Immunotherapy 2012

Five reports on Immunotherapy (IT) this year ...

Oral immunotherapy successfully controls the symptoms of allergic rhinoconjunctivitis in adults and children

Grass allergy immunotherapy tablet (grass AIT) treatment on children and adults in two separate trials in North America has been found to reduce nasal and ocular symptoms of allergic rhinoconjunctivitis.

In the trials carried out by a collaboration between Drexel University College of Medicine, Philadelphia, PA; Merck Research Laboratories, Kenilworth, NJ; Johns Hopkins University School of Medicine, Baltimore, MD; University of Tennessee Health Science Center, Memphis, TN and the National Jewish Medical & Research Center, Denver, CO, all in the USA, 345 children and 439 adults were given once-daily 2800 Bau grass AIT or placebo for 16 weeks before and during the pollen season. Allergic rhinoconjunctivitis symptoms were scored from 0 (no symptoms) to 3 (severe). Symptoms include runny, itchy and blocked nose, sneezing, gritty feeling, itchy, red and watery eyes.

The results show that the grass AIT effectively reduces nasal and ocular symptoms in both adults and children with grass pollen allergic rhinoconjunctivitis.

Source: The Journal of Allergy and Clinical Immunology

In the US, there are no Food and Drug Administration (FDA)-approved sublingual immunotherapy (SLIT) medications – 03/12

The reported increase in use of sublingual immunotherapy (SLIT) in non-research settings is disturbing, according to those scientists who are conducting research trials on the therapy. SLIT is commonly used in Europe, but in the United States there are currently no Food and Drug Administration (FDA) approved medications.

Otolaryngologists and physicians are among those who are using SLIT around the US. It is mostly being used for allergic nasal disease. Some are sublingually (under the tongue) administering extracts that are made for subcutaneous (under the skin) use.

President-elect of the American Academy of Allergy, Asthma and Immunology (AAAAI) Dr Wesley Burks is involved in SLIT trials for milk and peanut allergy. Dr Burks says that the safety profile of SLIT was originally thought to be very benign: however there are a few people who will have very serious systemic allergic reactions (possible anaphylaxis). Also, because the data is not yet clear about whether each SLIT product has the correct level of allergen to control the condition, there may be no clinical benefit.

Until it is approved, and levels set by the FDA, SLIT remains an exciting concept in the US – its disease modifying potential means it may be able to prevent the atopic march, or the development of asthma.

Source: Medscape

A longer exposure to sublingual immunotherapy improves safety of oral immunotherapy – 03/12

Scientists from Johns Hopkins University, Baltimore, MD, and Duke University, Durham, NC, USA recently found that although sublingual immunotherapy (SLIT) is safer than oral immunotherapy (OIT), OIT is more efficacious. They then carried out a trial to find out whether a longer progamme using SLIT would improve the safety of any subsequent OIT for patients.

SLIT involves holding the allergen under the tongue, and OIT involves swallowing the allergen. Thirty children with cows’ milk allergy were divided into two groups and given either a longer or a shorter schedule of SLIT. Of theses, 8 children were then moved over to OIT, and their reactions were measured across a range of doses. The authors concluded that although the levels of safety for OIT improved the longer the children had been on SLIT, it did not eliminate all symptoms.

This study shows that for at least some children, especially those with more frequent or severe reactions to oral immunotherapy, beginning treatment with sublingual immunotherapy might be beneficial.

Source: The Journal of Allergy and Clinical Immunology

Peanut oral immunotherapy improves food-related quality of life – 04/12

Researchers from the New England Food Allergy Treatment Centre, West Hartford, CT, USA, have ascertained from questionnaires on quality of life (QOL) and trialling peanut oral immunotherapy (OIT), that successful peanut OIT improves food allergy related QOL.

Of 57 patients who were enrolled in the study to take escalating doses of peanut protein (starting at 0.1mg escalating every two weeks to a maintenance dose of 450mg), 4 children (5-12 years) and 6 adolescents (13-17 years) reached the maintenance dose.

Parents’ assessment of their children’s QOL showed improvement in food related anxiety, emotional impact, social and dietary limitations. The adolescents’ assessments of their QOL were similar to the parents’ assessments done on behalf of their children.

Source: The Journal of Allergy and Clinical Immunology

Kids beat egg allergy with oral immunotherapy – 03/12

A study presented at the American Academy of Allergy, Asthma and Immunology  (AAAAI) carried out by several university medical Centres in the United States (University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR; Duke University Medical Center, Durham, NC; Johns Hopkins University Medical Center, Baltimore, MD; National Jewish Health, Denver, CO; Mount Sinai School of Medicine, New York, NY; The EMMES Corporation, Rockville, MD; Massachusetts General Hospital, Harvard Medical School, Boston, MA; National Institutes of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD) is among the first to evaluate oral immunotherapy (OIT) trials to assess tolerance induction.

Fifty-five egg-allergic children received either egg white (40) or placebo (15) in escalated doses, followed by an oral food challenge at 10, 22 and 24 months. After ten months, 22 of the 40 were desensitized, but none of the placebo group were. After 22 months, 30 of the 40 were desensitized. Egg OIT was then stopped for 6-8 weeks, after which there was another egg oral food challenge, which 11 of the 40 passed.

The scientists concluded that egg OIT can desensitize most patients and induce clinical tolerance in some.

Source: The Journal of Allergy and Clinical Immunology

First published in 2012

More research on the management of allergy

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