Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.349
Filtrar
1.
Ann Allergy Asthma Immunol ; 125(3): 311-318.e2, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32407947

RESUMO

BACKGROUND: Allergen immunotherapy can provide long-term benefits, including symptomatic relief and reduced disease progression, but it requires a lengthy regimen that presents barriers to patient adherence. Thus, there is a need for improved approaches to immunotherapy. Recently, several clinical trials have reported successful results from intralymphatic immunotherapy. OBJECTIVE: To evaluate the efficacy, safety, and tolerability of intralymphatic immunotherapy for allergies caused by mountain cedar pollen in a proof-of-concept study. METHODS: A total of 21 patients with allergic rhinoconjunctivitis because of mountain cedar pollen were randomized to receive 3 monthly intralymphatic injections of allergenic extract or placebo before the 2018-2019 mountain cedar pollen season. Safety was monitored during treatment to the end of the pollen season using structured and spontaneous reports. Clinical efficacy information was collected using a daily electronic diary of symptoms and allergy medication. Allergen-specific serum immunoglobulin E was assessed before treatment and at the end of the study. RESULTS: There were no serious adverse events or systemic reactions in either group. A total of 4 patients experienced mild injection-site reactions. Patients receiving intralymphatic immunotherapy experienced a significant improvement in allergy symptoms and medication use relative to patients receiving placebo (P < .001), and the active treatment group had lower average total combined scores on 20 of 27 days during the peak pollen season (P < .05). There was no significant difference among groups in changes to mean mountain cedar-specific serum immunoglobulin E levels. CONCLUSION: In this proof-of-concept trial, intralymphatic immunotherapy was well tolerated and improved the symptoms and medication use associated with allergic rhinoconjunctivitis caused by mountain cedar pollen. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov under the registration number NCT03682965 before the enrollment of the first subject.


Assuntos
Cedrus/imunologia , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/terapia , Adulto , Alérgenos/imunologia , Antígenos de Plantas/imunologia , Dessensibilização Imunológica/métodos , Método Duplo-Cego , Feminino , Humanos , Hipersensibilidade/imunologia , Imunoglobulina E/sangue , Injeções Intralinfáticas , Masculino , Pólen/imunologia
2.
Rhinology ; 58(3): 241-247, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32091032

RESUMO

BACKGROUND: Intralymphatic immunotherapy (ILIT) for allergic patients requires only a few intralymphatic injections of the allergen. However, the effectiveness and safety for Japanese cedar pollinosis are unclear. The objectives of this study were to clarify whether and how long ILIT is effective for pollinosis, and its safety. METHODS: In an open pilot investigation followed by a double-blind, placebo-controlled study, patients with Japanese cedar pollinosis received 3 intralymphatic inguinal injections of the pollen extracts before the first pollen season. The symptom medication score (SMS), nasal provocation testing and scoring visual analogue scale (VAS) were assessed after the first-third seasons. RESULTS: (1) Although mild adverse events were induced at the injected site, severe adverse events were not noted. (2) During the latter part of the first season, ILIT-treated patients (n=12) tended to show improved SMS compared to placebo-treated (n=6) without statistical significance. When assessed by nasal provocation testing and VAS scoring after the first season, the effectiveness of ILIT was significant. (3) The effects of ILIT continued until the second or third season. (4) Neither allergen-specific antibodies nor Treg/Breg cells changed in the peripheral blood. CONCLUSIONS: ILIT was safe and effective for Japanese cedar pollinosis. The clinical effects remained for 1-2 years.


