology and Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Emiko Noguchi
- Department of Medical Genetics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kenji Miura
- Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
- Tsukuba-Plant Innovation Research Center, University of Tsukuba, Tsukuba, Japan
- *Correspondence: Kenji Miura,
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15
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Fassio F, Guagnini F. House dust mite-related respiratory allergies and probiotics: a narrative review. Clin Mol Allergy 2018; 16:15. [PMID: 29946225 PMCID: PMC6006752 DOI: 10.1186/s12948-018-0092-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 12/24/2022] Open
Abstract
The socio-economic burden of allergic respiratory conditions on continental Europe is even higher than that of mainstream diseases, such as diabetes and cardiovascular disease, as allergic rhinitis alone accounts for billions of Euros in healthcare expenses across Europe. House dust mites (HDM) are one of the most common triggers behind allergic rhinitis and asthma. The role of probiotics in the treatment and prevention of some allergic conditions, such as atopic dermatitis, is already well recognized, whereas evidence about their efficacy in patients with respiratory allergies—while increasing—is still limited. Here the current evidence for the use of probiotics in patients with allergic rhinitis and/or asthma is discussed.
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Affiliation(s)
- Filippo Fassio
- 1SOC Allergologia e Immunologica Clinica, Azienda USL Toscana Centro, Nuovo Ospedale S. Giovanni di Dio, Via di Torregalli, 3, 50143 Florence, Italy
| | - Fabio Guagnini
- Allergy Therapeutics Italia, via IV Novembre 76, 20019 Settimo Milanese, Milan Italy
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16
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Molnár V, Nagy A, Tamási L, Gálffy G, Böcskei R, Bikov A, Czaller I, Csoma Z, Krasznai M, Csáki C, Zsigmond G, Csontos Z, Kurucz A, Kurucz E, Fábos B, Bálint BL, Sasvári-Székely M, Székely A, Kótyuk E, Kozma GT, Cserta G, Farkas A, Gál Z, Gézsi A, Millinghoffer A, Antal P, Szalai C. From genomes to diaries: a 3-year prospective, real-life study of ragweed-specific sublingual immunotherapy. Immunotherapy 2018; 9:1279-1294. [PMID: 29130793 DOI: 10.2217/imt-2017-0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
During the last decades, the prevalence of allergy has dramatically increased. Allergen-specific immunotherapy is the only currently available medical intervention that has the potential to affect the natural course of the disease, but there are still many questions and unmet needs hindering its widespread use to fulfill its treatment potential and maximize its benefits for the society. To provide a comprehensive phenome-wide overview in sublingual immunotherapy, using ragweed allergy as a target, we planned and carried out a longitudinal, prospective, observational, open-label study (DesensIT). In this paper we present challenges of using deep and comprehensive phenotypes embracing biological, clinical and patient-reported outcomes in allergen-specific immunotherapy and show how we designed the DesensIT project to optimize data collection, processing and evaluation.
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Affiliation(s)
- Viktor Molnár
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Adrienne Nagy
- Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Renáta Böcskei
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Ibolya Czaller
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Zsuzsanna Csoma
- National Korányi Institute of TB & Pulmonology, 1121 Budapest, Pihenő út 1, Hungary
| | - Magdolna Krasznai
- Department of Otorhinolaryngology, Semmelweis University, Head & Neck Surgery, 1083 Budapest, Szigony u. 36, Hungary
| | - Csilla Csáki
- Svábhegyi Healing Facility, 1037 Budapest, Bokor u. 17, Hungary
| | | | - Zoltán Csontos
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Anikó Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Edina Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Beáta Fábos
- Somogy County Kaposi Mór Teaching Hospital, 7400 Kaposvár Tallián Gyula u. 20-32, Hungary
| | - Bálint L Bálint
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary
| | - Mária Sasvári-Székely
- Institute of Medical Chemistry, Molecular Biology & Pathobiochemistry, Semmelweis University, 1094 Budapest, Tűzoltó utca 37-47, Hungary
| | - Anna Székely
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Eszter Kótyuk
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Gergely T Kozma
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Gábor Cserta
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Anita Farkas
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Zsófia Gál
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Gézsi
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Millinghoffer
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary.,Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Péter Antal
- Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Csaba Szalai
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary.,Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary.,Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
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17
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Abstract
House dust mite (HDM) is a predominant source of indoor aeroallergen worldwide, which induces allergic diseases including allergic rhinoconjunctivitis, allergic asthma, atopic eczema and other allergic skin diseases. Allergen specific immunotherapy (AIT) is the only potential disease-modifying treatment of HDM allergic subjects. However, AIT remains underused due to no universally accepted allergen standardization and a shortage of rigorous clinical studies to confirm safety and efficacy. With the effort of doctors and researchers in allergy field, efficacy, safety, standardization and strategy of AIT are being continuously developed. This review presents the updated research based on recently published trials and meta-analyses.
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Affiliation(s)
- Lin Yang
- a Department of Allergy , Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology , Wuhan , China
| | - Rongfei Zhu
- a Department of Allergy , Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology , Wuhan , China
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18
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Mösges R, Koch AF, Raskopf E, Singh J, Shah‐Hosseini K, Astvatsatourov A, Hauswald B, Yarin Y, Corazza F, Haazen L, Pirotton S, Allekotte S, Zadoyan G, Legon T, Durham SR, Shamji MH. Lolium perenne peptide immunotherapy is well tolerated and elicits a protective B-cell response in seasonal allergic rhinitis patients. Allergy 2018; 73:1254-1262. [PMID: 29322510 PMCID: PMC6032848 DOI: 10.1111/all.13392] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Systemic allergic reactions are a risk for allergen immunotherapy that utilizes intact allergen preparations. We evaluated the safety, efficacy and immune mechanisms of short-course treatment with adjuvant-free Lolium perenne peptides (LPP) following a 6-week dose-escalation protocol. METHODS In a prospective, dose-escalation study, 61 grass pollen-allergic patients received 2 subcutaneous injections of LPP once weekly for 6 weeks. Safety was assessed evaluating local reactions, systemic reactions and adverse events. The clinical effect of LPP was determined by reactivity to the conjunctival provocation test (CPT). Specific IgE, IgG4 and blocking antibodies were measured at baseline (V1), during (V6) and after treatment (V8). RESULTS No fatality, serious adverse event or epinephrine use was reported. Mean wheal diameters after injections were <0.6 cm and mean redness diameters <2.5 cm, independent of dose. Transient and mostly mild adverse events were reported in 33 patients. Two patients experienced a grade I and 4 patients a grade II reaction (AWMF classification). At V8, 69.8% of patients became nonreactive to CPT. sIgG4 levels were higher at V6 (8.1-fold, P < .001) and V8 (12.2-fold, P < .001) than at V1. The sIgE:sIgG4 ratio decreased at V6 (-54.6%, P < .001) and V8 (-71.6%, P < .001) compared to V1. The absolute decrease in IgE-facilitated allergen binding was 18% (P < .001) at V6 and 25% (P < .001) at V8. CONCLUSION Increasing doses of subcutaneous LPP appeared safe, substantially diminished reactivity to CPT and induced blocking antibodies as early as 4 weeks after treatment initiation. The benefit/risk balance of LPP immunotherapy remains to be further evaluated in large studies.
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Affiliation(s)
- R. Mösges
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
- CRI—Clinical Research International LimitedHamburgGermany
| | - A. F. Koch
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - E. Raskopf
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - J. Singh
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - K. Shah‐Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - A. Astvatsatourov
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - B. Hauswald
- Department of Oto‐Rhino‐LaryngologyUniversity Clinic Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Y. Yarin
- Department of Oto‐Rhino‐LaryngologyUniversity Clinic Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - F. Corazza
- Laboratory of Brussels University HospitalsLaboratory of Translational ResearchBrugmann University Hospital, ULBBrusselsBelgium
| | | | | | - S. Allekotte
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - G. Zadoyan
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)Faculty of MedicineUniversity of CologneCologneGermany
| | - T. Legon
- ASIT biotech s.a.BrusselsBelgium
| | - S. R. Durham
- Immunomodulation and Tolerance GroupAllergy and Clinical Immunology, Respiratory Science DivisionNational Heart and Lung InstituteImperial CollegeLondonUK
| | - M. H. Shamji
- Immunomodulation and Tolerance GroupAllergy and Clinical Immunology, Respiratory Science DivisionNational Heart and Lung InstituteImperial CollegeLondonUK
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19
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Abstract
PURPOSE OF REVIEW The progression of atopic disorders from atopic dermatitis in infants to allergic rhinitis and asthma in children, adolescents, and adults defines the allergy march. Allergen immunotherapy is the only causal treatment altering the immunological mechanism underlying the allergic diseases. The sublingual administration route is more acceptable than the subcutaneous one in pediatric age. RECENT FINDINGS Several studies show the efficacy and safety profile of sublingual immunotherapy (SLIT) for the treatment of respiratory allergy diseases, but few data are available on its effect of primary and secondary prevention of allergic disease. The purpose of this manuscript is to review the latest studies addressing the effect of SLIT on the development of new sensitizations in not sensitized or already sensitized patients and progression of the allergy march.
