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Nagy A, Balogh K, Csáki C, Fábos B, Mohácsi E, Papp G. Real-World Study of Ragweed Sublingual Immunotherapy in Hungary. Allergol Immunopathol (Madr) 2024; 52:80-84. [PMID: 39278855 DOI: 10.15586/aei.v52i5.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/08/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Ragweed (Ambrosia elatior) has become invasive in Europe, causing significant respiratory issues. Subcutaneous allergen immunotherapy (SCIT) has long been used to manage pollen allergies, but sublingual immunotherapy (SLIT) has gained interest. OBJECTIVE This study aimed to evaluate the clinical benefits of ragweed SLIT under real-world in a cohort of Hungarian patients allergic to ragweed pollen. METHODS We retrospectively reviewed the clinical records of 57 patients during the 2015 and 2016 ragweed pollen seasons. Patients were divided into two groups: Group 1 (n = 29), who had not received immunotherapy, and Group 2 (n = 28), who had previously undergone immunotherapy with another sublingual preparation. All patients were treated with Oraltek® ragweed for 4-6 months, initiating 2-4 months before the pollen season and rest of the period was 2 months of the 2016 pollen season. Symptom score (SS), medication score (MS), and combined symptom and medication score (CSMS) were evaluated intra- and intergroup. RESULTS Pollen counts were consistent between 2015 and 2016. All patients showed significant improvement in SS, MS, and CSMS, with a large effect size (>0.8). Group 2 had significantly lower SS and CSMS in 2015 because of prior immunotherapy. By 2016, both groups exhibited marked improvements, with Group 1 showing a 75% improvement in CSMS. No local or systemic reactions were recorded, indicating a high safety profile. CONCLUSIONS Ragweed SLIT significantly improved symptoms and reduced use of medication in patients allergic to ragweed pollen. The treatment was effective even in patients with previous immunotherapy, with a high benefit-risk ratio demonstrated by the absence of adverse reactions. These findings support the use of Oraltek SLIT for managing ragweed pollen allergy.
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Affiliation(s)
- Adrienne Nagy
- Heim Pál National Pediatric Institute, Budapest, Hungary;
| | | | - Csilla Csáki
- Calvinistic Pulmonological Centrum, Törökbálint, Hungary
| | - Beáta Fábos
- Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Edit Mohácsi
- St. Janos North-Buda Centrum Hospital, Budapest, Hungary
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Ojeda P, Barjau MC, Subiza J, Moreno A, Ojeda I, Solano E, Alonso A, Caballero R, Del Pozo S, Gómez-Perosanz M, Sánchez-Trincado JL, Benito-Villalvilla C, Angelina A, Soria I, Reche PA, Palomares O, Subiza JL, Casanovas M. Grass pollen allergoids conjugated with mannan for subcutaneous and sublingual immunotherapy: a dose-finding study. Front Immunol 2024; 15:1431351. [PMID: 38989287 PMCID: PMC11233432 DOI: 10.3389/fimmu.2024.1431351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
Background Polymerized allergoids conjugated with mannan represent a novel approach of allergen immunotherapy targeting dendritic cells. In this study, we aimed to determine the optimal dose of mannan-allergoid conjugates derived from grass pollen (Phleum pratense and Dactylis glomerata) administered via either the subcutaneous or sublingual route. Methods A randomized, double-blind, placebo-controlled trial with a double-dummy design was conducted, involving 162 participants across 12 centers in Spain. Subjects were randomly allocated to one of nine different treatment groups, each receiving either placebo or active treatment at doses of 500, 1,000, 3,000, or 5,000 mTU/mL over four months. Each participant received five subcutaneous (SC) doses of 0.5 mL each, every 30 days, and a daily sublingual (SL) dose of 0.2 mL. Participants who received active treatment through SC, received placebo through SL. Participants who received active treatment through SL, received placebo SC. One Group, as control, received bot SC and SL placebo. The primary efficacy outcome was the improvement in titrated nasal provocation tests (NPT) at the end of the study compared to baseline. Secondary outcomes included specific antibody (IgG4, IgE) and cellular (IL-10 producing and regulatory T cell) responses. All adverse events and side reactions were recorded and assessed. Results Post-treatment, the active groups showed improvements in NPT ranging from 33% to 53%, with the highest doses showing the greatest improvements regardless of the administration route. In comparison, the placebo group showed a 12% improvement. Significant differences over placebo were observed at doses of 3,000 mTU/mL (p=0.049 for SL, p=0.015 for SC) and 5,000 mTU/mL (p=0.011 for SL, p=0.015 for SC). A dose-dependent increase in IgG4 was observed following SC administration, and an increase in IL-10 producing cells for both routes of administration. No serious systemic or local adverse reactions were recorded, and no adrenaline was required. Conclusion Grass pollen immunotherapy with mannan-allergoid conjugates was found to be safe and efficacious in achieving the primary outcome, whether administered via the subcutaneous or sublingual routes, at doses of 3,000 and 5,000 mTU/mL. Clinical trial registration https://www.clinicaltrialsregister.eu/ctr-search (EudraCT), identifier 2014-005471-88; https://www.clinicaltrials.gov, identifier NCT02654223.