Assuntos
Cryptomeria , Dessensibilização Imunológica , Rinite Alérgica Sazonal , Alérgenos , Cryptomeria/imunologia , Método Duplo-Cego , Humanos , Pólen/imunologia , Rinite Alérgica Sazonal/terapia
3.
J Med Econ ; 23(1): 64-69, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31352853

RESUMO

Aims: Allergic rhinitis is caused by sensitivity to environmental allergens that can significantly impact quality-of-life. The objective of this analysis was to estimate health state utilities and quality-adjusted life days (QALDs) for a tree allergy immunotherapy trial, TT-04 (EudraCT No.2015-004821-15). Health-state utilities are a measure of patient preference for health states and are necessary to derive QALDs for cost-utility analysis. Preference-based utilities were not collected in the TT-04 trial, so a mapping algorithm was developed based on a similar grass allergy immunotherapy trial, GT-08 (EudraCT No. 2004-000083-27), to estimate utilities.Methods: A two-part model was developed to predict utilities for the GT-08 trial and applied to the TT-04 trial to estimate the difference in mean utility and QALDs between SQ tree sublingual immunotherapy (SLIT)-tablet and placebo.Results: Mean utility difference between SQ tree SLIT-tablet and placebo was 0.030 [95% CI = 0.015-0.046] during the birch pollen season (BPS), 0.019 [95% CI = 0.007-0.030] during the tree pollen season (TPS) and 0.018 [95% CI = 0.007-0.030] during the full trial. The treatment showed a QALD benefit of 1.26 [95% CI = 0.619-1.917] during the BPS, 1.90 [95% CI = 0.692-3.047] during the TPS, and 2.47 [95% CI = 0.930-4.101] during the full trial.Limitations: The generalizability of this algorithm is limited to allergy trials containing the same covariates as those present in the model. The analysis also assumes that grass and tree pollen allergy have the same relationship with EQ5D utilities, which is supported by the fact that both grass and tree pollen induce similar symptoms.Conclusions: Application of the mapping function enabled the calculation of QALDs associated with the treatment, with the caveat that data were extrapolated from grass seasonal allergy to tree seasonal allergy. The results showed a significant QALD benefit of the treatment over placebo in treatment of tree pollen-induced rhinoconjunctivitis.


Assuntos
Nível de Saúde , Preferência do Paciente , Qualidade de Vida , Imunoterapia Sublingual/métodos , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólen , Rinite Alérgica Sazonal/terapia , Árvores
4.
J Nippon Med Sch ; 87(1): 49-52, 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31564689

RESUMO

Basophils were reported to be associated with allergy pathogenesis and the efficacy of allergen immunotherapy. Using a purified cedar allergen, we recently studied the effectiveness of sublingual immunotherapy for patients with Japanese cedar pollinosis. Patients were classified as high responders (HR) and nonresponders (NR), and comprehensive microarray analysis was used to examine peripheral basophils in both groups. A total of 153 genes were differentially expressed in HR and NR patients. Most of these differentially expressed genes encoded intracellular molecules, and expression levels were higher in HR patients than in NR patients. mRNA expression of the gene encoding D4, zinc, and double plant homeodomain (PHD) fingers family 2 (DPF2) was significantly correlated with copy number variation (CNV). Genetic variation in the DPF2 gene and its expression in basophils might be associated with the efficacy of sublingual immunotherapy.


Assuntos
Basófilos/imunologia , Proteínas de Ligação a DNA/genética , Expressão Gênica/imunologia , Rinite Alérgica Sazonal/genética , Rinite Alérgica Sazonal/terapia , Imunoterapia Sublingual , Fatores de Transcrição/genética , Variações do Número de Cópias de DNA , Humanos , RNA Mensageiro
5.
Clin Immunol ; 210: 108310, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31743749

RESUMO

Sublingual immunotherapy (SLIT) with Japanese cedar (JCe) pollinosis was expected to be effective for Japanese cypress (JCy) pollinosis. However, only a half of JCy pollinosis patients clinically improved. Therefore, we examined the immunological effect of SLIT for JCy pollinosis. Peripheral blood mononuclear cells (PBMCs) from patients with JCe and JCy pollinosis who did and did not receive SLIT were incubated with Cry j 1, Cha o 1 and Cha o 3 antigens. Basophil activation test (BAT) were performed. Production of IL-5 and IL-17 induced by antigens was inhibited in the SLIT group. Cry j 1-specific production of IL-10 was increased, and serum Cry j 1-specific IgE and -IgG4 were elevated. However, Cha o 1- or Cha o 3-specific production of IL-10 and specific IgG4 was not increased. Antigens-specific BAT did not decrease after SLIT. New SLIT with JCe and JCy is needed for patients with combined JCe and JCy pollinosis.


