Planning and approach to allergen-specific immunotherapy in polyallergic patients

Immunotherapy ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 577-585
Author(s):  
Nerin N Bahceciler ◽  
Ozel Yuruker
Keyword(s):  
Clinical Management ◽  
Respiratory Diseases ◽  
Specific Immunotherapy ◽  
Clinical Symptoms ◽  
Allergen Specific Immunotherapy ◽  
Stepwise Approach ◽  
Future Studies ◽  
Disease Modifying ◽  
Management Recommendations ◽  
Disease Modifying Treatment

Allergy immunotherapy (AIT) is currently the only disease-modifying treatment for allergic-respiratory diseases. Polysensitization may increase the severity of current disease resulting in subsequent asthma development in patients with allergic rhinitis. Due to the absence of general recommendations for the practical approach to polysensitized patients, clinical management is not standardized. The correlation between sensitizations and clinical symptoms, elimination of possible pollen cross-reactivities and principles of homologous allergen groups will guide the allergists to deduce the most relevant allergens for AIT. In the highlight of the previously proposed approach strategies to polyallergic patients, hereby we propose a revised practical stepwise approach based on the current European Medicine Agency (EMA) guidelines. However, more supporting data from well-designed, controlled, future studies are needed to improve clinical management recommendations for AIT in polyallergic patients.

scholarly journals Diverse Mechanisms of Allergen Specific Immunotherapy

2019 ◽  
Vol 23 (3) ◽  
pp. 233-249 ◽  
Author(s):  
Lacin Cevhertas ◽  
Mübeccel Akdis
Keyword(s):  
Immune Response ◽  
Molecular Mechanisms ◽  
Allergen Immunotherapy ◽  
Specific Immunotherapy ◽  
Prognostic Markers ◽  
Recent Literature ◽  
Administration Route ◽  
Allergen Specific Immunotherapy ◽  
Disease Modifying ◽  
Disease Modifying Treatment

Allergen immunotherapy (AIT) is widely used to establish a tolerant immune response and it is currently the only disease modifying treatment. There are different routes to administer the allergen, including subcutaneous, sublingual, intralymphatic, epicutaneous, intradermal, and oral and local nasal allergen immunotherapy. Although the optimal administration route depends on the type of allergen, some patients remain unresponsive and so it is important to predict the outcome before and during treatment. Therefore, there is a need to identify candidate prognostic markers for allergen immunotherapy. Herein, we discuss the recent literature on the molecular mechanisms of AIT.

scholarly journals A study of common aero-allergen in Mewar region, Udaipur, Rajasthan, India

2017 ◽  
Vol 5 (2) ◽  
pp. 410 ◽  
Author(s):  
J. S. Matta ◽  
Priyank Jain ◽  
M. L. Ved
Keyword(s):  
Respiratory Diseases ◽  
Allergen Immunotherapy ◽  
Causative Factor ◽  
Positive Skin ◽  
Dust Mite ◽  
The Common ◽  
Disease Modifying ◽  
Allergen Extracts ◽  
Disease Modifying Treatment

Background: Aero-allergens are important causative factor in pathogenesis of allergic respiratory diseases (Asthma, Allergic Rhinitis). Present study aimed to identify the common aeroallergens in Mewar region, Udaipur, Rajasthan, India.Methods: Intradermal allergic testing done on 1050 respiratory allergic patients in last 15 yrs (2002 to 2016) by kit containing 125 allergen extracts includes pollen, fungi, insects, dust, dander’s, fabrics, feathers and wood. In 1020 patients (after excluding 30 patients), marked positive skin reaction (3+/4+) to one or more aeroallergen noted.Results: Most common aero allergens found were pollens (62%), woods (58.5%), dander (52%), insects (45%), dust mite (44.2%) and fungi (38.4%). Among pollens most common allergens were Holoptelia integrifolia, Parthenium hysterophorn, Cynodon. Among fungi aspergillus and candida species were most common. Cockroach and fly were predominant insects.Conclusions: Role of allergen testing have important role in management of allergic respiratory diseases as allergen immunotherapy or desensitization is only disease modifying treatment.

