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Evaluation of Six Years Allergen Immunotherapy in Allergic Rhinitis and Allergic Asthma
Reza Farid,Ramin Ghasemi,Mahmood Baradaran-Rahimi,Farahzad Jabbari
Iranian Journal Of Allergy, Asthma and Immunology , 2006,
Abstract: Allergen immunotherapy involves the administration of gradually increasing quantities of specific allergens to patients with IgE-mediated conditions until a dose is reached that is effective in reducing disease severity from natural exposure. In the present study we evaluated a period of six years immunotherapy allergic rhinitis and allergic asthma patients with positive skin prick test of common aeroallergen. The immunotherapy was performed on 156 patients. One hundred twenty of the cases were allergic rhinitis (80%), 29 cases had allergic asthma and 7 cases were mixed (4.5%). 70% in allergic rhinitis group, 75% in allergic asthma group and 42.8% in mixed group completely improved. Immunotherapy, an older therapeutic method, has now been updated, and with appropriate indications, precautions and methods, has been clearly shown to be effective in the treatment of allergic rhinitis and in some cases of asthma and insect hypersensitivity.
Greater risk of incident asthma cases in adults with Allergic Rhinitis and Effect of Allergen Immunotherapy: A Retrospective Cohort Study
Riccardo Polosa, Wael K Al-Delaimy, Cristina Russo, Giovita Piccillo, Maria Sarvà
Respiratory Research , 2005, DOI: 10.1186/1465-9921-6-153
Abstract: The aim of our study is to investigate history of allergic rhinitis as a risk factor for asthma and the potential effect of allergen immunotherapy in attenuating the incidence of asthma.Hospital-referred non-asthmatic adults, aged 18–40 years between 1990 and 1991, were retrospectively followed up until January and April 2000. At the end of follow up, available subjects were clinically examined for asthma diagnosis and history of allergen specific immunotherapy, second-hand smoking and the presence of pets in the household. A total of 436 non-asthmatic adults (332 subjects with allergic rhinitis and 104 with no allergic rhinitis nor history of atopy) were available for final analyses.The highest OR (odds ratio) associated with a diagnosis of asthma at the end of follow-up was for the diagnosis of allergic rhinitis at baseline (OR, 7.8; 95%CI, 3.1–20.0 in the model containing the covariates of rhinitis diagnosis, sex, second-hand smoke exposure, presence of pets at home, family history of allergic disorders, sensitization to Parietaria judaica; grass pollen; house dust mites; Olea europea: orchard; perennial rye; and cat allergens). Female sex, sensitization to Parietaria judaica and the presence of pets in the home were also significantly predictive of new onset asthma in the same model. Treatment with allergen immunotherapy was significantly and inversely related to the development of new onset asthma (OR, 0.53; 95%CI, 0.32–0.86).In the present study we found that allergic rhinitis is an important independent risk factor for asthma. Moreover, treatment with allergen immunotherapy lowers the risk of the development of new asthma cases in adults with allergic rhinitis.Asthma is one of the most common chronic conditions in developed countries, with a prevalence that has been increasing globally since the 1970s [1-3]. Asthma is often associated with allergic rhinitis (AR) and the overall characteristics of the diseases and treatment options for these disorders are simi
Cluster Subcutaneous Allergen Specific Immunotherapy for the Treatment of Allergic Rhinitis: A Systematic Review and Meta-Analysis  [PDF]
Shaoyan Feng, Ying Xu, Renqiang Ma, Yueqi Sun, Xi Luo, Huabin Li
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086529
Abstract: Background Although allergen specific immunotherapy (SIT) represents the only immune- modifying and curative option available for patients with allergic rhinitis (AR), the optimal schedule for specific subcutaneous immunotherapy (SCIT) is still unknown. The objective of this study is to systematically assess the efficacy and safety of cluster SCIT for patients with AR. Methods By searching PubMed, EMBASE and the Cochrane clinical trials database from 1980 through May 10th, 2013, we collected and analyzed the randomized controlled trials (RCTs) of cluster SCIT to assess its efficacy and safety. Results Eight trials involving 567 participants were included in this systematic review. Our meta-analysis showed that cluster SCIT have similar effect in reduction of both rhinitis symptoms and the requirement for anti-allergic medication compared with conventional SCIT, but when comparing cluster SCIT with placebo, no statistic significance were found in reduction of symptom scores or medication scores. Some caution is required in this interpretation as there was significant heterogeneity between studies. Data relating to Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) in 3 included studies were analyzed, which consistently point to the efficacy of cluster SCIT in improving quality of life compared to placebo. To assess the safety of cluster SCIT, meta-analysis showed that no differences existed in the incidence of either local adverse reaction or systemic adverse reaction between the cluster group and control group. Conclusion Based on the current limited evidence, we still could not conclude affirmatively that cluster SCIT was a safe and efficacious option for the treatment of AR patients. Further large-scale, well-designed RCTs on this topic are still needed.