Assuntos
Leucócitos Mononucleares/imunologia , Rinite Alérgica Sazonal/terapia , Imunoterapia Sublingual/métodos , Adulto , Antígenos de Plantas/imunologia , Teste de Degranulação Basófila , Células Cultivadas , Chamaecyparis/imunologia , Cryptomeria/imunologia , Citocinas/metabolismo , Feminino , Humanos , Imunoglobulina E/metabolismo , Imunoglobulina G/metabolismo , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/imunologia , Proteínas de Plantas/imunologia , Pólen/imunologia , Estudos Prospectivos , Rinite Alérgica Sazonal/imunologia
6.
EBioMedicine ; 50: 421-432, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786130

RESUMO

BACKGROUND: BM32, a grass pollen allergy vaccine containing four recombinant fusion proteins consisting of hepatitis B-derived PreS and hypoallergenic peptides from the major timothy grass pollen allergens adsorbed on aluminium hydroxide has been shown to be safe and to improve clinical symptoms of grass pollen allergy upon allergen-specific immunotherapy (AIT). We have investigated the immune responses in patients from a two years double-blind, placebo-controlled AIT field trial with BM32. METHODS: Blood samples from patients treated with BM32 (n = 27) or placebo (Aluminium hydroxide) (n = 13) were obtained to study the effects of vaccination and natural allergen exposure on allergen-specific antibody, T cell and cytokine responses. Allergen-specific IgE, IgG, IgG1 and IgG4 levels were determined by ImmunoCAP and ELISA, respectively. Allergen-specific lymphocyte proliferation by 3H thymidine incorporation and multiple cytokine responses with a human 17-plex cytokine assay were studied in cultured peripheral blood mononuclear cells (PBMCs). FINDINGS: Two years AIT comprising two courses of 3 pre-seasonal injections of BM32 and a single booster after the first pollen season induced a continuously increasing (year 2 > year 1) allergen-specific IgG4 response without boosting allergen-specific IgE responses. Specific IgG4 responses were accompanied by low stimulation of allergen-specific PBMC responses. Increases of allergen-specific pro-inflammatory cytokine responses were absent. The rise of allergen-specific IgE induced by seasonal grass pollen exposure was partially blunted in BM32-treated patients. INTERPRETATION: AIT with BM32 is characterised by the induction of a non-inflammatory, continuously increasing allergen-specific IgG4 response (year 2 > year1) which may explain that clinical efficacy was higher in year 2 than in year 1. The good safety profile of BM32 may be explained by lack of IgE reactivity and low stimulation of allergen-specific T cell and cytokine responses. FUNDINGS: Grants F4605, F4613 and DK 1248-B13 of the Austrian Science Fund (FWF).


Assuntos
Alérgenos/imunologia , Especificidade de Anticorpos/imunologia , Imunoglobulina G/imunologia , Pólen/imunologia , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/prevenção & controle , Vacinas Sintéticas/imunologia , Adulto , Citocinas/metabolismo , Dessensibilização Imunológica , Feminino , Humanos , Imunoglobulina E/imunologia , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Masculino , Pessoa de Meia-Idade , Rinite Alérgica Sazonal/terapia , Resultado do Tratamento , Vacinação , Vacinas Sintéticas/administração & dosagem , Adulto Jovem
7.
Int Arch Allergy Immunol ; 180(4): 284-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31665735

