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Results for “Desensitization, Immunologic”

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At least 631 records · Page 35Linked to original sources
PubMed1997

Oral immunotherapy with short ragweed extract in a novel encapsulated preparation: a double-blind study.

BACKGROUND: In the past, oral immunotherapy with allergens has had limited clinical effectiveness, presumably because of gastrointestinal destruction of allergens. OBJECTIVE: We have developed a new technique for microencapsulating protein antigens that permits them, when given orally, to bypass the stomach and be delivered to the small intestine in a highly immunogenic form. This study's purpose was to confirm the immunologic potency of orally administered short ragweed pollen extracts (SRW) microencapsulated (mSRW) by this new technique and to study the effectiveness of mSRW in controlling the symptoms of ragweed-induced hay fever. METHODS: Twenty-one SRW-sensitive patients were treated with mSRW in a double-blind placebo-controlled study. Serum SRW IgG and IgE antibodies and nasal secretory IgA antibodies were determined. During the ragweed season, symptoms were quantified by symptom-medication scoring. RESULTS: The treated patients had high titers of serum SRW IgG antibodies (1.15 microg/ml at baseline, increasing to 21.21 microg/ml), experienced regulation of the seasonal increase in serum SRW IgE antibodies (+9% vs +59% in placebo-treated patients), and produced a small amount of nasal SRW IgA antibodies. Despite an insubstantial pollen count, the symptom-medication scores in the treated group were lower than those in the placebo group (4.28 vs 6.18, p = 0.059), but the differences were statistically significant only in the subgroup that tolerated high doses (>20 microg of Amb a 1 in 19 of 21 patients, p = 0.04). These effects were accomplished without inducing any systemic reactions with a dose of mSRW (mean, 23.8 microg of Amb a 1) only slightly higher than that used in high-dose subcutaneous immunotherapy. CONCLUSION: Oral mSRW seems a safe, easily administered, and immunologically potent treatment for ragweed-induced hay fever, but its ultimate utility requires further study.

Administration, Oral↗
PubMed2000

Clinical and immunologic effects of long-term sublingual immunotherapy in asthmatic children sensitized to mites: a double-blind, placebo-controlled study.

BACKGROUND: Immunotherapy through local routes is thought to be a valuable therapeutic option for respiratory allergy. We investigated the clinical efficacy and immunologic effects of sublingual immunotherapy (SLIT) in asthmatic children with mite-induced respiratory allergy. METHODS: Twenty-four patients (age range 8-15 years), suffering from mild to moderate asthma, with single sensitization to mite allergen, were enrolled. After a 1-year observation phase, patients were randomly allocated to one of two groups, and were given SLIT (sublingual-spit) as drops for 2 years according to a double-blind, placebo-controlled (DBPC) design. Symptoms/medication scores (diary card), visual analog scale, and immunologic parameters (house-dust-mite [HDM]-specific IgE, and total HDM-specific IgG and IgG4) were determined during the observation phase and during the DBPC treatment period. RESULTS: Twenty-one patients completed the study. At the beginning of the treatment, no difference in environmental allergenic pressure could be shown between the groups. After 2 years of therapy, there was a significant decrease in asthmatic symptoms (P=0.0001) and medication use (P=0.0001) in the active group compared to the placebo group. The visual analog score on overall asthma symptoms improved in the SLIT group (P=0.0001), but not in the placebo group. Nevertheless, the immunologic results did not show significant differences in HDM-specific IgE and total HDM-specific IgG or IgG4 between the active and placebo groups (P = NS). No relevant side-effects were recorded throughout the study. CONCLUSIONS: Our results suggest that treatment for 2 years with SLIT is clinically safe and effective in significantly decreasing respiratory symptoms in children with mild to moderate asthma sensitized to HDM. On the other hand, the lack of changes of the immunologic parameters calls for further investigations with special reference to kinetics and mechanism(s) of action of this mode of treatment.

Administration, Sublingual↗
PubMed1983

Immunology of pregnancy.

Even though the paradox of the fetal allograft is still not completely understood, advances in reproductive immunology have made various immunological mechanisms apparent which seem to play a part in the tolerance of the fetal allograft by a seemingly normal maternal immune system. Pregnancy immunology is, however, not only restricted to the understanding of the transplant analogy of pregnancy, but has also achieved clinical significance through our increased awareness of immunological mechanisms being implicated in various pregnancy disorders. A review is presented outlining our present understanding of both basic immunological mechanisms and the normal process of pregnancy as well as those abnormal mechanisms which may be implicated in pathological states.

