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Results for “Desensitization, Immunologic”

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PubMed2006

Overview of inhibitors.

Inhibitory antibodies that develop in patients with hemophilia render standard therapy with factor concentrates ineffective. Several factors may influence inhibitor incidence, including genetics, the type of factor concentrate, and environment. A higher incidence of inhibitors in siblings compared to extended relatives, and in African Americans compared to Caucasians, suggests that genetics may play an important role in inhibitor development; however, genetic markers that indicate a predisposition for inhibitor development have yet to be identified. In addition, the appearance of inhibitors in immunologically challenged patients points to the role of the immune response system in the development of inhibitor antibodies, an area that warrants further study. Thus, the medical community faces the difficult task of developing new, improved therapies to combat inhibitors in patients with hemophilia, a task that will require careful consideration of the roles of environmental factors, the immune system, and genetics in inhibitor development.

Antibody Formation↗

PubMedDate not supplied

Allergen specific IgG subclass antibody response in hyposensitization with Dermatophagoides pteronyssinus extract.

Most of the controlled trials of specific immunotherapy (SIT) with house dust mite showed a good clinical efficacy of different kinds of extract after variable periods of treatment. However, few of them looked at all the parameters available to monitor this therapy, such as threshold dose of specific provocation test, end point titration and immunological variations. In particular, the behaviour of specific IgE antibodies is not completely known, while, in more recent studies, mite specific IgG antibodies have been shown to increase even in the early stages of treatment. Few data are available on mite specific IgG1-4 subclasses. The preliminary results of a double blind placebo controlled trial we performed with alginate conjugated Dermatophagoides pteronyssinus extract seem to indicate a good clinical and immunological response to this kind of extract. Moreover, we observed a significant increase of specific IgG antibodies, total and subclasses IgG1.2.4, with a prevalence of IgG4 subclass after three months of SIT. After two years of SIT mite specific IgG1 antibodies showed a tendency to decrease, while IgG4 antibodies maintained a constantly high level.

Animals↗

PubMed1999

[Mechanisms and applications of oral tolerance].

The term oral tolerance (OT) describes the antigen-specific suppression of immune responses following the feeding of the antigen. While some common features with other forms of induction of systemic tolerance have been disclosed, OT can be distinguished by certain immunologic characteristics. Thus, work in experimental animal models revealed the importance of intestinal antigen processing, especially antigen processing in the Peyer's patches, in inducing OT. It has become clear that suppressive T cell cytokines derived from mucosal sites play a major role in mediating OT. The variation of the dose of fed antigen and the modulation of the cytokine milieu both have influences on the underlying immunologic mechanisms active suppression, clonal anergy and clonal deletion following oral antigen uptake. In several animal models of autoimmunity the disease activity can be suppressed by feeding oral autoantigen. Based on these results, recent clinical studies have begun to explore OT as a means to treat autoimmune disorders such as multiple sclerosis, rheumatoid arthritis and diabetes.

Administration, Oral↗

PubMed1987

[Determination of specific serum IgG4 by an enzyme immunoassay].

Specific series IgG4 titrate is realized now with a enzymo-immunologic using "double sandwich" method with allergen and patient serum in presence of a conjugate with peroxidase monoclonal Anti IgG4. Calibration obtains with a standard curve, is realized with a monoclonal IgG4 concentration is known. The first tests are in favor of correlation between specific IgG4 specific, IgE and in another way, the increase of specific IgE and specific IgG4 in a venom immunotherapy.

Animals↗

PubMed1996

[Specific treatments of allergic manifestations].

Because we now know more about the relationship between environment and allergy, we should aim: at preventing allergic diseases in at-risk populations; at alleviating symptoms in sensitized patient using avoidance methods; and at modifying immunological responses through specific immunotherapy. Recent studies provide a better knowledge of the allergenic levels which induce sensitization and trigger symptoms in allergic patients. This knowledge allows a strategy for avoidance measures. A better understanding of cross allergenicity of several allergens has been drawn from a better knowledge of the epitopes. Specific immunotherapy has proven its efficacy in selected patients suffering from asthma and/or rhinitis and patients with hymenoptera sensitivity.

Desensitization, Immunologic↗

PubMed2003

Oral and sublingual immunotherapy in paediatric patients.