Treating allergic rhinitis by sublingual immunotherapy: a review
Incorvaia,Cristoforo; Di Rienzo,Alessia; Celani,Camilla; Makrì,Eleni; Frati,Franco;
Annali dell'Istituto Superiore di Sanità , 2012, DOI: 10.4415/ANN_12_02_10
Abstract: objective: allergic rhinitis (ar) is a disease with high and increasing prevalence. the management of ar includes allergen avoidance, anti-allergic drugs, and allergen specific immunotherapy (ait), but only the latter works on the causes of allergy and, due to its mechanisms of action, modifies the natural history of the disease. sublingual immunotherapy (slit) was proposed in the 1990s as an option to traditional, subcutaneous immunotherapy. material and methods: we reviewed all the available controlled trials on the efficacy and safety of slit. results and conclusion: thus far, more than 60 trials, globally evaluated in 6 meta-analyses, showed that slit is an effective and safe treatment for ar. however, it must be noted that to expect clinical efficacy in the current practice slit has to be performed following the indications from controlled trials, that is, sufficiently high doses to be regularly administered for at least 3 consecutive years.
Allergen-specific subcutaneous immunotherapy in allergic asthma: immunologic mechanisms and improvement
YA Taher, PAJ Henricks, AJM van Oosterhout
Libyan Journal of Medicine , 2010,
Abstract: Allergic asthma is a disease characterized by persistent allergen-driven airway inflammation, remodeling, and airway hyperresponsiveness. CD4+ T-cells, especially T-helper type 2 cells, play a critical role in orchestrating the disease process through the release of the cytokines IL-4, IL-5, and IL-13. Allergen-specific immunotherapy (SIT) is currently the only treatment with a long-term effect via modifying the natural course of allergy by interfering with the underlying immunological mechanisms. However, although SIT is effective in allergic rhinitis and insect venom allergy, in allergic asthma it seldom results in complete alleviation of the symptoms. Improvement of SIT is needed to enhance its efficacy in asthmatic patients. Herein, the immunoregulatory mechanisms underlying the beneficial effects of SIT are discussed with the ultimate aim to improve its treatment efficacy.
Local Nasal Specific Immunotherapy for Allergic Rhinitis
Giovanni Passalacqua, Giorgio Canonica
Allergy, Asthma & Clinical Immunology , 2006, DOI: 10.1186/1710-1492-2-3-117
Abstract: Since the first empirical attempts at the beginning of the twentieth century [1], specific immunotherapy (SIT) for allergic rhinitis has been administered via the subcutaneous route. The clinical efficacy of this treatment was immediately recognized, and its use rapidly spread. At the same time, attempts were made to administer the allergenic extracts via different routes, and in fact, oral immunotherapy was first proposed in the early 1900s [2,3]. Later, during the 1950s, local bronchial desensitization was suggested and investigated [4,5] whereas sublingual immunotherapy (SLIT) appeared only in 1986 [6]. The main stimulus to the development of noninjection routes was the problem of the safety of injected SIT, which became of primary relevance after the formal and detailed report of numerous deaths due to subcutaneous SIT [7]. Nevertheless, independent of the safety issue, local nasal immunotherapy (LNIT) has been extensively investigated since the 1970s [8,9], first in the United States and later in Italy. Within the last 20 years, reports from more than 60 controlled trials of various noninjection routes have been published in peer-reviewed journals, but in 1998, on the basis of an extensive review of the literature, a panel of experts from the World Health Organization concluded that only SLIT and LNIT are viable alternatives to therapy by the injection route [10]. These conclusions were soon confirmed in a position paper by the European Academy of Allergology and Clinical Immunology [11] and in the ARIA (Allergic Rhinitis and Its Impact on Asthma) study document [12]. Currently, SLIT is prescribed in many European countries whereas the use of LNIT is progressively decreasing, mainly because of technical limitations.LNIT is the administration (by spray) of gradually increasing amounts of allergen (build-up or up-dosing phase) into the nasal cavity until a maintenance dose is reached. The maintenance dose is then given continually at variable intervals to maintai
Allergic rhinitis  [cached]
Small Peter,Kim Harold
Allergy, Asthma & Clinical Immunology , 2011, DOI: 10.1186/1710-1492-7-s1-s3
Abstract: Allergic rhinitis is a common disorder that is strongly linked to asthma and conjunctivitis. It is usually a long-standing condition that often goes undetected in the primary-care setting. The classic symptoms of the disorder are nasal congestion, nasal itch, rhinorrhea and sneezing. A thorough history, physical examination and allergen skin testing are important for establishing the diagnosis of allergic rhinitis. Second-generation oral antihistamines and intranasal corticosteroids are the mainstay of treatment. Allergen immunotherapy is an effective immune-modulating treatment that should be recommended if pharmacologic therapy for allergic rhinitis is not effective or is not tolerated. This article provides an overview of the pathophysiology, diagnosis, and appropriate management of this disorder.
The current role of sublingual immunotherapy in the treatment of allergic rhinitis in adults and children
Cristoforo Incorvaia, Simonetta Masieri, Silvia Scurati, et al
Journal of Asthma and Allergy , 2011, DOI: http://dx.doi.org/10.2147/JAA.S16632
Abstract: urrent role of sublingual immunotherapy in the treatment of allergic rhinitis in adults and children Review (6402) Total Article Views Authors: Cristoforo Incorvaia, Simonetta Masieri, Silvia Scurati, et al Published Date February 2011 Volume 2011:4 Pages 13 - 17 DOI: http://dx.doi.org/10.2147/JAA.S16632 Cristoforo Incorvaia1, Simonetta Masieri2, Silvia Scurati3, Silvia Soffia3, Paola Puccinelli3, Franco Frati3 1Allergy/Pulmonary rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 2ENT Clinic, University La Sapienza, Rome, Italy; 3Medical and Scientific Department, Stallergenes, Milan, Italy Abstract: Allergic rhinitis is a very common disease affecting about 20% of people. It may be treated by allergen avoidance when possible, by antiallergic drugs such as antihistamines and topical corticosteroids, and by allergen-specific immunotherapy. The latter is the only treatment able to act on the causes and not only on the symptoms of respiratory allergy and is able to maintain its efficacy even after stopping, provided an adequate duration of treatment of 3–5 years is ensured. Sublingual immunotherapy (SLIT) was introduced in the 1990s as a possible solution to the problem of adverse systemic reactions to subcutaneous immunotherapy and has been demonstrated by more than 50 trials and globally evaluated thus far by five meta-analyses as an effective and safe treatment for allergic rhinitis. Life-threatening reactions are extremely rare. However, it is important to note that clinical efficacy occurs only if SLIT meets its needs, ie, sufficiently high doses are regularly administered for at least 3 consecutive years. This is often overlooked in the current practice and may prevent the same success reported by trials from being achieved.