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Affiliation(s)
- Federica Porcaro
- Respiratory Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127, Palermo, Italy
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20
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Puri BK, Howard JM, Monro JA. Desensitization to chemical and food sensitivities by low-dose immunotherapy ascertained by provocation neutralization is associated with reduced influx of calcium ions into lymphocytes. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2018; 14:/j/jcim.2017.14.issue-2/jcim-2016-0010/jcim-2016-0010.xml. [PMID: 28731314 DOI: 10.1515/jcim-2016-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/24/2017] [Indexed: 01/28/2023]
Abstract
Background Food and chemical sensitivities have detrimental effects on health and the quality of life. The natural course of such sensitivities can potentially be altered through various types of allergen-specific immunotherapy, including low-dose immunotherapy. The molecular mechanism by which low-dose immunotherapy causes desensitization has not thus far been elucidated. While resting lymphocytes maintain a low cytosolic calcium ion concentration, antigen receptor signaling results in calcium ion influx, predominantly via store-operated calcium channels. We therefore hypothesized that desensitization by low-dose immunotherapy is associated with reduced influx of calcium ions into lymphocytes. The aim of this study was to test this hypothesis. Methods Intracellular lymphocytic calcium ion concentrations were assayed in a total of 47 patients, following incubation with picogram amounts of the test allergens, using a cell-permeable calcium-sensing ratiometric fluorescent dye and fluorescence spectroscopy, both at baseline and following successful provocation neutralization treatment with low-dose immunotherapy. Results Low-dose immunotherapy was associated with a reduction in lymphocytic intracellular calcium ion concentration following treatment of: 23 % for metabisulfite sensitivity (p<0.0004); 12 % for salicylate sensitivity (p<0.01); 23 % for benzoate sensitivity (p<0.01); 30 % for formaldehyde sensitivity (p<0.0001); 16 % for sensitivity to petrol exhaust (p<0.003); 16 % for natural gas sensitivity (p<0.001); 13 % for nickel sensitivity (p<0.05); 30 % for sensitivity to organophosphates (p<0.01); and 24 % for sensitivity to nitrosamines (p<0.05). Conclusions Low-dose immunotherapy may affect baseline levels of intracellular calcium in lymphocytes, supporting the premise that allergens affect cell signaling in immune cells and provocation neutralization immunotherapy helps to promote more normal immune cell signaling.
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21
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Yonekura S, Okamoto Y, Sakurai D, Okubo K, Gotoh M, Kaneko S, Konno A. An analysis of factors related to the effect of sublingual immunotherapy on Japanese cedar pollen induced allergic rhinitis. Allergol Int 2018; 67:201-208. [PMID: 28760534 DOI: 10.1016/j.alit.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/17/2017] [Accepted: 06/28/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sublingual immunotherapy (SLIT) can improve the symptoms of allergic rhinitis and modify its natural history; however, its efficacy varies among patients. This study aimed to determine which factors modify the effect of SLIT through post hoc analysis of a previous phase 3 trial of standardized Japanese cedar (JC) pollen extract (CEDARTOLEN®). METHODS The study included 482 patients who had previously completed a phase 3 trial during two seasons. The SLIT and placebo groups each contained 241 subjects. Because pollen dispersal differed in the two seasons, we identified good and poor responders from the SLIT group in the 2nd season. We compared patient baseline characteristics, changes in serum immunoglobulin, and severity of symptoms in the 1st season between good and poor responders, as well as between SLIT and placebo groups. RESULTS When we compared the baseline characteristics of good and poor responders, a significant difference was observed in body mass index (BMI) such that the patients with BMI ≥25 presented with lower treatment efficacy. No significant difference was observed in correlation with any other factors or treatment-induced alterations of serum immunoglobulin levels. We found that 75.3% of the patients with moderate symptoms and 50.9% of the patients with severe or very severe symptoms in the 1st season met our criteria for good responders in the 2nd season. CONCLUSIONS BMI might modify the effect of SLIT; however, other factors were not related clearly. The severity of symptoms in the 1st season of treatment does not predict that in the 2nd season.
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Affiliation(s)
- Syuji Yonekura
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshitaka Okamoto
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Daiju Sakurai
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kimihiro Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - Minoru Gotoh
- Department of Otolaryngology, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | | | - Akiyoshi Konno
- Allergy and Head and Neck Tumor Center, Southern Tohoku General Hospital, Fukushima, Japan
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22
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Jeurink PV, Knipping K, Wiens F, Barańska K, Stahl B, Garssen J, Krolak-Olejnik B. Importance of maternal diet in the training of the infant's immune system during gestation and lactation. Crit Rev Food Sci Nutr 2018; 59:1311-1319. [PMID: 29393671 DOI: 10.1080/10408398.2017.1405907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Latest forecasts predict that half of the European population will be allergic within the coming 15 years, with food allergies contributing substantially to the total burden; preventive measures are urgently needed. Unfortunately, all attempted alimentary strategies for primary prevention of allergic diseases through allergen avoidance so far have failed. This also holds true for the prevention of food allergies in breastfed infants by the common practice of excluding certain foods with allergenic potential from the maternal diet. As a preventive measure, therefore, exclusion diets should be discouraged. They can exhaust nursing mothers and negatively impact both their nutritional status as well as their motivation to breastfeed. A prolonged exclusion diet may be indicated solely in cases of doctor-diagnosed food allergy following rigid medical tests (e.g. double-blind placebo-controlled food challenges). Indicated cases usually involve exclusion of only a few food items. Continued breastfeeding is generally important for many aspects of the infant's health, including the training of the infant's immune responses to foreign compounds and avoidance of overshooting inflammatory responses. Recent studies suggest that the presence of maternal dietary proteins in amniotic fluid, cord blood, and human milk might support the induction of tolerance towards solid foods in infants. These are exactly the same species of proteins or remnants thereof that, in comparatively few cases, trigger allergic responses. However, the insight that the proteins of maternal dietary origin in human milk are more likely to be cure (or, more precise, directing prevention) than curse has still largely evaded the attention of health care professionals consulted by worried breastfeeding mothers. In this paper, we summarize recent literature on the importance of exposure to dietary proteins in the establishment of immunological tolerance and hence prevention of allergic disease. Multiple organizations have used the scientific knowledge to build (local) guidelines (e.g. AAAAI, EAACI, BSACI) that can support health care professionals to provide the best strategy to prevent the onset of allergic diseases. We thus hope to clarify existing confusion about the allergenic propensities of dietary proteins during early life, which has contributed to exaggerated fears around the diet of pregnant and breastfeeding mothers.
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Affiliation(s)
- P V Jeurink
- a Nutricia Research , Utrecht , the Netherlands.,b Division of Pharmacology, Department of Pharmaceutical Sciences , Faculty of Science, Utrecht University , the Netherlands
| | - K Knipping
- a Nutricia Research , Utrecht , the Netherlands.,b Division of Pharmacology, Department of Pharmaceutical Sciences , Faculty of Science, Utrecht University , the Netherlands
| | - F Wiens
- a Nutricia Research , Utrecht , the Netherlands
| | - K Barańska
- c Department of Neonatology , Wroclaw Medical University , Wroclaw , Poland
| | - B Stahl
- a Nutricia Research , Utrecht , the Netherlands
| | - J Garssen
- a Nutricia Research , Utrecht , the Netherlands.,b Division of Pharmacology, Department of Pharmaceutical Sciences , Faculty of Science, Utrecht University , the Netherlands
| | - B Krolak-Olejnik
- c Department of Neonatology , Wroclaw Medical University , Wroclaw , Poland
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23
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Bao Y, Chen J, Cheng L, Guo Y, Hong S, Kong W, Lai H, Li H, Li H, Li J, Li T, Lin X, Liu S, Liu Z, Lou H, Meng J, Qiu Q, Shen K, Tang W, Tao Z, Wang C, Wang X, Wei Q, Xiang L, Xie H, Xu Y, Zhang G, Zhang Y, Zheng Y, Zhi Y, Chen D, Hong H, Li Q, Liu L, Meng Y, Wang N, Wang Y, Zhou Y, Zhang L. Chinese Guideline on allergen immunotherapy for allergic rhinitis. J Thorac Dis 2017; 9:4607-4650. [PMID: 29268533 DOI: 10.21037/jtd.2017.10.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present document is based on a consensus reached by a panel of experts from Chinese Society of Allergy (CSA) and Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G). Allergen immunotherapy (AIT), has increasingly been used as a treatment for allergic rhinitis (AR) globally, as it has been shown to provide a long-term effect in improving nasal and ocular symptoms, reducing medication need, and improving quality of life. AIT is currently the only curative intervention that can potentially modify the immune system in individuals suffering from AR and prevent the development of new sensitization and the progression of disease from AR to asthma. Although the use of AIT is becoming more acceptable in China, to date no AR immunotherapy guideline from China is available for use by the international community. This document has thus been produced and covers the main aspects of AIT undertaken in China; including selection of patients for AIT, the allergen extracts available on the Chinese market, schedules and doses of allergen employed in different routes of AIT, assessment of effect and safety, patients' administration and follow-up, and management of adverse reactions. The Chinese guideline for AR immunotherapy will thus serve as a reference point by doctors, healthcare professionals and organizations involved in the AIT of AR in China. Moreover, this guideline will serve as a source of information for the international community on AIT treatment strategies employed in China.