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Affiliation(s)
- Pedro Ojeda
- Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain
| | | | | | | | - Isabel Ojeda
- Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain
| | - Emilio Solano
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Sandra Del Pozo
- Inmunotek, Alcalá de Henares, Spain
- Department of Medicine and Medical Specialities, Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, Spain
| | - Marta Gómez-Perosanz
- Inmunotek, Alcalá de Henares, Spain
- Department of Immunology & O2, School of Medicine, University Complutense of Madrid, Madrid, Spain
| | | | - Cristina Benito-Villalvilla
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
| | - Alba Angelina
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
| | | | - Pedro A. Reche
- Department of Immunology & O2, School of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
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Nieto A, Mazón Á, Nieto M, Ibáñez E, Jang D, Calaforra S, Alba P, Pérez‐Francés C, Llusar R, Montoro J, de Mateo A, Alamar R, El‐Qutob D, Fernández J, Moral L, Toral T, Antón M, Andreu C, Ferrer Á, Flores I, Cerdá N, del Pozo S, Caballero R, Subiza JL, Casanovas M. First-in-human phase 2 trial with mite allergoids coupled to mannan in subcutaneous and sublingual immunotherapy. Allergy 2022; 77:3096-3107. [PMID: 35570712 PMCID: PMC9796063 DOI: 10.1111/all.15374] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/31/2022] [Accepted: 04/20/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Polymerized allergens conjugated to non-oxidized mannan (PM-allergoids) are novel vaccines targeting dendritic cells (DCs). Previous experimental data indicate that PM-allergoids are readily taken up by DCs and induce Treg cells. This first-in-human study was aimed to evaluate safety and to find the optimal dose of house dust mite PM-allergoid (PM-HDM) administered subcutaneously (SC) or sublingually (SL). METHODS In a randomized, double-blind, double-dummy, placebo-controlled trial, 196 subjects received placebo or PM-HDM at 500, 1000, 3000, or 5000 mannan-conjugated therapeutic units (mTU)/mL in 9-arm groups for 4 months. All subjects received 5 SC doses (0.5 ml each) every 30 days plus 0.2 ml SL daily. The primary efficacy outcome was the improvement of titrated nasal provocation tests (NPT) with D. pteronyssinus at baseline and at the end of the study. All adverse events and reactions were recorded and assessed. Secondary outcomes were the combination of symptom and medication scores (CSMS) and serological markers. RESULTS No moderate or severe adverse reactions were reported. Subjects improving the NPT after treatment ranged from 45% to 62% in active SC, 44% to 61% in active SL and 16% in placebo groups. Statistical differences between placebo and active groups were all significant above 500 mTU, being the highest with 3000 mTU SL (p = 0.004) and 5000 mTU SC (p = 0.011). CSMS improvement over placebo reached 70% (p < 0.001) in active 3000 mTU SC and 40% (p = 0.015) in 5000 mTU SL groups. CONCLUSIONS PM-HDM immunotherapy was safe and successful in achieving primary and secondary clinical outcomes in SC and SL at either 3000 or 5000 mTU/ml.