RESUMO

BACKGROUND: Numerous products are available for subcutaneous (SCIT) and sublingual allergen-specific immunotherapy, but there are no information about the direct comparability regarding efficacy, safety, and tolerability of the different extracts. AIMS: The aim of this open-labelled, prospective, controlled observational trial was to test the feasibility of a comparison of different products for SCIT in children. METHODS: Pediatrician practices recruited patients with a confirmed diagnosis of a seasonal allergic rhinoconjunctivitis (AR) with or without asthma and an allergic sensitization against grass pollen allergen. Every patient was offered SCIT with one out of six allergen extracts: ALK SQ Depot, ALK Avanz, Allergovit, Depigoid, Purethal, Pollinex Quattro. Scores for symptoms and medications were calculated and the difference between treatment years and baseline were recorded. RESULTS: In total, 284 were recruited and 255 children (89.8%; mean age 10.4, SD 3.54 years; 65% males) participated in this trial. Overall, 49,649 patient days were recorded in the electronic database (mean 183.2 days/patient). There was no significant difference in the AR and asthma symptom score or the medication score between the six different SCIT preparations. Similarly, no differences were observed in terms of safety and tolerability. CONCLUSION: The comparison of different SCIT products using an online tool is feasible. Based on our preliminary data, all extracts indicated efficacy; however, larger groups would be necessary to demonstrate superiority or non-inferiority of one specific SCIT product.


Assuntos
Alérgenos/uso terapêutico , Antígenos de Plantas/uso terapêutico , Asma/terapia , Conjuntivite Alérgica/terapia , Dessensibilização Imunológica/métodos , Extratos Vegetais/uso terapêutico , Rinite Alérgica Sazonal/terapia , Alérgenos/administração & dosagem , Antígenos de Plantas/administração & dosagem , Criança , Feminino , Humanos , Masculino , Extratos Vegetais/administração & dosagem , Estudos Prospectivos
8.
Arerugi ; 68(8): 958-965, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31534107

RESUMO

BACKGROUND: Cedarcure® for sublingual immunotherapy of cedar pollinosis was purchased in 2018. We studied clinical efficacy of Cedarcure® in the first year. METHODS: We compared 69 patients treated with Cedarcure® (age, 18.0±13.5 years; male-to-female ratio, 40;29) and a control group of 97 patients treated with Cedartolen® (age, 29.8±16.2 years; male-to-female ratio, 44;53) during the peak season of large amount of pollen dispersal (10933 grains/cm2/season) in 2019. The clinical efficacy was evaluated by assessing symptom scores by Japanese rhino-conjunctivitis quality of life questionnaire and visual analog scale (VAS). RESULTS: All the assessments except nasal congestion were slightly better in Cedarcure® group, but they were not significant. There was no difference of concomitant medication in both groups. Because insurance coverage of Cedartolen® is for patients over 12 years old in Japan, the efficacy in Cedarcure® group enhanced better in all assessments if comparing the patients of over 12 years old. Percentage of adverse events was even in both over and under 12 years old. CONCLUSION: Cedarcure® was treated in safe, and reduced symptoms as well as Cedartolen®.


Assuntos
Cryptomeria/imunologia , Rinite Alérgica Sazonal/terapia , Imunoterapia Sublingual , Administração Sublingual , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Adulto Jovem
9.
Regul Toxicol Pharmacol ; 108: 104441, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31425728