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Affiliation(s)
- Yixiao Bao
- Department of Pediatric Respiratory Medicine, Pubin Children Hospital, Shanghai Children Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lei Cheng
- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing 210029, China
| | - Yinshi Guo
- Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Suling Hong
- Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - He Lai
- Department of Allergy, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Houyong Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Huabin Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, Allergy and Clinical Immunology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Tianying Li
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoping Lin
- The PLA Center of respiratory and allergic disease diagnosing and management, Shenyang 110016, China
| | - Shixi Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zheng Liu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Juan Meng
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qianhui Qiu
- Department of Otorhinolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Kunling Shen
- Department of Pediatric Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wei Tang
- Department of Pulmonary and Critical Care Medicine, Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Zezhang Tao
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Qingyu Wei
- Department of Allergy, NO.202 Hospital of PLA, Shenyang 110003, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Hua Xie
- Department of Respiratory Medicine, the General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Yu Xu
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Yiwu Zheng
- Scientific Affairs, ALK, Guangzhou 510300, China
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100720, China
| | - Dehua Chen
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Haiyu Hong
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Quansheng Li
- Department of Allergy, NO.202 Hospital of PLA, Shenyang 110003, China
| | - Lin Liu
- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Nan Wang
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yihui Wang
- Department of Pediatric Respiratory Medicine, Pubin Children Hospital, Shanghai Children Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yue Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China
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24
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Rodríguez Del Rio P, Pitsios C, Tsoumani M, Pfaar O, Paraskevopoulos G, Gawlik R, Valovirta E, Larenas-Linnemann D, Demoly P, Calderón MA. Physicians' experience and opinion on contraindications to allergen immunotherapy: The CONSIT survey. Ann Allergy Asthma Immunol 2017; 118:621-628.e1. [PMID: 28477792 DOI: 10.1016/j.anai.2017.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy but several contraindications limit its use. OBJECTIVE To collect the outcome of using AIT in theoretically contraindicated situations in real patients in the Contraindications to Specific ImmunoTherapy (CONSIT) survey. METHODS The CONSIT is an electronic European Academy of Allergy and Clinical Immunology survey conducted to gather the safety outcomes of patients undergoing subcutaneous, sublingual, or venom AIT and the opinions of physicians on each of 17 selected conditions: children younger than 5 years; starting AIT during pregnancy; controlled severe asthma; arrhythmias; coronary disease; cancer; autoimmune disease; bone marrow and solid organ transplantation; human immunodeficiency virus and acquired immunodeficiency syndrome; previous anaphylaxis during AIT; use of β-blockers, angiotensin-converting inhibitors, cyclosporine, and methotrexate; and inability to communicate. Safety using AIT was reported in a 3-point scale: 1, "no problems"; 2, "minor problems" (requiring only dose modifications); and 3, "major problems" (AIT not tolerated). Each physician was asked about the degree of contraindication that each condition should have: no contraindication (score 1), relative contraindication (score 2), or absolute contraindication (score 3). RESULTS Five hundred twenty physicians (75% Europeans, 89% allergists) reported on approximately 45,000 patients undergoing AIT with any of these conditions. Major problems were infrequent, occurring more frequently in patients with asthma (9.9%) and with previous anaphylaxis from AIT (9.5%). Regarding opinions, experienced physicians scored a significantly lower mean for all conditions than non-experienced physicians for all routes. CONCLUSION Major problems were infrequent and experienced physicians were less likely to be restrictive in the use of AIT.
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Affiliation(s)
| | | | - Marina Tsoumani
- Centre for Respiratory Medicine and Allergy, University Hospital of South Manchester and Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Radoslaw Gawlik
- Department of Internal Medicine, Allergy and Clinical Immunology, Silesian University of Medicine, Katowice, Poland
| | - Erkka Valovirta
- Terveystalo Turku, Allergy Clinic, University of Turku, Turku, Finland
| | | | - Pascal Demoly
- Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013, Paris, France
| | - Moises A Calderón
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute and Royal Brompton Hospital NSH, London, United Kingdom
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25
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Abstract
Proteomics encompasses a variety of approaches unraveling both the structural features, post-translational modifications, and abundance of proteins. As of today, proteomic studies have shed light on the primary structure of about 850 allergens, enabling the design of microarrays for improved molecular diagnosis. Proteomic methods including mass spectrometry allow as well to investigate protein-protein interactions, thus yielding precise information on critical epitopes on the surface of allergens. Mass spectrometry is now being applied to the unambiguous identification, characterization, and comprehensive quantification of allergens in a variety of matrices, as diverse as food samples and allergen immunotherapy drug products. As such, it represents a method of choice for quality testing of allergen immunotherapy products.
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26
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Tanno LK, Haahtela T, Calderon MA, Cruz A, Demoly P. Implementation gaps for asthma prevention and control. Respir Med 2017; 130:13-19. [PMID: 29206628 DOI: 10.1016/j.rmed.2017.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 12/22/2022]
Abstract
Asthma and allergic diseases can start in childhood and persist throughout life, but could also be manifested later, at any time for still misunderstood reasons. They are major chronic multifactorial respiratory diseases, for which prevention, early diagnosis and treatment is recognized as a priority for the Europe's public health policy and the United Nations. Given that allergy triggers (including infections, rapid urbanization leading to loss in biodiversity, pollution and climate changes) are not expected to change in a foreseeable future, it is imperative that steps are taken to develop, strengthen and optimize preventive and treatment strategies. Currently there are good treatments for asthma, several risk factors are known (e.g., allergies, rhinitis, tobacco smoke) and tools to control the disease have been developed. However, we are still uncertain how to prevent patients from developing asthma and allergic diseases. In this paper, we list the positive and negative experiences in this field as well as analyze the missing links in the process. This critical analysis will be the basis of setting-up an effective program for prevention and making, a process labeled as "implementation gaps".
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Affiliation(s)
- Luciana K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil; Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France.
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Central Hospital, FI-00029 Helsinki, Finland
| | - Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Alvaro Cruz
- ProAR-Núcleo de Excelência em Asma da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
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27
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Hoffmann HJ, Valovirta E, Pfaar O, Moingeon P, Schmid JM, Skaarup SH, Cardell LO, Simonsen K, Larché M, Durham SR, Sørensen P. Novel approaches and perspectives in allergen immunotherapy. Allergy 2017; 72:1022-1034. [PMID: 28122129 DOI: 10.1111/all.13135] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 01/01/2023]
Abstract
In this review, we report on relevant current topics in allergen immunotherapy (AIT) which were broadly discussed during the first Aarhus Immunotherapy Symposium (Aarhus, Denmark) in December 2015 by leading clinicians, scientists and industry representatives in the field. The aim of this symposium was to highlight AIT-related aspects of public health, clinical efficacy evaluation, mechanisms, development of new biomarkers and an overview of novel therapeutic approaches. Allergy is a public health issue of high socioeconomic relevance, and development of evidence-based action plans to address allergy as a public health issue ought to be on national and regional agendas. The underlying mechanisms are in the focus of current research that lays the ground for innovative therapies. Standardization and harmonization of clinical endpoints in AIT trials as well as current knowledge about potential biomarkers have substantiated proof of effectiveness of this disease-modifying therapeutic option. Novel treatments such as peptide immunotherapy, intralymphatic immunotherapy and use of recombinant allergens herald a new age in which AIT may address treatment of allergy as a public health issue by reaching a large fraction of patients.