scholarly journals Allergen-Specific Immunotherapy Against Allergic Respiratory Diseases

2020 ◽  
Vol 95 (6) ◽  
pp. 370-376
Author(s):  
Sung-Yoon Kang ◽  
Min-Suk Yang ◽  
Sang Min Lee ◽  
Sang Pyo Lee
Keyword(s):  
Allergic Rhinitis ◽  
Respiratory Diseases ◽  
Randomized Clinical Trials ◽  
Specific Immunotherapy ◽  
Term Treatment ◽  
Therapeutic Modality ◽  
Double Blind ◽  
Allergen Specific Immunotherapy ◽  
Long Term Treatment ◽  
Meta Analyses

Allergen-specific immunotherapy (AIT) can alter the natural course of an allergic disease. It is widely held that the efficacy of a given therapeutic modality should be proven by well-designed double-blind placebo-controlled randomized clinical trials and meta-analyses. In this article, the therapeutic efficacy of AIT for allergic respiratory diseases, such as allergic rhinitis and asthma, is reviewed. In addition, potential clinical and experimental predictors of the treatment response are reviewed for AITs requiring long-term treatment, and for some allergic rhinitis and asthma patients who show no response to AIT.

scholarly journals Analysis of the dynamics of clinical indicators in patients with allergic rhinitis with sensitization to pollen and household allergens using combined allergen-specific immunotherapy

2021 ◽  
Vol 26 (4) ◽  
pp. 87-93
Author(s):  
S.V. Biletska ◽  
E.M. Dytyatkovska ◽  
M.A. Nikolaychuk
Keyword(s):  
Allergic Rhinitis ◽  
Specific Immunotherapy ◽  
High Efficiency ◽  
Comparison Group ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
House Dust Mites ◽  
Skin Tests ◽  
Pollen Allergens ◽  
Allergen Specific Immunotherapy

The aim of this study was to evaluate the clinical efficacy of combined allergen-specific immunotherapy (ASIT) in patients with allergic rhinitis (AR) with combined sensitization to pollen and household allergens. To achieve this goal, 49 patients with AR of working age were examined – 35.5±1.5 years with clinical manifestations of seasonal rhinoconjunctival syndrome with a long period of 9.2±1.1 years, among which there were 25 (51.0%) males and 24 (49%) females. All patients were divided into 2 homogeneous groups by age, sex, duration of the disease, the average number of etiologically significant allergens: the main one – 31 patients who received combined ASIT with solutions of pollen and household allergens and a comparison group – 18 patients for whom only pollen allergens were used. Allergological examination included anamnesis, skin tests with pollen allergens (wormwood, ragweed, quinoa, corn, etc.) and household (house dust, mites, epidermal agents) and / or molecular research methods using the ALEX technology. The quantitative integral assessment of the intensity of AR clinical symptoms was calculated as a total score for the main symptoms. The maximum score for the severity of nasal symptoms – 12, eye - 6, total – 18. The results obtained and their analysis indicate that under the influence of ASIT pollen and household allergens in patients there is a significant and reliable decrease in the intensity of clinical manifestations of seasonal rhinoconjunctive syndrome: nasal manifestations – by 52,2%, conjunctival – by 60%, integral – by 54.3% and an increase of 2.2 times in the percentage of patients in the main group with the disappearance or minimization of clinical symptoms of the disease after treatment compared with patients from the comparison group, which convincingly proves and confirms high efficiency of the selected type of therapy in patients with AR in combination with sensitization to pollen and household allergens.

scholarly journals Prevalence of Late-Onset Multiple Sclerosis in Fars Province, Southern Iran

2014 ◽  
Vol 3 (4) ◽  
pp. 228-31
Author(s):  
Sadegh Izadi ◽  
Maryam Sharifian ◽  
Alireza Nikseresht ◽  
Shima Rafiee
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Clinical History ◽  
Fars Province ◽  
Beta Interferon ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Disease Modifying Treatment ◽  
Epidemiological Characteristics