RESUMO

PQ Birch represents an allergen-specific immunotherapy for the treatment of birch pollinosis. It consists of native birch pollen extract chemically modified with glutaldehyde adsorbed to L-tyrosine in its microcrystalline form with addition of the adjuvant Monophosphoryl Lipid A (MPL®). A nonclinical safety testing strategy was designed based upon interpretation of current legislation and regulatory intelligence and comprised genotoxicity studies (bacterial reverse mutation and Chinese hamster ovary micronucleus assays), a rat repeat dose toxicology study and a rabbit local tolerance study. No safety findings of concern were found. Thus, no evidence of genotoxicity was found. Relatively minor, immunostimulatory effects were seen following repeated subcutaneous dosing (once every 2 weeks for 13 weeks) as reversible increased white cell count (notably neutrophils), increased globulin level (resulting in decreased albumin/globulin [A/G] ratio) and increased fibrinogen, as well as minor dose site reaction in the form of inflammatory cell infiltrate. These findings are likely due to the immunostimulatory nature of MPL® and/or the presence of L-tyrosine within the adjuvanted vaccine. Similar dose site inflammatory changes to the injected formulation were also noted in the rabbit local tolerance study.


Assuntos
Adjuvantes Imunológicos/toxicidade , Betula/imunologia , Imunoterapia/efeitos adversos , Lipídeo A/análogos & derivados , Pólen/imunologia , Tirosina/toxicidade , Animais , Células CHO , Cricetulus , Feminino , Lipídeo A/toxicidade , Masculino , Testes de Mutagenicidade , Coelhos , Ratos Wistar , Rinite Alérgica Sazonal/terapia , Salmonella typhimurium/efeitos dos fármacos , Salmonella typhimurium/crescimento & desenvolvimento , Pele/efeitos dos fármacos
10.
Ann Allergy Asthma Immunol ; 123(3): 284-287, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31276805

RESUMO

BACKGROUND: Systemic reactions are a known risk of subcutaneous immunotherapy (SCIT) for aeroallergens. OBJECTIVE: To identify the dose of SCIT that results in the most systemic reactions to SCIT (SCITSRs) and other risk factors for SCITSRs. METHODS: We performed a retrospective review of all SCIT encounters from 2013 to 2017 at a multisite allergy/immunology practice. SCITSRs were identified from the electronic health record through immunotherapy encounters in which epinephrine was administered. Collected data included patient demographics, the dose of immunotherapy at the time of the SCITSR, the presence or absence of asthma, and aeroallergen content. The control group was generated randomly from the same cohort during the same period. RESULTS: There were 86,949 SCIT visits, with 81 SCITSRs (0.9 per 1000 injections). A total of 77.8% of reactions occurred at a dose of 1:1 0.1 mL and above. The presence of cat (81.5% vs 63.0%, P = .01), dog (67.9% vs 37.0%, P < .001), and grass extracts (85.2% vs 67.5%, P = .01) were associated with SCITSRs. Asthma was not significantly associated with SCITSRs. The presence of dust mites, trees, weeds, and molds was not associated with SCITSRs. There were no months or seasons where SCITSRs were more likely to occur. Individuals who experienced SCITSRs had a mean (SD) higher number of included aeroallergenic groups compared with controls (5.86 [1.88] vs 5.00 [1.92], P < .001). CONCLUSION: Risk factors for SCITSRs in a multisite allergy/immunology practice included administration of the highest immunotherapy doses; inclusion of cat, dog, and grass extracts; and the number of aeroallergenic groups included in the extract. This information helps further characterize risk for patients receiving SCIT.


Assuntos
Alérgenos/uso terapêutico , Anafilaxia/prevenção & controle , Asma/terapia , Extratos Celulares/uso terapêutico , Dessensibilização Imunológica/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Rinite Alérgica Sazonal/imunologia , Adolescente , Adulto , Idoso , Alérgenos/imunologia , Anafilaxia/etiologia , Animais , Asma/imunologia , Gatos/imunologia , Extratos Celulares/imunologia , Criança , Pré-Escolar , Cães/imunologia , Feminino , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Poaceae/imunologia , Estudos Retrospectivos , Rinite Alérgica Sazonal/terapia , Fatores de Risco , Adulto Jovem
11.
Nihon Yakurigaku Zasshi ; 154(1): 23-27, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31308346