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Affiliation(s)
- H. J. Hoffmann
- Department of Clinical Medicine; HEALTH; Aarhus University; Aarhus Denmark
- Department of Respiratory Diseases and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - E. Valovirta
- Department of Lung Diseases and Clinical Immunology; University of Turku; Turku Finland
- Filha; Finnish Lung Health Association; Helsinki Finland
- Terveystalo Allergy Clinic Turku; Finland
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Medical Faculty Mannheim; Universitätsmedizin Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - P. Moingeon
- Research and Development; StallergenesGreer; Antony Cedex France
| | - J. M. Schmid
- Department of Clinical Medicine; HEALTH; Aarhus University; Aarhus Denmark
- Department of Respiratory Diseases and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - S. H. Skaarup
- Department of Clinical Medicine; HEALTH; Aarhus University; Aarhus Denmark
- Department of Respiratory Diseases and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - L.-O. Cardell
- Division of ENT Diseases; Department of Clinical Sciences, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of ENT Diseases; Karolinska University Hospital; Stockholm Sweden
| | - K. Simonsen
- Anergis SA; BioPole III; Epalinges Switzerland
| | - M. Larché
- Clinical Immunology & Allergy and Respirology Divisions; Department of Medicine; McMaster University; Hamilton ON Canada
- Firestone Institute for Respiratory Health; McMaster University; Hamilton ON Canada
| | - S. R. Durham
- Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College London; London UK
| | - P. Sørensen
- Research and Development; StallergenesGreer; Antony Cedex France
- Department of Biomedicine; HEALTH; Aarhus University & Research; Aarhus Denmark
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28
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Palomares Ó, Sánchez-Ramón S, Dávila I, Prieto L, Pérez de Llano L, Lleonart M, Domingo C, Nieto A. dIvergEnt: How IgE Axis Contributes to the Continuum of Allergic Asthma and Anti-IgE Therapies. Int J Mol Sci 2017. [PMID: 28635659 PMCID: PMC5486149 DOI: 10.3390/ijms18061328] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Asthma is an airway disease characterised by chronic inflammation with intermittent or permanent symptoms including wheezing, shortness of breath, chest tightness, and cough, which vary in terms of their occurrence, frequency, and intensity. The most common associated feature in the airways of patients with asthma is airway inflammation. In recent decades, efforts have been made to characterise the heterogeneous clinical nature of asthma. The interest in improving the definitions of asthma phenotypes and endotypes is growing, although these classifications do not always correlate with prognosis nor are always appropriate therapeutic approaches. Attempts have been made to identify the most relevant molecular and cellular biomarkers underlying the immunopathophysiological mechanisms of the disease. For almost 50 years, immunoglobulin E (IgE) has been identified as a central factor in allergic asthma, due to its allergen-specific nature. Many of the mechanisms of the inflammatory cascade underlying allergic asthma have already been elucidated, and IgE has been shown to play a fundamental role in the triggering, development, and chronicity of the inflammatory responses within the disease. Blocking IgE with monoclonal antibodies such as omalizumab have demonstrated their efficacy, effectiveness, and safety in treating allergic asthma. A better understanding of the multiple contributions of IgE to the inflammatory continuum of asthma could contribute to the development of novel therapeutic strategies for the disease.
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Affiliation(s)
- Óscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, 28040 Madrid, Spain.
| | - Silvia Sánchez-Ramón
- Department of Clinical Immunology and Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain.
- Department of Microbiology I, Complutense University School of Medicine, 28040 Madrid, Spain.
| | - Ignacio Dávila
- Allergy Service, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca (IBSAL), Biomedical and Diagnosis Science Department, Salamanca University School of Medicine, 37008 Salamanca, Spain.
| | - Luis Prieto
- Department of Allergy and Immunology, University of Valencia and Dr. Peset University Hospital, 46017 Valencia, Spain.
| | | | | | - Christian Domingo
- Pulmonary Service, Corporació Sanitària Parc Taulí, Department of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain.
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy Unit, Children's Hospital La Fe, 46026 Valencia, Spain.
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29
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30
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Işık S, Çağlar A, Eroğlu-Filibeli B, Çağlayan-Sözmen Ş, Arıkan-Ayyıldız Z, Asilsoy S, Uzuner N. Knowledge, perspectives and attitudes about allergen-specific immunotherapy for respiratory allergic disease among paediatricians in Turkey. Allergol Immunopathol (Madr) 2017; 45:193-197. [PMID: 27889335 DOI: 10.1016/j.aller.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Allergen-specific immunotherapy (ASI) is the only effective treatment for allergic respiratory diseases which has the potential to change the natural course of the disease. In this present study we aimed to evaluate the paediatricians' knowledge, perspectives and attitudes about ASI for allergic respiratory diseases. MATERIALS AND METHODS The study was conducted between September 2014 - January 2015. A survey of 25 questions assessing paediatricians' knowledge, perceptions and attitudes about ASI was developed by an expert panel and applied by physicians in hospitals in Izmir, Turkey, where the paediatricians work. Data were recorded in SPSS for Windows v.16. Descriptive statistics, chi square analysis was used. P<0.05 was considered as significant. RESULTS Fully completed surveys from 180 paediatricians were analysed. The respondent paediatricians had an age of 37±8.2 years, and 56 of them were male. The majority of the respondents (n: 146) were working fewer than five years as a paediatric specialist. 93.9% of the paediatricians believed that ASI was effective for the treatment of allergic respiratory diseases. There was satisfactory knowledge of the characteristics, aims, effects and limits of ASI. CONCLUSION ASI is generally well-known and accepted among paediatricians. A better synergy between paediatricians and paediatric allergy specialists can provide more use of this treatment method for allergic respiratory diseases in childhood.
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Affiliation(s)
- S Işık
- Dokuz Eylul University, Department of Pediatric Allergy and Immunology.
| | - A Çağlar
- Dokuz Eylul University, Department of Pediatrics
| | | | - Ş Çağlayan-Sözmen
- Dokuz Eylul University, Department of Pediatric Allergy and Immunology
| | - Z Arıkan-Ayyıldız
- Dokuz Eylul University, Department of Pediatric Allergy and Immunology
| | - S Asilsoy
- Dokuz Eylul University, Department of Pediatric Allergy and Immunology
| | - N Uzuner
- Dokuz Eylul University, Department of Pediatric Allergy and Immunology
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31
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Pajno GB, Bernardini R, Peroni D, Arasi S, Martelli A, Landi M, Passalacqua G, Muraro A, La Grutta S, Fiocchi A, Indinnimeo L, Caffarelli C, Calamelli E, Comberiati P, Duse M. Clinical practice recommendations for allergen-specific immunotherapy in children: the Italian consensus report. Ital J Pediatr 2017; 43:13. [PMID: 28257631 PMCID: PMC5347813 DOI: 10.1186/s13052-016-0315-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/25/2016] [Indexed: 02/07/2023] Open
Abstract
Allergen-specific immunotherapy (AIT) is currently recognized as a clinically effective treatment for allergic diseases, with a unique disease-modifying effect. AIT was introduced in clinical practice one century ago, and performed in the early years with allergenic extracts of poor quality and definition. After the mechanism of allergic reaction were recognized, the practice of AIT was refined, leading to remarkable improvement in the efficacy and safety profile of the treatment. Currently AIT is accepted and routinely prescribed worldwide for respiratory allergies and hymenoptera venom allergy. Both the subcutaneous (SCIT) and sublingual (SLIT) routes of administration are used in the pediatric population.AIT is recommended in allergic rhinitis/conjunctivitis with/without allergic asthma, with an evidence of specific IgE-sensitization towards clinically relevant inhalant allergens. Long-term studies provided evidence that AIT can also prevent the onset of asthma and of new sensitizations. The favorable response to AIT is strictly linked to adherence to treatment, that lasts 3-5 years. Therefore, several factors should be carefully evaluated before starting this intervention, including the severity of symptoms, pharmacotherapy requirements and children and caregivers' preference and compliance.In recent years, there have been increasing interest in the role of AIT for the treatment of IgE-associated food allergy and extrinsic atopic dermatitis. A growing body of evidence shows that oral immunotherapy represents a promising treatment option for IgE-associated food allergy. On the contrary, there are still controversies on the effectiveness of AIT for patients with atopic dermatitis.This consensus document was promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP) to provide evidence-based recommendations on AIT in order to implement and optimize current prescription practices of this treatment for allergic children.