Background: Multiple Sclerosis (MS) is the most common demyelinating and inflammatory disease of the central nevus system especially in young adults, but in a subgroup of patients the first clinical symptoms present after the age of 50. This clinical presentation is defined as Late-Onset Multiple Sclerosis (LOMS). The incidence and prevalence of MS including LOMS vary geographically. The aim of this study is to determine epidemiological characteristics of LOMS in Fars province, South of Iran.Materials and  Methods: All patients aged over 50, known to have had definite MS according to MC Donald’s criteria, being members of Shiraz University Multiple Sclerosis Database (SUMSD), were evaluated in this study. The following data were recorded via a questionnaire indicating gender, age at the time of diagnosis, clinical course and details of disease- modifying therapies (Beta-Interferon).Results: Among a total of 1705 patients, 7.2% were identified as having LOMS and 3.1% identified as having very late-onset MS (VLOMS). Mean age of the patients with LOMS at the time of diagnosis was 58.81 ± 2.6 years  (20.8% were male and 107 (79.2%) were female). 8.9 % had EDSS 6 and more. 89.1% of patients received Beta-Interferon as a disease-modifying treatment including Avonex (16.3 %), Cinovex (32.6%), Rebif (14.1%) and Betaferon (26.1 %). Conclusion: In our study, 7.2% of all MS patients were identified as LOMS. In LOMS subgroup, clinical history and para-clinical data should be thoroughly evaluated to exclude more common conditions like cerebrovascular disease. [GMJ. 2014;3(4):228-31]

Dynamics of basophil reactivity in the patients with allergic rhinitis on the background of allergen-specific immunotherapy

2021 ◽  
Vol 17 (4) ◽  
pp. 75-84
Author(s):  
Liudmila Yu. Barycheva ◽  
Liudmila V Dushina ◽  
Marina V. Golubeva ◽  
Milana M. Minasyan ◽  
Yulia N. Medvedenko
Keyword(s):  
Allergic Rhinitis ◽  
Specific Immunotherapy ◽  
Clinical Symptoms ◽  
Stimulation Index ◽  
Basophil Activation Test ◽  
Basophil Activation ◽  
House Dust Mites ◽  
Allergen Specific Immunotherapy ◽  
Activation Test ◽  
Positive Treatment

BACKGROUND: Allergen-specific immunotherapy (ASIT) helps to reduce spontaneous and to induce basophil reactivity, which is one of the major mechanisms of its effectiveness. A number of studies, though, have not confirmed the informative value of the basophil activation test (BAT), in case of ASIT, with house dust mites, meadow grass pollen, and wasp venom. BAT outcomes are likely to be influenced by the properties of the sensitizing allergen, the duration of ASIT, and the BAT markers that are used. AIMS: To evaluate the basophils reactivity in the patients sensitized to weed pollen and treated with allergen-specific therapy. MATERIALS AND METHODS: The study involved 60 patients (aged 1655) with allergic rhinitis sensitized to weed pollen. The diagnosis was based on the skin test outcomes as well as on identifying specific antibodies to major allergens of ragweed, wormwood, timothy, and birch. The pre-seasonal ASIT involved water-salted extracts of pollen allergens during 2 years. Clinical symptoms and the immunotherapy effectiveness were evaluated 6 and 18 months after the ASIT started. BATs were made before the treatment, after the first and second courses of pre-seasonal ASIT, which corresponded to zero, the 3rd and the 15th months of the treatment. The activated basophils were identified based on the CRTH2pos CD203brightCD3neg phenotype. RESULTS: The first treatment course was completed by 52 patients, while the second one by 43 patients. A statistically significant decrease in spontaneous basophil reactivity was detected only after the second course of ASIT. The decrease in the allergen-induced basophil activation was identified in 67.4% of the samples obtained after the first ASIT course, and in 67.6% of samples taken after the second immunotherapy course. A decrease in the BAT stimulation index (BAT SI) was identified mainly in the patients featuring positive treatment outcomes. CONCLUSIONS: ASIT influences on the basophil reactivity indicators in the patients sensitized to weed pollen. The basophil activation test may be considered as a potential predictor of ASIT effectiveness.

scholarly journals Experienceof subcutaneous allergen-specific immunotherapy with «Phostal» in children.