RESUMO

From the era of subcutaneous immunotherapy (SCIT) in 1960s, allergen immunotherapy (AIT) has been established as a highly effective and curable treatment for allergic diseases. Furthermore, the recent appearance of sublingual immunotherapy (SLIT) in which the complicated administration procedure in SCIT was improved has been causing paradigm shifts in the treatment of allergic rhinitis. During the long history of AIT, the mechanisms by which this therapy leads its strong efficacy have been investigated but not fully clarified yet. The production of blocking antibodies that interrupt allergen-IgE binding, normalization of Th1/Th2 balance, and introduction of regulatory T cells are the major candidate mechanisms, though there are several conflicting reports. In our recent clinical study of SLIT against Japanese cedar pollinosis, we also tried to elucidate its mechanisms. Especially by comparing high-responder and non-responder patients using integrated analysis with multiple data, not by comparing with a placebo control group using individual data, we have successfully identified several target molecules and cascades of SLIT. Herein, we would like to describe the potential mechanisms by which AIT exhibits its strong efficacy with referring our recent novel findings.


Assuntos
Dessensibilização Imunológica , Hipersensibilidade/terapia , Rinite Alérgica Sazonal/terapia , Imunoterapia Sublingual , Alérgenos , Humanos
12.
Allergol Int ; 68(4): 494-505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257168

RESUMO

BACKGROUND: We conducted a randomized, placebo-controlled, double-blind clinical trial to investigate the optimal dose and long-term efficacy and safety of Japanese cedar (JC) pollen tablets for SLIT (JapicCTI-142579). Here, we report details of the effects of the JC pollen SLIT tablet on rhinitis and conjunctivitis symptoms over three pollen dispersal seasons. METHODS: A total of 1042 JC pollinosis patients (aged 5-64 years) were randomized to receive tablets containing placebo (P), 2000, 5000, or 10,000 Japanese allergy units (JAU) of JC pollen for 15 months to identify an optimal dose. Patients receiving P (n = 240) and the optimal dose (5000 JAU; A, n = 236) were then randomized to receive P or A for an additional 18 months (AA, AP, PA, and PP groups, allocation ratio 2:1:1:2). Nasal and ocular symptoms, rescue medication use, and quality of life (QOL) were assessed on quantitative scales. RESULTS: In the second and third seasons, the AA, AP, and PA groups exhibited significantly better improvements in nasal, ocular, and medication scores compared with the PP group in the order AA > AP > PA > PP during the second season and AA > PA > AP > PP during the third season. Rescue medication use and QOL scores were also significantly better in the AA, AP, and PA groups compared with the PP group. CONCLUSIONS: The JC pollen SLIT tablet relieved nasal and ocular symptoms and medication use and improved QOL in a treatment duration-dependent manner. Continuous dosing regimens appear to enhance the efficacy of the drug.


Assuntos
Alérgenos/imunologia , Cryptomeria/efeitos adversos , Pólen/imunologia , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/terapia , Imunoterapia Sublingual , Adolescente , Adulto , Alérgenos/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estações do Ano , Resultado do Tratamento , Adulto Jovem
13.
Hum Vaccin Immunother ; 15(12): 2887-2895, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31157592

RESUMO

Allergen immunotherapy has been used for more than 100 y, but only recently underlying immunological mechanisms have started to be understood. New Allergy vaccines are now considered to be full pharmaceutical products, that should comply with general as well as specific pharmaceutical legal framework. GRAZAX® is the first global allergy vaccine developed in compliance with the new legal environment and is thus a reference for developing new allergy vaccines. Here, we provide a rationale description of GRAZAX®, providing a sequential description of its pharmaceutical and clinical development. With more than 25 clinical trials, involving more than 8000 patients, including as well three 5-y prospective clinical trials, GRAZAX® is a key product to understand the unique position of allergen-specific immunotherapy as a disease-modifying intervention.