PURPOSE OF REVIEW: Sublingual immunotherapy is becoming a routine treatment for respiratory allergy in several countries and it has been validated in international documents. This article will review the available literature on oral and sublingual immunotherapy, discussing the possible use of sublingual immunotherapy in paediatric patients. RECENT FINDINGS: As oral immunotherapy was found to be poorly effective in clinical trials, its use has been discontinued. In contrast, several controlled studies have shown the efficacy of sublingual immunotherapy in children with allergic asthma and rhinitis, and a postmarketing survey has confirmed its safety. Moreover, new data on the long-lasting efficacy of this treatment and on the absence of local immunological effects have recently been published. SUMMARY: The clinical efficacy and the optimal safety profile of sublingual immunotherapy make it a good candidate for treating respiratory allergy in children. Some aspects, such as the dose-response relationship and preventive effect, will be a research challenge for future developments and better definition of indications in children.

Administration, Oral↗

PubMed1984

[Diagnostic and therapeutic aspects in the treatment of bee venom allergy].

In 50 patients who had severe allergic general reactions after a bee sting clinical and immunological parameters were examined under the desensitisation with apitoxin. Under the introduction of the hospital treatment 25 patients showed side effects. 14 of these patients had milder general reactions also during the further continuation of the ambulatory treatment. In no case the treatment had to be stopped. The behaviour of the specific IgE and IgG antibodies does not allow a prognostic evidence concerning possible side effects and is little suited for the individual case also as objective parameter of success. 17 patients who during the first weeks after the beginning of the therapy spontaneously had been stung by a bee did not show any reactions or only reduced reactions. This result shows that the desensitization of desensitized patients gives a secure protection from life-threatening incidents. Open remains among others the problem of the objective judgment of the therapy and thus the question of the duration of the treatment.

Adolescent↗

PubMedDate not supplied

IgG subclass antibody response to hymenoptera venom.

Venom immunotherapy provides clinical protection against hymenoptera stings in almost all treated allergic patients. Venom specific IgG antibodies often rise during immunotherapy and some studies found an association between their levels and clinical protection in subjects treated with Yellow Jacket venom. It is interesting to report that, among IgG subclasses, venom specific IgG4 show the most significant increase but IgG1 could represent a relevant immunological mechanism, exerting a regulatory function on venom specific IgE levels. We observed in patients submitted to Honey Bee venom immunotherapy a significant increase of venom specific IgG1 and IgG4 antibodies, while IgG2 showed an insignificant increase only in some patients. Persistent high levels of IgG4 with respect to decreasing levels of IgG1 were observed only after prolonged treatment.

Antigen-Antibody Reactions↗

PubMed2003

Efficacy of sublingual immunotherapy in asthma and eczema.

Sublingual immunotherapy (SLIT) is the local route of administration of allergen extracts investigated in several controlled clinical trials. In a number of countries, particularly Italy, France and Spain, this has become common in office practice. At variance with subcutaneous immunotherapy, the knowledge of mechanisms of action of SLIT is still at the beginning: some studies, in animal models, provided interesting information: the dendritic cells of oral mucosa act as efficient antigen-presenting cells and produce IL-12, which directs the immune response towards a Th1 profile away from IgE-Th2 profile. Its clinical efficacy (improvement of symptoms and reduction of drug intake) for both asthma and rhinitis has been assessed in detail for the most common allergens: house dust mites, grass pollen, Parietaria, birch pollen and olive tree. SLIT requires further evaluation concerning the treatment of the extrinsic form of atopic dermatitis. The induction of immunologic tolerance rather than immunoreactivity should be worth pursuing due to the immunologic pathway involved in the pathophysiology of atopic dermatitis. The safety profile of SLIT, derived from the clinical trials and postmarketing surveillance studies, turned out to be satisfactory in adults and children. SLIT represents an important step towards an efficacious and safe treatment of patients with allergic respiratory diseases; nevertheless, further studies are necessary to establish it as a viable alternative to subcutaneous immunotherapy.

Administration, Sublingual↗

PubMed2000

[The immunologic study on local nasal immunotherapy for perennial allergic rhinitis].

