Background
Systemic allergic reactions are a risk for allergen immunotherapy that utilizes intact allergen preparations. We evaluated the safety, efficacy and immune mechanisms of short‐course ...treatment with adjuvant‐free Lolium perenne peptides (LPP) following a 6‐week dose‐escalation protocol.
Methods
In a prospective, dose‐escalation study, 61 grass pollen–allergic patients received 2 subcutaneous injections of LPP once weekly for 6 weeks. Safety was assessed evaluating local reactions, systemic reactions and adverse events. The clinical effect of LPP was determined by reactivity to the conjunctival provocation test (CPT). Specific IgE, IgG4 and blocking antibodies were measured at baseline (V1), during (V6) and after treatment (V8).
Results
No fatality, serious adverse event or epinephrine use was reported. Mean wheal diameters after injections were <0.6 cm and mean redness diameters <2.5 cm, independent of dose. Transient and mostly mild adverse events were reported in 33 patients. Two patients experienced a grade I and 4 patients a grade II reaction (AWMF classification). At V8, 69.8% of patients became nonreactive to CPT. sIgG4 levels were higher at V6 (8.1‐fold, P < .001) and V8 (12.2‐fold, P < .001) than at V1. The sIgE:sIgG4 ratio decreased at V6 (−54.6%, P < .001) and V8 (−71.6%, P < .001) compared to V1. The absolute decrease in IgE‐facilitated allergen binding was 18% (P < .001) at V6 and 25% (P < .001) at V8.
Conclusion
Increasing doses of subcutaneous LPP appeared safe, substantially diminished reactivity to CPT and induced blocking antibodies as early as 4 weeks after treatment initiation. The benefit/risk balance of LPP immunotherapy remains to be further evaluated in large studies.
Summary
Background
Subcutaneous allergen immunotherapy with grass pollen allergoids has been proven to be effective and safe in the treatment of patients with allergic rhinoconjunctivitis. Based on ...the extensive cross‐reactivity among Pooideae species, it has been suggested that grass pollen extracts could be prepared from a single species, rather than from a multiple species mixture.
Objective
To find the optimal dose of a Phleum pratense (P. pratense) allergoid preparation and compare its efficacy and safety to a 6‐grass pollen allergoid preparation.
Methods
In this double‐blind, placebo‐controlled study (EudraCT: 2011‐000674‐58), three doses of P. pratense allergoid (1800 therapeutic units (TU), standard‐dose 6000 TU and 18 000 TU) were compared with placebo and the marketed 6‐grass pollen allergoid (6000 TU). In a pre‐seasonal dosing regimen, 102 patients were randomized to five treatment groups and received nine subcutaneous injections. The primary efficacy endpoint was the change in weal size (late‐phase reaction LPR) in response to the intracutaneous testing (ICT) before and after treatment, comparing the active allergoids to placebo. Secondary outcomes were the change in Total Nasal Symptom Score (TNSS) assessed in the allergen exposure chamber (AEC), the changes in P. pratense‐serum‐specific IgG4 and the incidence of adverse events (AEs).
Results
All three doses of the P. pratense and the 6‐grass pollen allergoid preparations were significantly superior to placebo for the primary outcome, whereas there were no significant differences in the change in TNSS. Compared to the standard‐dose, the high‐dose of P. pratense did not produce any additional significant benefit, but showed a slight increase in AEs. Yet this increase in AEs was lower than for the 6‐grass pollen preparation.
Conclusions & Clinical relevance
The standard‐dose of the new P. pratense allergoid was comparable to the marketed 6‐grass pollen preparation at equal dose for the parameters measured.
The prevalence of allergic diseases is increasing worldwide. The highest increase rate is observed in rhinitis allergica. Apart from the anamnesis, the diagnosis relies mainly on skin tests, ...laboratory analyses and if necessary provocation tests. Symptomatic and causal therapy with abstention and specific immunotherapy are available as therapeutic means. Specific immunotherapy should be aspired as the method of choice. It is comprised of subcutane and sublingular immunity therapy. Usually native allergens and allergoids are used as therapeutics. Recombinant allergens are currently under development. Modern therapy procedures involving these drugs consist of year-round or pre- and co-seasonal treatment which spans at least 3-4 years. In cases of polyvalent allergy, different types of drugs and therapy procedures can be combined. The future of rhinitis allergica treatment lies in further development of specific immunotherapy.
Introduction
This study evaluated the efficacy and safety of mometasone furoate nasal spray (MFNS) in patients with chronic sinusitis.
Methods
In this double-blind, placebocontrolled, multicenter, ...parallel-group study, 60 patients with persistent sinusitis symptoms were randomized to receive either MFNS 200 μg twice daily or placebo, for 16 weeks (112 days). Eventually, 53 patients terminated the study in regular course.