Assuntos
Desenvolvimento de Medicamentos , Extratos Vegetais/uso terapêutico , Rinite Alérgica Sazonal/terapia , Imunoterapia Sublingual , Vacinas , Administração Sublingual , Alérgenos/imunologia , Animais , Ensaios Clínicos como Assunto , Humanos , Modelos Animais , Extratos Vegetais/imunologia , Poaceae/imunologia , Pólen/imunologia , Vigilância de Produtos Comercializados , Estudos Prospectivos , Rinite Alérgica Sazonal/imunologia , Comprimidos , Vacinas/imunologia , Vacinas/uso terapêutico
14.
Int Forum Allergy Rhinol ; 9(6): 615-623, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31173675

RESUMO

BACKGROUND: Sublingual immunotherapy (SLIT) is safe and effective but compliance is problematic. In this study we evaluated dropout and compliance among adults (≥20 years of age) and adolescents (<20 years of age) for Japanese cedar pollen extract (JCPE), an aqueous SLIT approved in 2014 in Japan. METHODS: Administrative claims data on 1236 Japanese patients, 846 adults (mean age, 43.0 years; 41.8% female) and 249 adolescents (mean age, 14.1 years; 36.6% female), with a JCPE prescription between October 2014 and June 2016 were reviewed. Adults and adolescents were divided according to the year they started SLIT (1- and 2-year cohorts) to calculate dropout and compliance and identify associated factors using multivariate Cox and linear regression models. RESULTS: In 1- and 2-year adult cohorts, dropout rates were 13.5% and 22.1% and compliance rates were 92.8% and 88.8%, respectively. Adolescents had higher dropout and lower compliance. Patients 40-59 years of age had a lower dropout risk than patients 20-29 years of age. Dropout hazard ratios (95% confidence interval) in 1- and 2-year cohorts were 0.26 (0.12-0.58) and 0.40 (0.17-0.93) in patients 40-49 years of age and 0.32 (0.14-0.75) and 0.35 (0.13-0.92) in patients 50-59 years of age, respectively. Younger age contributed to lower compliance in 1- and 2-year adult cohorts (p = 0.001 and p = 0.02, respectively). Systemic steroidal medication history and male gender were positively associated with compliance in adults but not in adolescents. CONCLUSION: High dropout rate was associated with younger generations. Compliance in adults, but not in adolescents, was associated with age, systemic steroidal medication history, and gender.


Assuntos
Cryptomeria/imunologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Rinite Alérgica Sazonal/terapia , Imunoterapia Sublingual/psicologia , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Alérgenos/administração & dosagem , Alérgenos/imunologia , Cryptomeria/química , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pólen/química , Pólen/imunologia , Rinite Alérgica Sazonal/epidemiologia , Rinite Alérgica Sazonal/psicologia , Fatores de Risco
16.
Am J Med Sci ; 357(5): 442-447, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010469

RESUMO

Allergic rhinitis is a prevalent condition that has a significant impact on the quality of life of many patients. When initial therapy fails to control the symptoms, allergen immunotherapy (AIT) has been suggested as an option by the Joint Task Force on Practice Parameters. The 2 main forms of AIT are via subcutaneous and sublingual routes, called subcutaneous immunotherapy and sublingual immunotherapy, respectively. There is debate about which is the better option for patients with each method offering its own pros and cons. We present 2 patients with allergic rhinitisAR that were deemed good candidates for AIT and explore current evidence for both subcutaneous immunotherapy and sublingual immunotherapy. The advantages and disadvantages of each method are discussed with the goal of providing a framework for the physician when deciding on AIT for their patients. In addition, we explore the use of AIT in patients with asthma and atopic dermatitis as potential patient populations that may benefit from the treatment. We use the discussion to provide recommendations regarding which method of AIT is best suited for both our patients.