OBJECTIVE: To investigate the clinical efficacy and immune mechanism of local nasal immunotherapy (LNIT). METHOD: 142 cases of perennial allergic rhinitis (PAR) were treated with LNIT. Immunologic study was carried out in 30 cases. RESULT: LNIT was as effective as traditional subcutaneous immunotherapy (P > 0.05). Immunologic study demonstrated, that the nasal secretory IgA (S-IgA) increased significantly after treatment (P < 0.05). The levels of nasal secretory total IgE, serum total IgE and serum specific IgE (anti-mite, ragweed pollon) decreased, but there was no significance (P > 0.05). CONCLUSION: LNIT can improve the local immune function and modify the local nasal allergic inflammatory response. It is an effective, safe and convenient treatment.

Adolescent↗

PubMed1999

[WHO position paper (summary)--allergen-immunotherapy: therapeutic vaccines for allergic diseases].

From January 27 to 29, 1997, experts on allergen immunotherapy from various geographic locations throughout the world met at the headquarter of the World Health Organization (WHO) in Geneva, Switzerland to reach a consensus on international guidelines. Guidelines or indications for immunotherapy with inhalant allergens and venoms have been published before by the WHO, the European Academy of Allergy and Clinical Immunology (EAACI), the International Consensus Report on Asthma, the Global Strategy for Asthma Management and Prevention, the International Consensus Report on Rhinitis, the British Society for Allergy and Clinical Immunology, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI). The committee wrote a position paper based on scientific articles reviewed for data before April 1, 1997. These guidelines should result in a better understanding of the science and rationale for using allergen immunotherapy as well as improve the safety of such therapy. The document also defines new techniques being developed which may result in better efficacy and less risk for allergen immunotherapy as well as recommends areas of additional and necessary research.

Allergens↗

PubMed1977

Topical chemotherapy and immunotherapy of mycosis fungoides: intermediate-term results.

A group of 220 patients with mycosis fungoides (MF) and other lymphomatous diseases was treated with sustained topical applications of dilute aqueous solutions of mechlorethamine hydrochloride for intervals ranging in excess of seven years. Response to treatment, immunologic responsiveness, and subsequent course and survival were inversely related to magnitude of disease at time of starting treatment. Relapses were common and in most instances were related to failure to maintenance of topical therapy rather than to drug resistance. In selected patients topical therapy with an analog of mechlorethamine (nor-mechlorethamine) and with topical immunogenic agents provided additional improvement.

Administration, Topical↗

PubMed1997

Immunotherapy with an alum-adsorbed Parietaria-pollen allergoid: a 2-year, double-blind, placebo-controlled study.

A double-blind, placebo-controlled study was performed in order to confirm the safety, suitability, and efficacy of an alum-adsorbed Parietaria judaica-pollen allergoid, Allergovit, for allergen-specific immunotherapy. Parietaria pollen is an important cause of pollinosis, particularly in the Mediterranean zone, where it may be encountered for up to 8-9 months of the year. It is an aggressive allergen, and the doses tolerated during immunotherapy are less than those achieved with grass pollen. This factor increases the desirability of using therapeutic preparations with minimal IgE-binding activity, such as allergoids, in order to reduce the risk of side-effects and enable patients to tolerate a higher dose of allergen, thereby increasing the chances of successful specific immunotherapy. Forty patients with rhinitis and/or asthma were allocated at random to active- or placebo-treatment groups at the beginning of the study. All patients received the active preparation during the second year of the study. Immunotherapy was well tolerated by all patients and the incidence of side-effects was low. Treatment resulted in significant reductions in specific cutaneous reactivity and increases in nasal tolerance. A progressive improvement in nasal inspiratory peak flow in association with the immunotherapy indicated a reduction in nasal inflammation. These objective assessments of efficacy endorsed the results from the patients' diary cards, which indicated significant improvements in symptoms and reductions in the use of medication. The immunologic activity of the therapeutic preparation was demonstrated by the induction of a significant specific-IgG antibody response, with increases in IgG4 during the second year of treatment. We conclude that the safety and efficacy of immunotherapy with the Parietaria allergoid make it suitable for consideration in the treatment of patients with Parietaria-pollen-induced rhinitis or asthma.

Adolescent↗

PubMed2006

Biological standardization and maximum tolerated dose estimation of an Alternaria alternata allergenic extract.