Antigen-Antibody Complex↗
PubMed1981

Bee venom immunotherapy: clinical and immunologic observations.

In the present study the authors evaluated the usefulness of pure venom (PV) in the diagnosis and prevention of bee allergy in a group of 25 patients. In addition, they followed changes in specific IgE and IgG serum levels during the course of immunotherapy. They found excellent correlation between the clinical history and skin test reactivity to PV. The RAST values correlated well with skin test but were somewhat less specific. They used a rather moderate schedule of desensitization by which a 100 mcg maintenance dose was attained by the 11th week. This schedule resulted in minimal side effects and was extremely effective. None of the live insect challenged patients had major reactions. Successful immunization was not associated by a decrease in specific IgE level. In contrast, most patients exhibited an increase in specific serum IgG levels. An increase in IgG level did not prove to be an absolute indication of successful immunization.

Bee Venoms↗
PubMed1988

Effective hyposensitization in allergic rhinitis using a potent partially purified extract of house dust mite.

Thirty-eight adults with allergic rhinitis have been treated with a new partially purified extract of house dust mite (Dermatophagoides pteronyssinus) in a double-blind placebo-controlled trial. Patients were randomized to active (Pharmalgen, D. pteronyssinus) and placebo (histamine) treatment by sensitivity to D. pteronyssinus on nasal challenge. In the actively treated group nasal symptoms, assessed by visual analogue score, improved (P less than 0.01), sensitivity on nasal challenge with allergen was reduced (P less than 0.05) and weal size on skin-prick test with allergen was reduced (P less than 0.01), compared with the placebo group. These results occurred after 3 months of treatment. Reduction in target organ sensitivity occurred, while the serum level of D. pteronyssinus IgE rose in the active group from 14.2 to 22.5 PRU/ml (geometric mean) but did not change significantly in the placebo group. As anticipated, because of the treatment schedule used, a number of generalized allergic reactions were induced by injections, but all responded promptly and easily to treatment. These results suggest this is an effective form of therapy, which now offers us the opportunity to study the immunological mechanisms of hyposensitization and to devise a modified schedule causing fewer reactions.

Adolescent↗
PubMed1990

Comparison of the in-vivo and in-vitro response to ragweed immunotherapy in children and adults with ragweed-induced rhinitis.

In order to compare results of allergen immunotherapy in paediatric and adult populations, 22 children with a history of ragweed hay fever were matched with an equal number of adults for skin sensitivity to ragweed and all were given a 1-year course of immunotherapy with a partially purified ragweed extract. Biological responses were measured by nasal challenges with ragweed before therapy was started, after 12 weekly injections and when the maintenance dose had been reached and also by methacholine bronchoprovocation tests before and after 12 months of therapy. Skin-test sensitivity to ragweed and control allergens, and ragweed-specific IgE and IgG antibody responses were measured at the same intervals as the challenges and at the end of the study. The effect of the therapy on clinical symptoms was not evaluated. Before therapy the groups of adults and children were comparable by all indices, except for TAME esterase activity in nasal washes during ragweed nasal challenge which was significantly lower in children. During treatment, mediators released during sequential nasal challenges declined to undetectable levels in most patients and changes in nasal ragweed sensitivity were comparable in both groups. Ragweed IgE increases after 12 weeks of therapy and IgG levels at maintenance therapy tended to be higher in the children, but neither difference was statistically significant. At the end of the study IgE and IgG antibody levels were comparable in both groups. Results of methacholine inhalation tests did not change significantly in either group. The decrease in skin sensitivity to ragweed was similar in both groups. We conclude that ragweed immunotherapy leads to immunological and biological consequences that are comparable in children and adults.

Adolescent↗
PubMed1985

Immunotherapy--state of the art.

Immunotherapy for hay fever due to ragweed, grass, birch, and mountain cedar pollens and for asthma due to ragweed, grass, house dust mite, and cat dander allergens relieves symptoms in controlled studies. Clinical improvement is specific for the allergen employed, depends on the dose administered, and may relapse six months to a year after injections are stopped. Immunological changes include a rise in IgG antibodies, an early rise and later decline in IgE antibodies, sometimes a rise in secretional antibodies, reduced basophil reactivity and sensitivity, and reduced lymphocyte responsiveness to allergens.

Asthma↗
PubMedDate not supplied

Early effects of rush immunotherapy with Dermatophagoides pteronyssinus in asthmatics.

In this study we assessed the effects of Dermatophagoides pteronyssinus (Dpt) rush immunotherapy in comparison with placebo treatment in our asthmatic patients. Fourteen highly Dpt-susceptible adults were randomized in two groups (immunotherapy and placebo) and treated in single-blind manner. Patients were selected according to the recommendation of the immunotherapy position paper (1993). To minimize side effects we modified the protocol by adjusting allergen doses for each patient separately. Immunologic (total and Dpt-specific serum IgE and IgG antibodies/EIA, Pharmacia) and clinical parameters (spirometry, medication score and skin testing) were recorded before treatment, after 2 weeks, at the second month and after 4 months of immunotherapy onset. None of the patients had life-threatening side effects in the course of the treatment. The results obtained demonstrated significant influence of immunotherapy on Dpt-specific serum IgG synthesis (Kruskal Wallis test, p < 0.05) and on the late phase skin reaction with Dpt (U-test, p < 0.05) at the end of the second month of immunotherapy onset. In the immunotherapy group, we also registered a negative correlation between concentrations of Dpt-specific serum IgE and IgG antibodies (p = -0.83; p < 0.05), at the end of the second month. In addition, diversities among patients, expressed by immunologic parameters, were related to the amount of delivered allergen. There were no significant differences between groups concerning medication score from opposite to better FEV, PEFR and dPEFR results (Kruskal Wallis, p < 0.05) in the placebo group. In conclusion, Dpt-specific serum IgG concentration, immunologic score and late phase skin reactivity to allergen appeared to be the valid parameters of rush-immunotherapy achievement, while delivered allergen dose also seemed to be an influencing factor.

Adult↗
PubMed2006

Advances in upper airway diseases and allergen immunotherapy.

The purpose of this review is to highlight important articles on upper airway disease and immunotherapy that appeared in the Journal of Allergy and Clinical Immunology and elsewhere during 2005. In recent studies of tissue from patients with chronic hypertrophic eosinophilic sinusitis, increased leukotriene C4 synthase and 5-lipoxygenase activity and increased levels of cysteinyl leukotriene production were demonstrated that correlated with disease severity but not with whether the patient was aspirin sensitive. However, the cysteinyl leukotriene 1 receptor was increased in leukocytes in the sinus tissue only in those patients with aspirin sensitivity. Major basic protein, released by eosinophils into the mucus in the paranasal sinus lumen, was found to reach concentrations capable of damaging the sinus epithelium, predisposing to bacterial infections. Testing the hypothesis that chronic hypertrophic eosinophilic sinusitis represents a reaction to common fungi, a double-blind trial of intranasal instillation of amphotericin B was conducted. There were marginal but significant differences in favor of amphotericin B treatment for sinus mucosal thickening on the basis of computed tomography and the evidence of eosinophilic inflammation in the sinus mucus. The effectiveness of topical nasal corticosteroids for treatment of nasal polyps was confirmed in 2 large studies. Improvement in sleep quality and daytime drowsiness in patients with allergic rhinitis treated with nasal corticosteroids was reported to correlate with reduction in nasal obstruction. The statistical analysis behind studies that reported a decrease in asthma exacerbations with nasal corticosteroids or oral antihistamines has been questioned. It appears that the results of at least one of these studies are indeed too good to be true. Although caution is still indicated in administering immunotherapy to patients receiving beta-adrenergic blocking agents, the prohibition might not be absolute. A study in patients with Hymenoptera sensitivity given venom immunotherapy revealed no increase in serious adverse reactions to venom injections and no greater incidence of reactions to insect stings in those taking beta-blocking agents. Sublingual immunotherapy for 8 to 12 weeks in patients with hazelnut sensitivity significantly increased their tolerance to hazelnut in double-blind, placebo-controlled challenges while inducing increased IgG4 and IL-10 levels, indicating induction of regulatory T cells. There were a number of articles in the Journal of Allergy and Clinical Immunology in 2005 that addressed the entity of chronic hypertrophic eosinophilic sinusitis. In addition, an update of the "Practice parameters on sinusitis" was published. The major focus in allergen immunotherapy continues to be sublingual administration.

Allergens↗
PubMed1999

Immunologic tolerance for immune system-mediated diseases.