Assuntos
Dessensibilização Imunológica/métodos , Injeções Subcutâneas/métodos , Rinite Alérgica Perene/terapia , Rinite Alérgica Sazonal/terapia , Imunoterapia Sublingual/métodos , Administração Sublingual , Adulto , Criança , Dessensibilização Imunológica/classificação , Humanos , Masculino
18.
Immunotherapy ; 11(6): 473-482, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30860439

RESUMO

AIM: The aim of this study was to clarify whether there are more regulatory T (Treg) and regulatory B (Breg) cells, and higher levels of IL-10-related transcription factors in subcutaneous immunotherapy (SCIT)-treated pollinosis patients than in non-SCIT-treated patients. METHODS: Japanese cedar pollinosis patients undergoing SCIT had received treatment for at least 2.8 years. Peripheral blood mononuclear cells were used for flow cytometer analyses and mRNA measurement. RESULTS: The numbers of type 1 regulatory T (Tr1)-like cells and Breg cells, and expression of E4BP4 mRNA by peripheral blood mononuclear cells in SCIT-treated patients were higher than those in non-SCIT-treated patients. CONCLUSION: Tr1-like cells, Breg cells and E4BP4 may be involved in the effectiveness of SCIT.


Assuntos
Linfócitos B Reguladores/imunologia , Dessensibilização Imunológica/métodos , Rinite Alérgica Sazonal/terapia , Linfócitos T Reguladores/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alérgenos/imunologia , Antígenos de Plantas/imunologia , Fatores de Transcrição de Zíper de Leucina Básica/genética , Fatores de Transcrição de Zíper de Leucina Básica/metabolismo , Biomarcadores/metabolismo , Circulação Sanguínea , Cryptomeria/imunologia , Feminino , Humanos , Injeções Subcutâneas , Interleucina-10/genética , Interleucina-10/metabolismo , Masculino , Pessoa de Meia-Idade , Pólen/imunologia , Rinite Alérgica Sazonal/imunologia , Adulto Jovem
19.
Inflammation ; 42(3): 961-972, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30715691

RESUMO

Birch pollen allergy is a common cause of spring pollinosis in China. However, there is little research on birch pollen allergen in China and only the major allergen (Bet v 1) has been fully characterized. Chinese birch pollen-induced airway inflammation models in BALB/c mice were developed and administered subcutaneous immunotherapy (SCIT). BALB/c mice were sensitized subcutaneously on days 1, 8, and 15 with 25 µg/µL birch pollen extract. On days 24-26, the mice were challenged with 0.1% birch pollen aerosol. To investigate the efficacy of SCIT, mice were subcutaneously injected 0.3 mg birch pollen extract (BPE) with or without being adsorbed to alum. Airway hyper-responsiveness (AHR) to methacholine and immunological parameters was detected. Western blot analysis was applied with mice serum and mass spectrometry was used to identify the IgE-binding bands in birch pollen. Compared with PBS group, birch pollen sensitization and challenge BALB/c mice developed AHR, and IL4, IL5, IL6, IL10, and IL17 were significantly higher. Mice sensitized by birch pollen showed increased plasma levels of anti-BPE IgE, IgG1, and IgG2a. Histologic analyses showed that mice had peribranchial infiltration of inflammatory cells and mucosal hyperplasia. After SCIT, allergic symptoms effectively alleviated and kept for a long time. Interestingly, mice serum pool showed strong reactions to 70-kDa proteins. Mass spectrometry data suggests that the 70-kDa protein belongs to the HSP 70 family. SCIT inhibited the inflammatory response in the long term and a 70-kDa protein potentially belonging to the HSP 70 family plays a significant role in Chinese birch pollen-induced mice model.


Assuntos
Betula/imunologia , Imunoterapia/métodos , Rinite Alérgica Sazonal/terapia , Animais , China , Proteínas de Choque Térmico HSP70/análise , Inflamação/terapia , Espectrometria de Massas , Camundongos Endogâmicos BALB C , Hipersensibilidade Respiratória/imunologia , Rinite Alérgica Sazonal/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA