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Pham MN, Murugesan K, Banaei N, Pinsky BA, Tang M, Hoyte E, Lewis DB, Gernez Y. Immunogenicity and Tolerability of COVID-19 mRNA Vaccines in PID patients with functional B-cell defects. J Allergy Clin Immunol 2021; 149:907-911.e3. [PMID: 34952033 PMCID: PMC8690218 DOI: 10.1016/j.jaci.2021.11.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022]
Abstract
Background Data on the safety and efficacy of coronavirus disease 2019 (COVID-19) vaccination in people with a range of primary immunodeficiencies (PIDs) are lacking because these patients were excluded from COVID-19 vaccine trials. This information may help in clinical management of this vulnerable patient group. Objective We assessed humoral and T-cell immune responses after 2 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with PID and functional B-cell defects. Methods A double-center retrospective review was performed of patients with PID who completed COVID-19 mRNA vaccination and who had humoral responses assessed through SARS-CoV-2 spike protein receptor binding domain (RBD) IgG antibody levels with reflex assessment of the antibody to block RBD binding to angiotensin-converting enzyme 2 (ACE2; hereafter referred to as ACE2 receptor blocking activity, as a surrogate test for neutralization) and T-cell response evaluated by an IFN-γ release assay. Immunization reactogenicity was also reviewed. Results A total of 33 patients with humoral defect were evaluated; 69.6% received BNT162b2 vaccine (Pfizer-BioNTech) and 30.3% received mRNA-1273 (Moderna). The mRNA vaccines were generally well tolerated without severe reactions. The IFN-γ release assay result was positive in 24 (77.4%) of 31 patients. Sixteen of 33 subjects had detectable RBD-specific IgG responses, but only 2 of these 16 subjects had an ACE2 receptor blocking activity level of ≥50%. Conclusion Vaccination of this cohort of patients with PID with COVID-19 mRNA vaccines was safe, and cellular immunity was stimulated in most subjects. However, antibody responses to the spike protein RBD were less consistent, and, when detected, were not effective at ACE2 blocking.
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Affiliation(s)
- Michele N Pham
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Internal Medicine, University of California, San Francisco, Calif
| | - Kanagavel Murugesan
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Clinical Microbiology Laboratory, Stanford Health Care, Stanford, Calif
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Clinical Virology Laboratory, Stanford Health Care, Stanford, Calif
| | - Monica Tang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Internal Medicine, University of California, San Francisco, Calif
| | - Elisabeth Hoyte
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - David B Lewis
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Yael Gernez
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
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Bégin P, Winterroth LC, Dominguez T, Wilson SP, Bacal L, Mehrotra A, Kausch B, Trela A, Hoyte E, O'Riordan G, Seki S, Blakemore A, Woch M, Hamilton RG, Nadeau KC. Erratum to: Safety and feasibility of oral immunotherapy to multiple allergens for food allergy. Allergy Asthma Clin Immunol 2016; 12:28. [PMID: 27222658 PMCID: PMC4877751 DOI: 10.1186/s13223-016-0133-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Philippe Bégin
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Lisa C Winterroth
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Tina Dominguez
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Shruti P Wilson
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Liane Bacal
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Anjuli Mehrotra
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Bethany Kausch
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Anthony Trela
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Elisabeth Hoyte
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Gerri O'Riordan
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Scott Seki
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Alanna Blakemore
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Margie Woch
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
| | - Robert G Hamilton
- Johns Hopkins University School of Medicine, Dermatology, Allergy and Clinical Immunology Reference Laboratory, Baltimore, MD USA
| | - Kari C Nadeau
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305 USA
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Bégin P, Dominguez T, Wilson SP, Bacal L, Mehrotra A, Kausch B, Trela A, Tavassoli M, Hoyte E, O’Riordan G, Blakemore A, Seki S, Hamilton RG, Nadeau KC. Phase 1 results of safety and tolerability in a rush oral immunotherapy protocol to multiple foods using Omalizumab. Allergy Asthma Clin Immunol 2014; 10:7. [PMID: 24576338 PMCID: PMC3936817 DOI: 10.1186/1710-1492-10-7] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/14/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Up to 30% of patients with food allergies have clinical reactivity to more than one food allergen. Although there is currently no cure, oral immunotherapy (OIT) is under investigation. Pilot data have shown that omalizumab may hasten the ability to tolerate over 4 g of food allergen protein. OBJECTIVE To evaluate