Induction of long-term, antigen-specific immunologic unresponsiveness holds great promise for the treatment of many immune system-mediated diseases, including asthma, allergies, autoimmune diseases, and transplant rejection. Unlike current immunosuppressive treatments, immunologic tolerance therapies would affect only the undesired immune responses, leaving protective immunity intact. A variety of approaches to immunologic tolerance induction are being taken, reflecting the molecular and cellular complexity of immune system activation and regulation. The presentations summarized in this report represent promising strategies, some of which are being evaluated in advanced animal models and human clinical trials. Approaches presented include the following: interference with costimulatory signals in T-cell induction, T-cell receptor antagonism by altered peptides, exploitation of antigen-induced apoptosis to eliminate undesired T cells, opposition of inflammation by the induction of regulatory cytokines, induction of transplant tolerance by mixed chimerism, and deviation from deleterious allergic antibody responses by use of immunostimulatory DNA sequences. These multifaceted approaches are strongly supported by knowledge of basic immune mechanisms, which should facilitate the rational development of these therapies for controlling immune-mediated diseases.

Abatacept↗
PubMed2006

Clinical and immunologic effects of sublingual immunotherapy in asthmatic children sensitized to mites: a double-blind, randomized, placebo-controlled study.

Immunotherapy through oral routes is thought to be a valuable therapeutic option for asthma. The clinical and immunologic effects of sublingual immunotherapy (SLIT) in children with asthma caused by mites were evaluated in a double-blind, placebo-controlled study for 6 months. Patients (aged 6-12 yr) with mild-to-moderate asthma, with single sensitization to mite allergen, received either SLIT or placebo with a standardized Dermatophagoides pteronyssinus (D.p.)/D. farinae (D.f.) 50/50 extract. The cumulative dose was around 41824 IR, equivalent to 1.7 mg of D.p. and 3.0 mg of D.f. allergen. Symptom and medication scores were assessed throughout the study. Serum total immunoglobulin (Ig)E, eosinophil count, eosinophil cationic protein, specific IgE, specific IgG4, and skin sensitivity were evaluated before starting the treatment and after the treatment period. Twenty patients completed the study. At the beginning of the treatment, no differences were observed between the groups for symptom and medication scores, skin sensitivity, or immunologic parameters. After 6 months of treatment, there was a significant difference in nighttime asthma symptom scores and specific IgG4 (p < 0.05) in the SLIT group compared with the placebo group. Daytime symptom and medication scores, total IgE, eosinophil count, forced expiratory volume in 1 s, and mean evening peak expiratory flow rate reached significant differences in the SLIT group during the treatment period (p < 0.05). No severe adverse effects were reported. Our results revealed that treatment for 6 months with SLIT is clinically effective in decreasing asthmatic symptoms and medication use in children with mild-to-moderate asthma because of mite sensitivity. The clinical usefulness of this form of immunotherapy and the mechanism underlying its immunologic effects deserve further studies.

Administration, Sublingual↗
PubMed1973

Seasonal changes in IgE antibodies and their relationship to IgG antibodies during immunotherapy for ragweed hay fever.

Seasonal changes in IgE antibodies and their relationship to IgG antibodies were studied in 52 patients with ragweed hay fever and 10 normal controls. Allergic patients received either no immunotherapy, preseasonal immunotherapy, or high dose perennial immunotherapy with aqueous-mixed ragweed extract. Serums were collected before, during, just after, and 4 mo after the ragweed pollination season. IgE antibodies to ragweed antigen E (AgE) were measured using the radioallergosorbent test, and IgG antibodies were measured by radioimmunoprecipitation.IgE antibodies to AgE were elevated in all allergic patients, and rose during the ragweed pollination season. The magnitude of the rise in IgE antibody was a function of the preseasonal IgE antibody level. IgE antibody production in the treated groups was the same as in the untreated group when patients were matched on the basis of their preseasonal IgE antibody levels. Thus, we were not able to confirm previous reports that immunotherapy suppresses the seasonal rise in IgE antibodies. Furthermore, there was a close relationship between the levels of IgE and IgG antibodies in the high dose group. This finding is contrary to what one would expect were IgG antibodies acting to suppress the formation of IgE antibodies. Rather, it suggests that in certain patients either humoral immunological reactivity to ragweed antigens in the IgG and IgE classes is low to begin with or that this reactivity may wane after treatment with high doses of ragweed extract.

Adult↗
PubMedDate not supplied

Treatment update for allergic rhinitis.

This manuscript addresses the pathogenesis of allergic rhinitis, use of nasal provocation as a method to assess inflammatory mediators and the role of cytokines, and topical glucocorticosteroids. Immunologic changes of allergen immunotherapy, pharmacotherapy with a focus on non-sedating, and topical antihistamines are discussed. The antiinflammatory potential of fexofenadine, azelastine, and newer therapeutic modalities with anti-IgE are addressed.

Anti-Inflammatory Agents↗