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Affiliation(s)
- Giovanni Battista Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Via Consolare Valeria-Gazzi, Messina, 98124 Italy
| | | | | | - Stefania Arasi
- Department of Pediatrics, Allergy Unit, University of Messina, Via Consolare Valeria-Gazzi, Messina, 98124 Italy
- Molecular Allergology and Immunomodulation- Department of Pediatric Pneumology and Immunology, Charité Medical University Berlin, Berlin, Germany
| | - Alberto Martelli
- Pediatric Unit, Hospital “G. Salvini”, Garbagnate Milanese, Italy
| | - Massimo Landi
- National Pediatric Healthcare System, Turin, Italy
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Genoa, Italy
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Stefania La Grutta
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | | | | | - Carlo Caffarelli
- Pediatric Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | | | - Marzia Duse
- Department of Pediatrics, University “La Sapienza”, Rome, Italy
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Cardona V, Luengo O, Labrador-Horrillo M. Immunotherapy in allergic rhinitis and lower airway outcomes. Allergy 2017; 72:35-42. [PMID: 27439141 DOI: 10.1111/all.12989] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 11/29/2022]
Abstract
Allergic rhinitis and asthma constitute two clinical expressions of a single-condition, respiratory allergy. Allergen immunotherapy (AIT) is a form of treatment specifically aimed at modifying the response to sensitizing allergens. The inherent potential benefit of AIT is the simultaneous treatment of all clinical expressions of respiratory allergy. Current data support the effectiveness of subcutaneous and sublingual immunotherapy in rhinitis. Studies also provide proof for a beneficial effect in allergic asthma. Even more, substantial evidence points to the preventive effect on the progression from rhinitis to asthma. Despite the current knowledge on the basic mechanisms underlying the immunological effect of AIT is vast, the specific mechanisms for the preventive effect of primary sensitization or new sensitizations are poorly understood. This review aimed to provide a critical overview of the current knowledge on the effectiveness of AIT and its potential role in secondary prevention of respiratory allergy progression.
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Affiliation(s)
- V. Cardona
- Allergy Section; Department of Internal Medicine; Hospital Vall d'Hebron; Barcelona Spain
- Allergy Research Group; Institut de Recerca Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona Spain
| | - O. Luengo
- Allergy Section; Department of Internal Medicine; Hospital Vall d'Hebron; Barcelona Spain
- Allergy Research Group; Institut de Recerca Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona Spain
| | - M. Labrador-Horrillo
- Allergy Section; Department of Internal Medicine; Hospital Vall d'Hebron; Barcelona Spain
- Allergy Research Group; Institut de Recerca Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona Spain
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Feng B, Wu J, Chen B, Xiang H, Chen R, Li B, Chen S. Efficacy and Safety of Sublingual Immunotherapy for Allergic Rhinitis in Pediatric Patients: A Meta-Analysis of Randomized Controlled Trials. Am J Rhinol Allergy 2017; 31:27-35. [PMID: 28234149 DOI: 10.2500/ajra.2017.31.4382] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Allergic rhinitis (AR) has become a global health problem that constantly affects a large part of the general population, especially children. Objective Sublingual allergen immunotherapy (SLIT) has been used extensively for pediatric AR, although its efficacy and safety are often questioned. In this meta-analysis of randomized controlled trials (RCT), we evaluated the use of SLIT for pediatric AR. Methods A number of medical literature data bases were searched through January 2016 to identify RCTs that examined the use of SLIT for pediatric AR and that assessed clinical outcomes related to efficacy. Descriptive and quantitative information was abstracted. Standardized mean differences (SMD) were calculated by using fixed- and random-effects models. Subgroup analyses were performed. Heterogeneity was assessed by using the I2 metric. A network meta-analysis was used to estimate SMDs between two SLIT protocols for pediatric seasonal AR. All data were extracted from publications or received from the authors. Results Twenty-six studies were eligible for inclusion in the meta-analysis of rhinitis or rhinoconjunctivitis symptom scores, and 19 studies were eligible for the meta-analysis of medication scores. Descriptive and quantitative data were extracted. SLIT differed significantly from placebo in terms of symptom scores (SMD -0.55 [95% confidence interval {CI}, -0.86 to -0.25]; p = 0.0003, I2 = 90%) and medication scores (SMD -0.67 [95% CI, -0.96 to -0.38J; p < 0.00001, I2 = 83%). Oral pruritus was the adverse effect, which occurred most commonly in children who were receiving SLIT. Network meta-analysis revealed no significant difference between the pre-coseasonal and continuous SLIT protocols for seasonal AR in symptom scores (SMD -6.55 [95% CI, -25.38 to 12.29]; p = 0.496) and medication scores (SMD -8.83 [95% CI, -22.10 to 4.43]; p = 0.192). Conclusions Our meta-analysis results indicated that SLIT provided significant symptom relief and reduced the need for medication in pediatric patients Moreover, the safety of SLIT needs to be confirmed in RCTs with larger samples.
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Affiliation(s)
- Bohai Feng
- Department of Otolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China. No.523302
| | - Jueting Wu
- Department of Otolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China. No.523302
| | - Bobei Chen
- Department of Otolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China. No.523302
| | - Haijie Xiang
- Department of Otolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China. No.523302
| | - Ruru Chen
- Department of Otolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China. No.523302
| | - Bangliang Li
- Department of Otolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China. No.523302
| | - Si Chen
- Department of Otolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China. No.523302
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Canonica GW, Senna G, Mitchell PD, O'Byrne PM, Passalacqua G, Varricchi G. Therapeutic interventions in severe asthma. World Allergy Organ J 2016; 9:40. [PMID: 27942351 PMCID: PMC5125042 DOI: 10.1186/s40413-016-0130-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/04/2016] [Indexed: 12/29/2022] Open
Abstract
The present paper addresses severe asthma which is limited to 5-10% of the overall population of asthmatics. However, it accounts for 50% or more of socials costs of the disease, as it is responsible for hospitalizations and Emergency Department accesses as well as expensive treatments. The recent identification of different endotypes of asthma, based on the inflammatory pattern, has led to the development of tailored treatments that target different inflammatory mediators. These are major achievements in the perspective of Precision Medicine: a leading approach to the modern treatment strategy. Omalizumab, an anti-IgE antibody, has been the only biologic treatment available on the market for severe asthma during the last decade. It prevents the linkage of the IgE and the receptors, thereby inhibiting mast cell degranulation. In clinical practice omalizumab significantly reduced the asthma exacerbations as well as the concomitant use of oral glucocorticoids. In the "Th2-high asthma" phenotype, the hallmarks are increased levels of eosinophils and other markers (such as periostin). Because anti-IL-5 in this condition plays a crucial role in driving eosinophil inflammation, this cytokine or its receptors on the eosinophil surface has been studied as a potential target for therapy. Two different anti-IL-5 humanized monoclonal antibodies, mepolizumab and reslizumab, have been proven effective in this phenotype of asthma (recently they both came on the market in the United States), as well as an anti-IL-5 receptor alpha (IL5Rα), benralizumab. Other monoclonal antibodies, targeting different cytokines (IL-13, IL-4, IL-17 and TSLP) are still under evaluation, though the preliminary results are encouraging. Finally, AIT, Allergen Immunotherapy, a prototype of Precision Medicine, is considered, also in light of the recent evidences of Sublingual Immunotherapy (SLIT) tablet efficacy and safety in mite allergic asthma patients. Given the high costs of these therapies, however, there is an urgent need to identify biomarkers that can predict the clinical responders.
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Affiliation(s)
- Giorgio Walter Canonica
- Allergy & Respiratory Disease Clinic, DIMI Department of Internal Medicine, IRCCS AOU San Martino-IST, University of Genoa, Genova, Italy
| | - Gianenrico Senna
- Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Patrick D Mitchell
- Firestone Institute of Respiratory Health and Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Paul M O'Byrne
- Firestone Institute of Respiratory Health and Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Giovanni Passalacqua
- Allergy & Respiratory Disease Clinic, DIMI Department of Internal Medicine, IRCCS AOU San Martino-IST, University of Genoa, Genova, Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences, Division of Clinical Immunology and Allergy, University of Naples Federico II, Naples, Italy
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Elenius V, Jartti T. Vaccines: could asthma in young children be a preventable disease? . Pediatr Allergy Immunol 2016; 27:682-686. [PMID: 27171908 DOI: 10.1111/pai.12598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 12/14/2022]
Abstract
The long battle with asthma is far from over in developed countries. Its incidence, prevalence, and severity have been increasing for decades. By reducing the risk for asthma, significant healthcare costs can be saved. The desire to create a vaccine that might prevent asthma in young children is attractive and widely considered one of the main goals in translational asthma research. Several vaccination strategies have been tested. These include allergen-specific immunotherapy, vaccination against infectious pathogens, and modification of cell and cytokine responses. The lack of success in the prevention of asthma in young children lies on the complexity of the disease, which involves many genetic, epigenetic, and environmental interactions. This review provides a summary of current literature and aims to address key questions how to develop vaccines to prevent asthma in young children. .