BACKGROUND: The manufacture of allergenic extracts from the mold Alternaria alternata is influenced by factors such as strain variability, allergenic origin, culturing conditions and extraction process, which affect the reproducibility of the preparations intended for diagnostic and therapeutic use. OBJECTIVES: To select the most adequate antigenic source of A. alternata extracts and determine its maximum tolerated dose (MTD) to be used in a subsequent immunotherapy efficacy clinical trial. METHODS: Twenty-one patients monosensitized to A. alternata were involved in a biological standardization process of A. alternata extracts. Four different mold strains were cultured and used to produce extracts by three different methods, each incorporating proteins from different origins: culture filtrate, buffer extractable fraction and cellular antigens. The selected extract, characterized as in-house reference (IHR) preparation was used in a MTD finding immunotherapy study. Serum IgE, IgG, IgG1 and IgG4 specific of complete extract and purified natural and recombinant forms of Alt a 1 were determined by different EIA methods. RESULTS: Culture filtrate extract containing the allergens secreted to the spent medium was shown to be the most adequate option for establishing an IHR preparation for A. alternata extract manufacturing. A maximum dose of 1670 UBE, equivalent to 0.1 microg Alt a 1, was determined as MTD for immunotherapy. One year of administration of such a dose at monthly intervals elicited pronounced immunological changes with statistically significant decreases in IgE and increases in IgG4, both estimated with whole extract or purified Alt a 1. CONCLUSION: A high quality natural A. alternata extract has been developed and preliminarily tested to define its MTD for subsequent determination of the optimal dose in an immunotherapy efficacy clinical trial.

Adolescent↗

PubMed1990

Oral immunotherapy with grass pollen in enterosoluble capsules. A prospective study of the clinical and immunological response.

In a prospective study spanning 2 years, 60 patients with grass pollen allergy were treated with either a low dose oral, a high dose oral or a subcutaneous hyposensitization regime. No significant improvement was seen in the orally treated patients whereas those on the subcutaneous hyposensitization regime demonstrated a decreased specific cutaneous reactivity, a rise in specific IgG antibodies and a reduction in symptoms. This study suggests that oral hyposensitization, even with enterosoluble grass pollen capsules, is ineffective.

Administration, Oral↗

PubMed2002

Pregnancy and immunology: selected aspects.

LEARNING OBJECTIVES: This article reviews current concepts of the immunology of pregnancy and of the diagnosis and management of certain allergic conditions in the pregnant woman: asthma, rhinitis, immunotherapy, and hereditary angioedema (HAE). DATA SOURCES: Current texts, reviews, and individual studies were picked from the National Library of Medicine database. RESULTS AND CONCLUSIONS: Knowledge concerning the immunologic paradox of pregnancy continues to evolve. Although the answer is not definitive, attention is being paid to the role of a Th-2 shift in the pregnant uterus. Extensive studies, both epidemiologic and therapeutic, are clarifying the influence of pregnancy on asthma and rhinitis (and vice versa) and the best methods for treatment of these conditions in the pregnant woman. A brief guideline to the handling of hereditary angioedema in pregnancy is presented.

Angioedema↗

PubMed1994

[Purification and standardization of allergens].

Allergen preparations cannot be compared with any other class of drugs. Their compositions are as varied as the raw materials that induce sensitisation and their biological activities are as variable as the individual immunological profiles of patients. They are obtained by extraction and therefore very dependent on the methods used, based on known principles. The multiplicity of the allergens they contain have mostly not yet been characterised and this does not allow individual measurement. Standardisation of the allergen preparations is done mostly by comparison of their overall activity with that of a reference preparation. This is expressed in arbitrary units or in units of biological activity determined on representative mean populations of allergic subjects.

Allergens↗

PubMed1982

Immunotherapy with grass pollen major allergens. Immunological results from a prospective 3-year double blind study.

Preseasonal hyposensitization stimulated an intercorrelated increase in both serum-specific IgE and allergen-specific IgG. Subsequent perennial treatment depressed the stimulated IgE response and the basophil cell sensitivity, whereas the allergen-specific IgG response showed further increase and persisted at a high level. Nasal IgE response was stimulated from the second pollen season and subsequently became depressed. One year after the end of hyposensitization the allergen-specific IgG response had fallen by 25-50%.

Allergens↗