Biomarkers for monitoring clinical efficacy of allergen immunotherapy for allergic rhinoconjunctivitis and allergic asthma: an EAACI Position Paper.

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Abstract

Allergen immunotherapy (AIT) is an effective treatment for allergic rhinoconjunctivitis (AR) with or without asthma. It is important to note that due to the complex interaction between patient, allergy triggers, symptomatology and vaccines used for AIT, some patients do not respond optimally to the treatment. Furthermore, there are no validated or generally accepted candidate biomarkers that are predictive of the clinical response to AIT. Clinical management of patients receiving AIT and efficacy in randomised controlled trials for drug development could be enhanced by predictive biomarkers.

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Most cited references 173

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Allergen immunotherapy: a practice parameter third update.

Linda Cox, Harold Nelson, Richard Lockey … (2011)

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Long-term clinical efficacy of grass-pollen immunotherapy.

S. R. Durham, S Walker, E. M. Varga … (1999)

Pollen immunotherapy is effective in selected patients with IgE-mediated seasonal allergic rhinitis, although it is questionable whether there is long-term benefit after the discontinuation of treatment. We conducted a randomized, double-blind, placebo-controlled trial of the discontinuation of immunotherapy for grass-pollen allergy in patients in whom three to four years of this treatment had previously been shown to be effective. During the three years of this trial, primary outcome measures were scores for seasonal symptoms and the use of rescue medication. Objective measures included the immediate conjunctival response and the immediate and late skin responses to allergen challenge. Cutaneous-biopsy specimens obtained 24 hours after intradermal allergen challenge were examined for T-cell infiltration and the presence of cytokine-producing T helper cells (TH2 cells) (as evidenced by the presence of interleukin-4 messenger RNA). A matched group of patients with hay fever who had not received immunotherapy was followed as a control for the natural course of the disease. Scores for seasonal symptoms and the use of rescue antiallergic medication, which included short courses of prednisolone, remained low after the discontinuation of immunotherapy, and there was no significant difference between patients who continued immunotherapy and those who discontinued it. Symptom scores in both treatment groups (median areas under the curve in 1995, 921 for continuation of immunotherapy and 504 for discontinuation of immunotherapy; P=0.60) were markedly lower than those in the group that had not received immunotherapy (median value in 1995, 2863). Although there was a tendency for immediate sensitivity to allergen to return late after discontinuation, there was a sustained reduction in the late skin response and associated CD3+ T-cell infiltration and interleukin-4 messenger RNA expression. Immunotherapy for grass-pollen allergy for three to four years induces prolonged clinical remission accompanied by a persistent alteration in immunologic reactivity.

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International consensus on allergy immunotherapy.

Marek Jutel, Ioana Agache, Sergio Bonini … (2015)

Allergen immunotherapy (AIT) has been used to treat allergic disease since the early 1900s. Despite numerous clinical trials and meta-analyses proving AIT efficacious, it remains underused and is estimated to be used in less than 10% of patients with allergic rhinitis or asthma worldwide. In addition, there are large differences between regions, which are not only due to socioeconomic status. There is practically no controversy about the use of AIT in the treatment of allergic rhinitis and allergic asthma, but for atopic dermatitis or food allergy, the indications for AIT are not well defined. The elaboration of a wider consensus is of utmost importance because AIT is the only treatment that can change the course of allergic disease by preventing the development of asthma and new allergen sensitizations and by inducing allergen-specific immune tolerance. Safer and more effective AIT strategies are being continuously developed both through elaboration of new allergen preparations and adjuvants and alternate routes of administration. A number of guidelines, consensus documents, or both are available on both the international and national levels. The international community of allergy specialists recognizes the need to develop a comprehensive consensus report to harmonize, disseminate, and implement the best AIT practice. Consequently, the International Collaboration in Asthma, Allergy and Immunology, formed by the European Academy of Allergy and Clinical Immunology; the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma & Immunology; and the World Allergy Organization, has decided to issue an international consensus on AIT.

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Author and article information

Journal

Journal ID (iso-abbrev): Allergy

Title: Allergy

Publisher: Wiley

ISSN (Electronic): 1398-9995

ISSN (Print): 0105-4538

Publication date (Electronic): Aug 2017

Volume: 72

Issue: 8

Affiliations

[1 ] Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK.

[2 ] MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.

[3 ] Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, Imperial College London, London, UK.

[4 ] Department of Pulmonology, STZ Centre of Excellence for Asthma & COPD, Sint Franciscus Vlietland Group, Rotterdam, The Netherlands.

[5 ] Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland.

[6 ] Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria.

[7 ] The interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, Vienna, Austria.

[8 ] Departments Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.

[9 ] Allergy & Asthma Center Westend, Outpatient Clinic and Research Center Hanf, Ackermann & Kleine-Tebbe, Berlin, Germany.

[10 ] Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria.

[11 ] Center of Allergy and Environment (ZAUM), Technische Universität and Helmholtz Center Munich, Munich, Germany.

[12 ] Department of Otolaryngology, Allergy Section, Klinikum rechts der Isar, Technische Universität, Munich, Germany.

[13 ] Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.

[14 ] Department of Allergy, Guy's and St. Thomas' NHS Foundation Trust, London, UK.

[15 ] Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.

[16 ] Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark.

[17 ] Division of Allergy, Department of Pulmonology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier and Sorbonne University, Paris, France.

[18 ] Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

[19 ] Center for Rhinology and Allergology, Wiesbaden, Germany.

[20 ] Allergy Learning and Consulting, Copenhagen, Denmark.

Article

DOI: 10.1111/all.13138

PubMed ID: 28152201

SO-VID: 4ccfc84d-9d00-46f5-af53-20847b9272b1

History

Keywords: IgG4,IgE-FAB,biomarkers,allergen immunotherapy,basophil activation

Data availability:

Keywords: IgG4, IgE-FAB, biomarkers, allergen immunotherapy, basophil activation

Biomarkers for monitoring clinical efficacy of allergen immunotherapy for allergic rhinoconjunctivitis and allergic asthma: an EAACI Position Paper.

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Abstract

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Journal of Circulating Biomarkers

Most cited references 173

Allergen immunotherapy: a practice parameter third update.

Long-term clinical efficacy of grass-pollen immunotherapy.

International consensus on allergy immunotherapy.

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