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Affiliation(s)
- Varpu Elenius
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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Clinically relevant outcome measures for new pharmacotherapy, allergen avoidance and immunotherapy trials in allergic rhinoconjunctivitis. Curr Opin Allergy Clin Immunol 2016; 15:197-203. [PMID: 25899694 DOI: 10.1097/aci.0000000000000164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a current overview on both primary and secondary measures of efficacy of therapeutic interventions for clinical trials in allergic rhinoconjunctivitis (ARC) patients. In particular, this review highlights similarities and differences regarding endpoints in trials involving allergen immunotherapy (AIT), pharmacotherapy and allergen avoidance and addresses unmet needs regarding these measures in the future. RECENT FINDINGS In 2014, the European Academy of Allergy and Clinical Immunology (EAACI) proposed a standard for the definition of the primary endpoint for AIT trials in ARC and, moreover, emphasized the advantages and disadvantages as well as unmet needs considering outcome measures for this treatment. Recently, as an (indirect) comparison of clinical efficacy of different interventions, the relative clinical impact (RCI) has been used to determine the percentage reduction of symptom scores in active versus placebo treatment. SUMMARY Several primary and secondary clinical endpoints of therapeutic interventions for clinical trials in ARC patients such as AIT or pharmacotherapy have been proposed by the U.S. Food and Drug Administration (FDA) as well as by the European Medicines Agency (EMA). Moreover, recommendations for the implication of these endpoints in clinical trials have been promoted by academia such as the World Allergy Organization (WAO) or the European Academy of Allergy and Clinical Immunology (EAACI).However, an urgent need for the future will be a thorough international harmonization regarding the definition of clinical endpoints, timing of assessments of clinical efficacy and determination of the clinically meaningful and relevant magnitude of efficacy of therapeutic interventions for clinical trials in ARC patients.
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Abstract
Allergic rhinitis and migraine remain on the list of the most common diseases affecting adults. Migraines and headaches due to allergic rhinitis are easily confused because the symptoms of both conditions often overlap. Both may occur with sinus headache, nasal congestion, and lacrimation and may worsen with weather changes and exposure to allergens. No precise clinical definition exists for what constitutes a sinus headache, which has always been a diagnostic dilemma. Contrary to popular belief, headache is not a typical symptom of rhinitis. Some studies have shown that up to 90 % of sinus headaches are actually migraines. Nevertheless, patients with self-diagnosed sinus headache self-treat or are treated by primary care physicians and/or otolaryngologists with medications for rhinosinusitis, ignoring the neurogenic causes of the symptoms when most of these patients fulfill diagnostic criteria for chronic migraine. Chronic migraine affects 2 % of the general population and has a significant socioeconomic impact on society, incurring health care costs and diminishing quality of life; therefore, the proper diagnosis and treatment of these headache patients should be a priority.
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Affiliation(s)
- Anna Gryglas
- Department of Neurology, Gromkovski Voivodship Hospital, Department of Social Pediatrics, Wroclaw Medical University, Wroclaw, Poland.
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Henmar H, Frisenette SMT, Grosch K, Nielsen K, Smith G, Sønderkær S, Larsen JN. Fractionation of Source Materials Leads to a High Reproducibility of the SQ House Dust Mite SLIT-Tablets. Int Arch Allergy Immunol 2016; 169:23-32. [PMID: 26954940 DOI: 10.1159/000444016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The production of house dust mite (HDM) allergen products for allergy immunotherapy has traditionally been based on purified mite bodies or whole-mite culture, which are quite different source materials with a limited possibility for adjusting the chemical composition. The SQ HDM SLIT-tablet is a fast-dissolving pharmaceutical formulation that has been developed for sublingual immunotherapy (SLIT) of HDM respiratory allergic disease. OBJECTIVE The objective of the present study was to establish a process for the production of drug substances for the SQ HDM SLIT-tablet offering a high reproducibility and independent control of the major allergens. METHODS Process controls were documented in a comprehensive process parameter qualification. The analyses comprised composition by crossed immunoelectrophoresis, protein content by BCA, total IgE binding potency by Centaur assay, quantitative major allergen determination by radial immunodiffusion and ELISA, and the ranking of emPAI scores generated by mass spectrometry. RESULTS Analysis of 20 batches of final product yielded a normalized mean and standard deviation for IgE binding potency of 100 ± 4.5. The standard deviation in the contents of Der f 1 and Der p 1 were correspondingly 11.9 and 6.1, whereas the variation in the group 2 major allergen content was 6.4. All measured 95% confidence limits between batches were less than 12%. CONCLUSIONS The production process for the SQ HDM SLIT-tablet based on the separation of source material into four fractions each enriched in one major allergen enables precise adjustment of the relative major allergen content and high reproducibility of the final product.
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Affiliation(s)
- Helene Henmar
- ALK A/S Research and Development, Hx00F8;rsholm, Denmark
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Abstract
PURPOSE OF REVIEW To evaluate the cost-effectiveness of allergen immunotherapy (AIT) in the treatment of allergic rhinitis and asthma. Individual studies and systematic reviews that included information on AIT economic outcomes as compared with symptomatic drug treatment (SDT) were evaluated. RECENT FINDINGS One systematic review that included 14 studies concluded that subcutaneous and sublingual immunotherapy may be cost-effective compared with SDT from around 6 years. Another systematic review of 24 studies comparing economic outcomes of subcutaneous allergy immunotherapy and/or sublingual allergy immunotherapy with SDT found compelling evidence for cost-savings with both forms of AIT over SDT. There was no strong evidence indicating superior cost-efficacy of subcutaneous allergy immunotherapy or sublingual allergy immunotherapy over SDT in either of these systematic reviews. Individual studies have demonstrated AIT cost-savings as high as 80% compared with SDT. Significant cost-savings were reported as early as 3 months after AIT initiation. In some studies, cost-efficacy time-point was not established until after treatment discontinuation - presumably due to time required for the clinical benefits to outweigh the AIT treatment costs. Although some economic modeling studies included the costs of 'asthma prevented', the collective literature of AIT economics provides very little to no information about the cost benefits of the preventive aspect of AIT. SUMMARY Overall, individual studies and systematic reviews provide strong evidence for the cost-effectiveness of AIT over SDT. The magnitude of cost-efficacy is likely underestimated in that few studies consider the cost-savings due to AIT's long-term benefits or preventive effect.
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Schmid JM, Würtzen PA, Dahl R, Hoffmann HJ. Pretreatment IgE sensitization patterns determine the molecular profile of the IgG4 response during updosing of subcutaneous immunotherapy with timothy grass pollen extract. J Allergy Clin Immunol 2016; 137:562-70. [DOI: 10.1016/j.jaci.2015.05.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
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Al-Moamary MS, Alhaider SA, Idrees MM, Al Ghobain MO, Zeitouni MO, Al-Harbi AS, Yousef AA, Al-Matar H, Alorainy HS, Al-Hajjaj MS. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2016; 11:3-42. [PMID: 26933455 PMCID: PMC4748613 DOI: 10.4103/1817-1737.173196] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/08/2015] [Indexed: 12/21/2022] Open
Abstract
This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan.