The current role of sublingual immunotherapy in the treatment of allergic rhinitis in adults and children  [cached]
Cristoforo Incorvaia,Simonetta Masieri,Silvia Scurati,et al
Journal of Asthma and Allergy , 2011,
Abstract: Cristoforo Incorvaia1, Simonetta Masieri2, Silvia Scurati3, Silvia Soffia3, Paola Puccinelli3, Franco Frati31Allergy/Pulmonary rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 2ENT Clinic, University La Sapienza, Rome, Italy; 3Medical and Scientific Department, Stallergenes, Milan, ItalyAbstract: Allergic rhinitis is a very common disease affecting about 20% of people. It may be treated by allergen avoidance when possible, by antiallergic drugs such as antihistamines and topical corticosteroids, and by allergen-specific immunotherapy. The latter is the only treatment able to act on the causes and not only on the symptoms of respiratory allergy and is able to maintain its efficacy even after stopping, provided an adequate duration of treatment of 3–5 years is ensured. Sublingual immunotherapy (SLIT) was introduced in the 1990s as a possible solution to the problem of adverse systemic reactions to subcutaneous immunotherapy and has been demonstrated by more than 50 trials and globally evaluated thus far by five meta-analyses as an effective and safe treatment for allergic rhinitis. Life-threatening reactions are extremely rare. However, it is important to note that clinical efficacy occurs only if SLIT meets its needs, ie, sufficiently high doses are regularly administered for at least 3 consecutive years. This is often overlooked in the current practice and may prevent the same success reported by trials from being achieved.Keywords: allergic rhinitis, sublingual immunotherapy, efficacy, safety, compliance, meta-analysis
Diminished levels of nasal S100A7 (psoriasin) in seasonal allergic rhinitis: an effect mediated by Th2 cytokines
Anne Kvarnhammar, Camilla Rydberg, Malin J?rnkrants, Mia Eriksson, Rolf Uddman, Mikael Benson, Lars-Olaf Cardell
Respiratory Research , 2012, DOI: 10.1186/1465-9921-13-2
Abstract: Nasal lavage (NAL) fluid was obtained from healthy controls before and after lipopolysaccharide (LPS) provocation, from SAR patients before and after allergen challenge, and from SAR patients having completed allergen-specific immunotherapy (ASIT). Nasal biopsies, nasal epithelial cells and blood were acquired from healthy donors. The airway epithelial cell line FaDu was used for in vitro experiments. Real-time RT-PCR and immunohistochemistry were used to determine S100A7 expression in nasal tissue and cells. Release of S100A7 in NAL and culture supernatants was measured by ELISA. The function of recombinant S100A7 was explored in epithelial cells, neutrophils and peripheral blood mononuclear cells (PBMC).Nasal administration of LPS induced S100A7 release in healthy non-allergic subjects. The level of S100A7 was lower in NAL from SAR patients than from healthy controls, and it was further reduced in the SAR group 6 h post allergen provocation. In contrast, ASIT patients displayed higher levels after completed treatment. S100A7 was expressed in the nasal epithelium and in glands, and it was secreted by cultured epithelial cells. Stimulation with IL-4 and histamine repressed the epithelial S100A7 release. Further, recombinant S100A7 induced activation of neutrophils and PBMC.The present study shows an epithelial expression and excretion of S100A7 in the nose after microbial stimulation. The levels are diminished in rhinitis patients and in the presence of an allergic cytokine milieu, suggesting that the antimicrobial defense is compromised in patients with SAR.S100A7, also known as psoriasin, belongs to the S100 protein family consisting of ~20 different EF-hand type proteins [1]. It was first identified as highly up-regulated in the skin of psoriatic patients [2], but has also been attributed a role in atopic dermatitis (AD) and different types of cancer, including skin, breast and bladder cancer [3-6]. The function of S100A7 is still poorly understood, but several s
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