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Affiliation(s)
- Antonio Nieto
- Unit of Pediatric Allergy and PneumologyHospital Universitari i Politècnic la FeValenciaSpain
| | - Ángel Mazón
- Unit of Pediatric Allergy and PneumologyHospital Universitari i Politècnic la FeValenciaSpain
| | - María Nieto
- Unit of Pediatric Allergy and PneumologyHospital Universitari i Politècnic la FeValenciaSpain
| | - Ethel Ibáñez
- Department of AllergyHospital Universitari i Politècnic la FeValenciaSpain
| | - Dah‐Tay Jang
- Unit of Pediatric Allergy and PneumologyHospital Universitari i Politècnic la FeValenciaSpain
| | | | - Pilar Alba
- Allergy ServiceHospital ManisesValenciaSpain
| | | | - Ruth Llusar
- Allergy ServiceUniversity Hospital Doctor PesetValenciaSpain
| | - Javier Montoro
- Allergy ServiceUniversity Hospital Arnau de VilanovaValenciaSpain
| | | | | | - David El‐Qutob
- Allergy ServiceUniversity Hospital de la PlanaCastellónSpain
| | - Javier Fernández
- Allergy ServiceHospital General Universitario Dr. Balmis, ISABIALAlicanteSpain
| | - Luis Moral
- Pediatric Allergy and Respiratory UnitHospital Universitario Dr. Balmis, ISABIALAlicanteSpain
| | - Teresa Toral
- Pediatric Allergy and Respiratory UnitHospital Universitario Dr. Balmis, ISABIALAlicanteSpain
| | - Mónica Antón
- Allergy ServiceUniversity Hospital VinalopóElche, AlicanteSpain
| | - Carmen Andreu
- Allergy ServiceHospital Vega BajaOrihuela, AlicanteSpain
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Robbins T, Gonevski M, Clark C, Baitule S, Sharma K, Magar A, Patel K, Sankar S, Kyrou I, Ali A, Randeva HS. Hyperbaric oxygen therapy for the treatment of long COVID: early evaluation of a highly promising intervention. Clin Med (Lond) 2021; 21:e629-e632. [PMID: 34862223 PMCID: PMC8806311 DOI: 10.7861/clinmed.2021-0462] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long COVID is a common occurrence following COVID-19 infection. The most common symptom reported is fatigue. Limited interventional treatment options exist. We report the first evaluation of hyperbaric oxygen therapy (HBOT) for long COVID treatment. METHODS A total of 10 consecutive patients received 10 sessions of HBOT to 2.4 atmospheres over 12 days. Each treatment session lasted 105 minutes, consisting of three 30-minute exposures to 100% oxygen, interspersed with 5-minute air breaks. Validated fatigue and cognitive scoring assessments were performed at day 1 and 10. Statistical analysis was with Wilcoxon signed-rank testing reported alongside effect sizes. RESULTS HBOT yielded a statistically significant improvement in the Chalder fatigue scale (p=0.0059; d=1.75 (very large)), global cognition (p=0.0137; d=-1.07 (large)), executive function (p=0.0039; d=-1.06 (large)), attention (p=0.0020; d=-1.2 (very large)), information processing (p=0.0059; d=-1.25 (very large)) and verbal function (p=0.0098; d=-0.92 (large)). CONCLUSION Long COVID-related fatigue can be debilitating, and may affect young people who were previously in economic employment. The results presented here suggest potential benefits of HBOT, with statistically significant results following 10 sessions.
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Affiliation(s)
- Tim Robbins
- AUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, Warwick Medical School, Coventry, UK and Coventry University, Coventry, UK,Address for correspondence: Dr Timothy Robbins, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK.
| | | | - Cain Clark
- CUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Coventry University, Coventry, UK
| | - Sudhanshu Baitule
- DUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kavi Sharma
- EUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Angel Magar
- FUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kiran Patel
- Gdeputy chief executive officer and consultant cardiologist, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
| | - Sailesh Sankar
- HUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
| | - Ioannis Kyrou
- IUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, Warwick Medical School, Coventry, UK and Coventry University, Coventry, UK
| | - Asad Ali
- JUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
| | - Harpal S Randeva
- KUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
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