2011 ◽  
Vol 8 (6) ◽  
pp. 28-32
Author(s):  
Natal'ya Viktorovna Shakhova ◽  
V V Gordeev ◽  
V P Tokarev ◽  
T Yu Borisenko ◽  
S S Kharchenko ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Specific Immunotherapy ◽  
Clinical Symptoms ◽  
Control Group ◽  
Tree Pollen ◽  
Allergen Specific Immunotherapy ◽  
Drug Load ◽  
Initial Stage ◽  
Local Reactions

Background. The purpose of the work is to investigate the effectiveness and safety of the subcutaneous allergenspecific immunotherapy (scIT ) using F ostal at pollinosis children. Methods. 31 patient (19 boys and 12 girls) at the age from 5 to 16 with pollinosis with sensibilization to tree pollen (birch, alder, hazel) allergens were observed. A ll patients were divided into 2 groups. T he first group consisted of 11 children, which were treated with F ostal. T he second group was a control group, consisted of 20 children, no treatment was assigned to them. A ll patients from both groups got the basis pollinosis therapy. Efficiency of the scIT using F ostal was estimated in terms of its influence on the childrens quality of life, clinical symptoms and drug load. Results. Good results demonstrated in terms of increased quality of life indexes were achieved after the initial stage of the scIT using F ostal. C ompared to the control group, the amount of needed drugs was significantly decreased, and the decrease in the severity of clinical symptoms of rhinitis (p=0,001) and conjunctivitis (p=0,002) was observed. During the scIT with the F ostal trees pollen some negligible local reactions were observed in all cases, in 7 of 11 patients marked local reactions appeared. O n the initial stage of the therapy no systemic allergic reaction was observed. Conclusion. On the basis of the results of the study, F ostal could be considered as a highly effective and safe for treatment of pollinosis children. S cIT with the F ostal leads to the improvement of childrens quality of life, decreasing of clinical symptoms severity as well as drug load.

scholarly journals Dynamics of clinical symptoms and immunity local parametres during allergen - specific immunotherapy in patents with pollinosis and combined forms of sensibilization

2009 ◽  
Vol 7 (3) ◽  
pp. 14-18
Author(s):  
E V Bezrukova ◽  
B A Molotilov
Keyword(s):  
Czech Republic ◽  
Oral Cavity ◽  
Specific Immunotherapy ◽  
Sublingual Immunotherapy ◽  
Clinical Symptoms ◽  
Pollen Allergens ◽  
Local Immunity ◽  
Allergen Specific Immunotherapy ◽  
Made In

Background. To evaluate clinical and immunological efficiency of immunotherapy of pollinosis patients with combined forms of sensitization with «Sevapharma» allergens, Czech Republic. Materials and methods. 189 patients with pollinosis (age 18-55 years old) were examined during this study. Out of these 189 patients three groups were chosen to be treated with pollen allergens made in Czech Republic and domestic allergens from Russia. During the study slgA in saliva was examined and the efficiency of different AS IT methods with combined forms of sensitization was tested. Results. Patients with pollinosis had disruption in local immunity. slASIT increases slgA production in saliva. Treatment with interfacing allergens is most effective in combined forms of sensitization. Conclusion. The sensibilization to different kinds of pollen allergens was observed in 10- 15% of cases. Combined forms of sensitization are much more common. Moreover, combined forms of sensitization to pollen and domestic allergens predominate. Besides that, the study showed pollinosis patients have disruption of local immunity that appeared in slgA deficit in oral cavity. Sublingual immunotherapy is the most effective method of treatment. In case of combined forms of sensitization treatment with interfacing allergens is the most efficient.

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