the safety and dose tolerability of a Phase 1 Single Site OIT protocol using omalizumab to allow for a faster and safe desensitization to multiple foods simultaneously. METHODS Participants with multiple food allergies received OIT for up to 5 allergens simultaneously with omalizumab (rush mOIT). Omalizumab was administered for 8 weeks prior to and 8 weeks following the initiation of a rush mOIT schedule. Home reactions were recorded with diaries. RESULTS Twenty-five (25) participants were enrolled in the protocol (median age 7 years). For each included food, participants had failed an initial double-blind placebo-controlled food challenge at a protein dose of 100 mg or less. After pre-treatment with omalizumab, 19 participants tolerated all 6 steps of the initial escalation day (up to 1250 mg of combined food proteins), requiring minimal or no rescue therapy. The remaining 6 were started on their highest tolerated dose as their initial daily home doses. Participants reported 401 reactions per 7,530 home doses (5.3%) with a median of 3.2 reactions per 100 doses. Ninety-four percent (94%) of reactions were mild. There was one severe reaction. Participants reached their maintenance dose of 4,000 mg protein per allergen at a median of 18 weeks. CONCLUSION These phase 1 data demonstrate that rush OIT to multiple foods with 16 weeks of treatment with omalizumab could allow for a fast desensitization in subjects with multiple food allergies. Phase 2 randomized controlled trials are needed to better define safety and efficacy parameters of multi OIT experimental treatments with and without omalizumab.
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Affiliation(s)
- Philippe Bégin
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Tina Dominguez
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Shruti P Wilson
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Liane Bacal
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Anjuli Mehrotra
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Bethany Kausch
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Anthony Trela
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Morvarid Tavassoli
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Elisabeth Hoyte
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Gerri O’Riordan
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Alanna Blakemore
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Scott Seki
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
| | - Robert G Hamilton
- Dermatology, Allergy and Clinical Immunology Reference Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kari C Nadeau
- Allergy, Immunology, and Rheumatology Division, Stanford University, 269 Campus Drive, CCSR3215c, Stanford, CA 94305, USA
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Bégin P, Winterroth LC, Dominguez T, Wilson SP, Bacal L, Mehrotra A, Kausch B, Trela A, Hoyte E, O'Riordan G, Seki S, Blakemore A, Woch M, Hamilton RG, Nadeau KC. Safety and feasibility of oral immunotherapy to multiple allergens for food allergy. Allergy Asthma Clin Immunol 2014; 10:1. [PMID: 24428859 PMCID: PMC3913318 DOI: 10.1186/1710-1492-10-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/15/2013] [Indexed: 01/07/2023] Open
Abstract
Background Thirty percent of children with food allergy are allergic to more than one food. Previous studies on oral immunotherapy (OIT) for food allergy have focused on the administration of a single allergen at the time. This study aimed at evaluating the safety of a modified OIT protocol using multiple foods at one time. Methods Participants underwent double-blind placebo-controlled food challenges (DBPCFC) up to a cumulative dose of 182 mg of food protein to peanut followed by other nuts, sesame, dairy or egg. Those meeting inclusion criteria for peanut only were started on single-allergen OIT while those with additional allergies had up to 5 foods included in their OIT mix. Reactions during dose escalations and home dosing were recorded in a symptom diary. Results Forty participants met inclusion criteria on peanut DBPCFC. Of these, 15 were mono-allergic to peanut and 25 had additional food allergies. Rates of reaction per dose did not differ significantly between the two groups (median of 3.3% and 3.7% in multi and single OIT group, respectively; p = .31). In both groups, most reactions were mild but two severe reactions requiring epinephrine occurred in each group. Dose escalations progressed similarly in both groups although, per protocol design, those on multiple food took longer to reach equivalent doses per food (median +4 mo.; p < .0001). Conclusions Preliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel. Additional, larger, randomized studies are required to continue to test safety and efficacy of multi-OIT. Trial registration Clinicaltrial.gov NCT01490177
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Affiliation(s)
- Philippe Bégin
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305, USA.
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LeBovidge J, Haskell S, Borras I, Hoyte E, Umetsu D, Nadeau K, Schneider L. Patient and Parent Perspectives on Quality of Life during Participation in a Study of Rapid Oral Desensitization with Omalizumab Therapy in Patients with Milk Allergy. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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