Results
Total Symptom Scores (TSS) in patients receiving MFNS changed by a mean of −7.27 (95% CI −9.71, −4.84), versus −5.35 (95% CI −6.73, −3.96) in the placebo group (
P
=0.51). MFNS reduced nasal congestion and discharge scores, and improved patients’ olfactory function. There were few side effects. Considerably more patients in the MFNS group were satisfied with the treatment than those who had received placebo (
P
<0.05). Also, more patients would take the medication again in the event of symptoms, compared with those who had taken placebo (
P
<0.05). Furthermore, the MFNS patients would recommend it to others.
Conclusion
The positive patient assessment and few side effects are reflected in the efficacy evaluation performed by the physicians. The endoscopic results under MFNS were always numerically more favorable than those under placebo, and the overall difference reached statistical significance (
P
<0.01). MFNS offers an effective and safe treatment for chronic rhinosinusitis.
Many patients with olfactory dysfunction not only experience quantitative reduction of olfactory function, but also suffer from distorted olfactory sensations. This qualitative dysfunction is ...referred to as parosmia (also called "troposmia") or phantosmia, with the major difference that distorted olfactory sensations are experienced in the presence or absence of an odor, respectively. Our clinical observations corroborate the literature in terms of a general underestimation of the incidence of olfactory distortions. Based on selected cases we try to show that olfactory distortions exhibit a large variance in their clinical appearance. Further, emphasis is placed on the fact that only a detailed and directed history of the patient can provide cues to the correct diagnosis.
A fast updosed immunologically enhanced subcutaneous immunotherapy (SCIT) formulation with an optimized allergen to aluminium hydroxide ratio was first introduced in September 2009 in Germany. A ...large randomized controlled trial showed that the formulation had considerable immunologic effects and good tolerability. In this open-label, uncontrolled, noninterventional study, tolerability was investigated during routine application.
Patients with allergic rhinoconjunctivitis and/or asthma were treated with pollen and mite allergens using a 5-injection updosing schedule (AVANZ: 300, 600, 3000, 6000 and 15 000 SQ+ units) with weekly intervals, followed by a maintenance schedule with injections of 15,000 SQ+ units.Adverse events (AEs) were recorded by physicians, and symptoms and use of symptomatic medication were analyzed before the start of therapy and after an average 8-month treatment period.
SCIT was documented by 362 allergists in 1036 patients between September 2009 and February 2011. AEs mainly consisted of local reactions during updosing (in 24.5% of patients). Systemic reactions were observed during updosing (8.4%) and maintenance therapy (1.7%), the most frequent of which was dyspnea. Overall, tolerability and the effect of treatment were rated as good or very good by 94.9% and 86.6% of patients and by 96.2% and 89.6% of physicians, respectively.
In this open-label, noninterventional study, fast updosed immunologically enhanced SCIT (AVANZ) was well tolerated in a large group of patients.
Perceived and objective food hypersensitivity reactions are increasing steadily in the western countries. Therefore, otorhinolaryngologists are facing more frequently the challenge to evaluate ...individual food hypersensitivity reactions, to set these reactions into context with otorhinolaryngologic symptoms and to start systemic and appropriate diagnostic procedures and possibly therapy. Although a good portion of the perceived food hypersensitivity reactions can neither be objectivated nor causaly linked to the occurring symptoms, the recent literature provides documentation, suggestions and prospects for the link between food hypersensitivity reactions and distinct ENT-diseases. Based on that, this review intends to provide an overview of the current knowledge about the impact of food hypersensitivity reactions on otorhinolaryngologic diseases. The aim of the article is to give support in assessing this intricate issue in the daily otorhinolaryngological practice.
Zusammenfassung
Patienten mit einer Allergie gegen Birkenpollen sind einem erhöhten Risiko ausgesetzt, bei Verzehr sojahaltiger Nahrungsmittel schwerwiegende anaphylaktische Reaktionen zu erleiden. ...Grund dafür ist die Strukturhomologie eines Majorallergens des Birkenpollens und eines Strukturproteins im Soja (Gly m 4). Wir berichten über einen 65-jährigen, nicht therapierten Birkenpollenallergiker, der nach Genuss eines sojahaltigen Getränks eine systemische allergische Reaktion erlitt. Die Diagnose konnte mit Hilfe von In-vitro- und Hauttestungen gestellt werden. Birkenpollenallergiker sollten sojahaltige Nahrungsmittel unbedingt meiden.
Efficacy of Acupuncture for Allergic Rhinitis (AR) Hauswald, B.; Kretschmann, D.E.; Slansky, C. ...
Journal of acupuncture and meridian studies,
August 2018, 2018-08-00, Letnik:
11, Številka:
4
Journal Article
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