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Affiliation(s)
- Mohamed S. Al-Moamary
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami A. Alhaider
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Majdy M. Idrees
- Department of Medicine, Pulmonary Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed O. Al Ghobain
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Adel S. Al-Harbi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah A. Yousef
- Department of Pediatrics, College of Medicine, University of Dammam, Dammam, Saudi Arabia
| | - Hussain Al-Matar
- Department of Medicine, Imam Abdulrahman Al Faisal Hospital, Dammam, Saudi Arabia
| | - Hassan S. Alorainy
- Department of Respiratory Care, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Medicine, Respiratory Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Lin Z, Liu Q, Li T, Chen D, Chen D, Xu R. The effects of house dust mite sublingual immunotherapy in patients with allergic rhinitis according to duration. Int Forum Allergy Rhinol 2015; 6:82-7. [PMID: 26575696 DOI: 10.1002/alr.21657] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 08/06/2015] [Accepted: 09/01/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The safety and efficacy of sublingual immunotherapy (SLIT) have been demonstrated in the recent 2 decades. However, the data is still mixed regarding the efficacy of house dust mite (HDM) SLIT. The objective of this work was to evaluate the different clinical efficacy SLIT in patients with allergic rhinitis (AR) according to different durations of treatment. METHODS A total of 500 subjects with HDM-induced AR were randomized to receive SLIT with Dermatophagoides farinae (Der.f) drops or pharmacotherapy with oral antihistamines. Patients in the SLIT group were further divided into SLIT1, SLIT2, and SLIT3 subgroups. After SLIT completion, a yearly follow-up visit was given to patients in the SLIT1 and SLIT2 subgroups. The total nasal symptom score (TNSS), the proportion of medication withdrawal, the visual analogue scale (VAS) score, and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores were assessed at each monthly visit. RESULTS Comparing with the baseline value, TNSS, VAS, and RQLQ were significantly improved in 3 SLIT subgroups after treatment (p < 0.05). In addition, patients in SLIT3 subgroup achieved the highest proportion of medication withdrawal compared to the SLIT1 and SLIT2 subgroups (p < 0.05). After 1-year follow-up, no significant differences were observed in TNSS, VAS scores, and the proportion of medication withdrawal of SLIT1 and SLIT2 subgroups (p > 0.05) with respect to the completion value. No severe systemic adverse events (AEs) were reported. CONCLUSION The randomized study suggested that 3-year courses of SLIT in patients with AR was more efficacious than 1-year or 2-year courses. Furthermore, patients achieved 1-year long-term clinical benefits from HDM SLIT.
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Affiliation(s)
- Zhibin Lin
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qihong Liu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tianying Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dong Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dehua Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rui Xu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Mirzakhani H, Al-Garawi A, Weiss ST, Litonjua AA. Vitamin D and the development of allergic disease: how important is it? Clin Exp Allergy 2015; 45:114-25. [PMID: 25307157 DOI: 10.1111/cea.12430] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Vitamin D has known effects on lung development and the immune system that may be important in the development, severity, and course of allergic diseases (asthma, eczema, and food allergy). Vitamin D deficiency is prevalent worldwide and may partly explain the increases in asthma and allergic diseases that have occurred over the last 50-60 years. In this review, we explore past and current knowledge on the effect of vitamin D on lung development and immunomodulation and present the evidence of its role in allergic conditions. While there is growing observational and experimental evidence for the role of vitamin D, well-designed and well-powered clinical trials are needed to determine whether supplementation of vitamin D should be recommended in these disorders.
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Affiliation(s)
- H Mirzakhani
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Bachert C, Larché M, Bonini S, Canonica GW, Kündig T, Larenas-Linnemann D, Ledford D, Neffen H, Pawankar R, Passalacqua G. Allergen immunotherapy on the way to product-based evaluation-a WAO statement. World Allergy Organ J 2015; 8:29. [PMID: 26417398 PMCID: PMC4571059 DOI: 10.1186/s40413-015-0078-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/23/2015] [Indexed: 12/16/2022] Open
Abstract
Allergen immunotherapy (AIT) is widely used in clinical practice for patients with moderate to severe allergic rhinitis due to inhalant allergens and may be delivered via subcutaneous (SCIT) and sublingual routes (SLIT). However, the quality of evidence for individual AIT products is very heterogeneous, and extensions of overall conclusions ("class effects") on the efficacy and disease-modifying effects to all AIT products are unjustified. In contrast, each product needs to be evaluated individually, based on available study results, to justify efficacy and specific claims on sustained and disease modifying effects per allergen and targeted patient group (children vs. adults, allergic rhinitis vs. asthma). WAO intends to support the current development to evidence-based AIT, which ultimately will lead to a more efficacious treatment of allergic patients and the appropriate recognition of AIT.
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Affiliation(s)
- Claus Bachert
- />Upper Airway Research Laboratory, University of Ghent, Ghent, Belgium
| | - Mark Larché
- />Firestone Institute for Respiratory Health, Department of Medicine, St. Joseph’s Hospital Healthcare, McMaster University, Hamilton, Canada
| | | | - Giorgio Walter Canonica
- />Allergy and Respiratory Diseases, DIMI Department of Internal Medicine, University of Genova, IRCCS AOU S. Martino, Genova, Italy
| | - Thomas Kündig
- />Department of Dermatology, University Hospital Zurich, Zürich, Switzerland
| | | | - Dennis Ledford
- />Morsani College of Medicine, University of South Florida, Tampa, Florida USA
| | - Hugo Neffen
- />Head, Respiratory Medicine Unit, Orlando Alassia Hospital, Santa Fe, Argentina
| | - Ruby Pawankar
- />Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Giovanni Passalacqua
- />Allergy and Respiratory Diseases, DIMI Department of Internal Medicine, University of Genova, IRCCS AOU S. Martino, Genova, Italy
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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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Price D, Smith P, Hellings P, Papadopoulos N, Fokkens W, Muraro A, Murray R, Chisholm A, Demoly P, Scadding G, Mullol J, Lieberman P, Bachert C, Mösges R, Ryan D, Bousquet J. Current controversies and challenges in allergic rhinitis management. Expert Rev Clin Immunol 2015; 11:1205-17. [PMID: 26325631 DOI: 10.1586/1744666x.2015.1081814] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are many obstacles in the path of effective allergy management, in general, and allergic rhinitis (AR) control, in particular. Chief among them are: insufficient symptom relief in some patients provided by some currently considered first-line AR treatments in real life; an over-reliance on randomized controlled trials to direct AR guideline recommendations; the need for a broader interpretation of the AR evidence base (to include randomized controlled trials and real-life studies); poorly designed and interpreted studies; and lack of an AR control concept and common language of control. These controversies are fully reviewed here and challenging solutions have been presented.
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Affiliation(s)
- David Price
- a 1 Research in Real Life, Singapore, Singapore
| | - Pete Smith
- b 2 Department of Clinical Medicine, Griffith University, Southport, Australia
| | - Peter Hellings
- c 3 Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - Nikos Papadopoulos
- d 4 Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Wytske Fokkens
- e 5 Department of Otorhinolaryngology, Academic Medical Center (AMC) Amsterdam, Amsterdam, The Netherlands
| | - Antonella Muraro
- f 6 Food Allergy Referral Centre, Veneto Region, Department of Women and Child Health, Padua University Hospital, Padua, Italy
| | - Ruth Murray
- g 7 Medscript (Scientific & Medical Affairs), Dundalk, Ireland
| | | | - Pascal Demoly
- i 9 Department of Pulmonology - Division of Allergy, University Hospital of Montpellier, Hôpital Arnaud de Villeneuve, France
| | | | - Joaquim Mullol
- k 11 Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Catalonia, Spain
| | - Phil Lieberman
- l 12 University of Tennessee College of Medicine, Memphis, USA
| | - Claus Bachert
- m 13 Upper Airways Research Laboratory (URL), University Hospital Ghent, Ghent, Belgium
| | - Ralph Mösges
- n 14 Institute of Medical Statistics, Informatics, and Epidemiology, Medical Faculty, University of Köln, Cologne, Germany
| | - Dermot Ryan
- o 15 University of Edinburgh, Edinburgh, UK and Optimum Patient Care, Cambridge, UK
| | - Jean Bousquet
- p 16 University Hospital, Montpellier, France.,q 17 MACVIA-LR, Contre les Maladies Chronique spour un Vieillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, France.,r 18 INSERM, VIMA: Ageing and chronic diseases. Epidemiological and public health approaches, U1168, Paris, and UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
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Shershakova N, Bashkatova E, Babakhin A, Andreev S, Nikonova A, Shilovsky I, Kamyshnikov O, Buzuk A, Elisyutina O, Fedenko E, Khaitov M. Allergen-Specific Immunotherapy with Monomeric Allergoid in a Mouse Model of Atopic Dermatitis. PLoS One 2015; 10:e0135070. [PMID: 26275152 PMCID: PMC4537237 DOI: 10.1371/journal.pone.0135070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022] Open
Abstract
Atopic dermatitis (AD) is a widespread and difficult to treat allergic skin disease and is a tough challenge for healthcare. In this study, we investigated whether allergen-specific immunotherapy (ASIT) with a monomeric allergoid obtained by succinylation of ovalbumin (sOVA) is effective in a mouse model of atopic dermatitis. An experimental model of AD was reproduced by epicutaneous sensitization with ovalbumin (OVA). ASIT was performed with subcutaneous (SC) administration of increasing doses of OVA or sOVA. The levels of anti-OVA antibodies, as well as cytokines, were detected by ELISA. Skin samples from patch areas were taken for histologic examination. ASIT with either OVA or sOVA resulted in a reduction of both the anti-OVA IgE level and the IgG1/IgG2a ratio. Moreover, ASIT with sOVA increased the IFN-γ level in supernatants after splenocyte stimulation with OVA. Histologic analysis of skin samples from the sites of allergen application showed that ASIT improved the histologic picture by decreasing allergic inflammation in comparison with untreated mice. These data suggest that ASIT with a succinylated allergen represents promising approach for the treatment of AD.
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Affiliation(s)
- Nadezda Shershakova
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
- * E-mail: (MK); (NS); (SA)
| | - Elena Bashkatova
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Alexander Babakhin
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Sergey Andreev
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
- * E-mail: (MK); (NS); (SA)
| | - Alexandra Nikonova
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Igor Shilovsky
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Oleg Kamyshnikov
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Andrey Buzuk
- Faculty of Natural Sciences, Imperial College London, London, United Kingdom
| | - Olga Elisyutina
- Department of Skin Allergology and Immunopathology, National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Elena Fedenko
- Department of Skin Allergology and Immunopathology, National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Musa Khaitov
- Department of Nanobiomedical Technology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
- * E-mail: (MK); (NS); (SA)
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48
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Rossi O, Massaro I, Caminati M, Quecchia C, Fassio F, Heffler E, Canonica GW. Escaping the trap of allergic rhinitis. Clin Mol Allergy 2015; 13:17. [PMID: 26244040 PMCID: PMC4524393 DOI: 10.1186/s12948-015-0023-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/18/2015] [Indexed: 01/03/2023] Open
Abstract
Rhinitis is often the first symptom of allergy but is frequently ignored and classified as a nuisance condition. Ironically it has the greatest socioeconomic burden worldwide caused by its impact on work and on daily life. However, patients appear reticent to seek professional advice, visiting their doctor only when symptoms become ‘intolerable’ and often when their usual therapy proves ineffective. Clearly, it’s time for new and more effective allergic rhinitis treatments. MP29-02 (Dymista®; Meda, Solna, Sweden) is a new class of medication for moderate to severe seasonal and perennial allergic rhinitis if monotherapy with either intranasal antihistamine or intranasal corticosteroids is not considered sufficient. MP29-02 is a novel formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP). It benefits not only from the incorporation of two active agents, but also from a novel formulation; its lower viscosity, smaller droplet size, larger volume (137 μl) and wider spray angle ensure optimal coverage of, and retention on the nasal mucosa and contribute to its clinical efficacy. In clinical trials, patients treated with MP29-02 experienced twice the symptom relief as those treated with FP and AZE, who in turn exhibited significantly greater symptom relief than placebo-patients. Indeed, the advantage of MP29-02 over FP was approximately the same as that shown for FP over placebo. The advantage of MP29-02 was particularly evident in those patients for whom nasal congestion is predominant, with MP29-02 providing three times the nasal congestion relief of FP (p = 0.0018) and five times the relief of AZE (p = 0.0001). Moreover, patients treated with MP29-02 achieved each and every response up to a week faster than those treated with FP or AZE alone and in real life 1 in 2 patients reported the perception of well-controlled disease after only 3 days. MP29-02’s superiority over FP was also apparent long-term in patients with perennial allergic rhinitis or non-allergic rhinitis, with statistical significance noted from the first day of treatment, with treatment difference maintained for a full year. Taken together, these data suggest that MP29-02 may improve the lives of many of our patients, enabling them to finally escape the allergic rhinitis trap.
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Affiliation(s)
- Oliviero Rossi
- Allergy Unit, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 1, 50129 Firenze, Italy
| | | | - Marco Caminati
- Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Cristina Quecchia
- Allergy Unit, Melegnano Hospital, Melegnano (Milano), Italy and Clinical Pedagogical Laboratory and Biomedical Research, Pediatric Hospital, Brescia, Italy
| | | | - Enrico Heffler
- Respiratory Medicine and Allergy - Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giorgio Walter Canonica
- Respiratory Diseases & Allergy Clinic, DIMI-Department Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S. Martino Genoa, Genoa, Italy
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49
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Pitsios C, Demoly P, Bilò MB, Gerth van Wijk R, Pfaar O, Sturm GJ, Rodriguez del Rio P, Tsoumani M, Gawlik R, Paraskevopoulos G, Ruëff F, Valovirta E, Papadopoulos NG, Calderón MA. Clinical contraindications to allergen immunotherapy: an EAACI position paper. Allergy 2015; 70:897-909. [PMID: 25913519 DOI: 10.1111/all.12638] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
Clinical indications for allergen immunotherapy (AIT) in respiratory and Hymenoptera venom allergy are well established; however, clinical contraindications to AIT are not always well documented. There are some discrepancies when classifying clinical contraindications for different forms of AIT as 'absolute' or 'relative'. EAACI Task Force on 'Contraindications to AIT' was created to evaluate and review current literature on clinical contraindications, and to update recommendations for both sublingual and subcutaneous AIT for respiratory and venom immunotherapy. An extensive review of the literature was performed on the use of AIT in asthma, autoimmune disorders, malignant neoplasias, cardiovascular diseases, acquired immunodeficiencies and other chronic diseases (including mental disorders), in patients treated with β-blockers, ACE inhibitors or monoamine oxidase inhibitors, in children under 5 years of age, during pregnancy and in patients with poor compliance. Each topic was addressed by the following three questions: (1) Are there any negative effects of AIT on this concomitant condition/disease? (2) Are more frequent or more severe AIT-related side-effects expected? and (3) Is AIT expected to be less efficacious? The evidence, for the evaluation of these clinical conditions as contraindications, was limited, and most of the conclusions were based on case reports. Based on an extended literature research, recommendations for each medical condition assessed are provided. The final decision on the administration of AIT should be based on individual evaluation of any medical condition and a risk/benefit assessment for each patient.
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Affiliation(s)
- C. Pitsios
- Department of Nutrition and Dietetics; Harokopio University; Athens Greece
| | - P. Demoly
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
| | - M. B. Bilò
- Allergy Unit; Department of Internal Medicine; University Hospital; Ancona Italy
| | - R. Gerth van Wijk
- Department of Internal Medicine; Section of Allergology; Erasmus MC; Rotterdam The Netherlands
| | - O. Pfaar
- Center for Rhinology and Allergology; Wiesbaden Germany
- Department of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - G. J. Sturm
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | | | - M. Tsoumani
- Centre for Respiratory Medicine and Allergy; University Hospital of South Manchester; The University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - R. Gawlik
- Department of Internal Medicine, Allergy and Clinical Immunology; Medical University of Silesia; Katowice Poland
| | - G. Paraskevopoulos
- Allergy Outpatient Clinic; 401 General Military Hospital of Athens; Athens Greece
| | - F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilians University; Munich Germany
| | - E. Valovirta
- Department of Lung Diseases and Clinical Allergology; University of Turku; Turku Finland
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Center for Pediatrics & Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - M. A. Calderón
- Section of Allergy and Clinical Immunology; Imperial College London; National Heart and Lung Institute and Royal Brompton Hospital NHS; London UK
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50
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Sola J, Sánchez V, Landeta A, Madariaga B, Martínez A, Álvarez-Cuesta E. A Phase I clinical trial with subcutaneous immunotherapy vaccine of Timothy grass pollen extract according to EMA guidelines. Immunotherapy 2015; 7:343-52. [DOI: 10.2217/imt.15.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: A double-blind placebo-controlled study was conducted according to EMA guidelines, to evaluate safety, tolerability and short-term treatment effects of three up-dosing regimens of Phleum pratense subcutaneous immunotherapy. Materials & methods: Forty-two patients were randomized to groups: A (6 weekly doses), B (8 weekly doses) or C (eight doses, two clustered increasing doses over 3 weeks). Results: The most frequent adverse events were local reactions. No serious adverse events were found. Higher number and more severe systemic reactions were reported in group C. A decrease in cutaneous responses and an increase of specific antibodies was shown in all active groups even at very short-term. Conclusion: Phleum pratense subcutaneous immunotherapy in depot presentation exhibited good safety and tolerability. Group A seemed to show the best profile.
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Affiliation(s)
- Javier Sola
- Allergy Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Vanesa Sánchez
- Allergy Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Araitz Landeta
- Bial-Industrial Farmacéutica S.A., Parque Científico y Tecnológico de Bizkaia, Edificio 401. [48170], Zamudio, Bizkaia, Spain
| | - Begoña Madariaga
- Bial-Industrial Farmacéutica S.A., Parque Científico y Tecnológico de Bizkaia, Edificio 401. [48170], Zamudio, Bizkaia, Spain
| | - Alberto Martínez
- Bial-Industrial Farmacéutica S.A., Parque Científico y Tecnológico de Bizkaia, Edificio 401. [48170], Zamudio, Bizkaia, Spain
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