Multiallergen immunotherapy for allergic rhinitis and asthma

doi:10.1016/j.jaci.2008.12.013

Journal of Allergy and Clinical Immunology

Volume 123, Issue 4, April 2009, Pages 763-769

https://doi.org/10.1016/j.jaci.2008.12.013 Get rights and content

The English and non–English language literature on allergen immunotherapy was reviewed for studies simultaneously using 2 or more distinct allergen extracts in either subcutaneous or sublingual immunotherapy. Thirteen studies were identified, 11 using subcutaneous injections, 1 using sublingual administration, and 1 using both. In studies with adequate information, administration of 2 extracts by means of either subcutaneous immunotherapy or sublingual immunotherapy was effective. In studies using multiple allergens, 3 studies showed clear efficacy, whereas in the other 2 studies, lack of efficacy might have been due to inadequate doses of extract or omission of clinically relevant allergens in the treatment regimen. It is concluded that simultaneous administration of more than 1 allergen extract is clinically effective. However, more studies are needed, particularly with more than 2 allergen extracts and with sublingual administration.

Section snippets

Methods

Articles reviewed in the current study were selected in a 2-part process. Part 1 consisted of searching existing English and non-English language review articles and meta-analyses to identify studies that used 2 or more allergen extracts. Part 2 involved searching 3 databases (Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE) to identify relevant articles published between 2002 and 2007. Using the year 2002 allowed the capture of all studies published after the meta-analyses

Results

In total, 13 studies published between 1961 and 2007 were identified that reported the administration of 2 or more unrelated allergens. Seven of the studies used combinations of 2 non–cross-reacting extracts; of these, 3 studies also included some patients receiving only 1 extract, and outcomes in the 2 groups (single versus multiple allergens) were not reported separately. In the other 4 studies using 2 simultaneously administered extracts, clinical outcomes were superior to placebo and, when

Discussion

An extensive search of the English and non–English language literature on allergen immunotherapy revealed only 13 articles reporting the simultaneous administration of more than 1 unrelated allergen extract. Eleven of the studies used subcutaneous administration, 1 study used sublingual administration, and 1 study used a combination of subcutaneous and sublingual administration. In 9 studies allergic rhinitis was the primary condition being treated, whereas bronchial asthma was the primary

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Randomized double-blind pilot study of universal, species abundant, multiallergen subcutaneous immunotherapy for moderate-severe allergic rhinitis
2023, Annals of Allergy, Asthma and Immunology
Allergic rhinitis affects approximately 10% to 20% of people living in industrialized nations leading to significant morbidity and large health care expenditures. Individualized high-dose, single-species allergen immunotherapy has been found to be effective in treating allergic rhinitis but can be associated with significant risks including anaphylaxis. Few studies have evaluated the safety and efficacy of universal low-dose multiallergen immunotherapy (MAIT).
To determine the efficacy and safety of a universal MAIT formula for the treatment of allergic rhinitis.
Patients with moderate-severe perennial and seasonal allergic rhinitis were randomized in a double-blind, placebo-controlled fashion to receive a novel, subcutaneous MAIT regimen containing a unique mixture of more than 150 aeroallergens, including several cross-reactive species. All patients received the exact same universal immunotherapy formula regardless of which specific skin tests were positive. Primary outcome measures at 8 and 12 weeks of therapy included validated clinical assessments, total nasal sinus score and mini-rhinoconjunctivitis quality of life questionnaire, and the use of rescue medications.
A total of 31 patients (n = 31) were randomized to receive MAIT vs placebo. By week 12, MAIT resulted in a −4.6 (−58%) decrease in the combined total nasal sinus score and rescue medication score (daily combined score) compared with −1.5 (−20%) for placebo (P = .04). Likewise, MAIT resulted in a decrease in the mini-rhinoconjunctivitis quality of life questionnaire score of −34.9 (−68%) compared with −17 (−42%) for the placebo (P = .04). Mild adverse events were uncommon and with similar frequency among the groups.
A novel, universal, and high-species abundant MAIT formula was well tolerated and resulted in significant improvement in symptoms of moderate-severe allergic rhinitis. The results of this pilot study should be considered preliminary, pending further randomized clinical trials.
Immunotherapy to environmental allergens
2022, Allergic and Immunologic Diseases: A Practical Guide to the Evaluation, Diagnosis and Management of Allergic and Immunologic Diseases
Many treatments exist for allergic diseases, including allergen avoidance, environmental controls, and medications. One of the treatments in the armamentarium is allergen immunotherapy (AIT), usually for diseases refractory to initial treatments or for those unable to tolerate the side effects of other treatments. Allergic conditions that have been shown to benefit from AIT include allergic rhinitis, allergic conjunctivitis, allergic asthma, and atopic dermatitis. AIT entails accurate diagnosis of IgE-mediated allergy to the allergen through the skin or serum testing. Next, extracts containing those specific allergens are mixed and administered via subcutaneous injection. Some allergens contain enzymes, such as proteases, and may not be able to be mixed with allergens susceptible to these proteases. Different injection schedules are available based on patient and provider preference. AIT has shown benefits in the improvement of allergic symptoms as well as protection against developing further allergic sensitivities or asthma in certain populations. Immunomodulatory changes from AIT are thought to be responsible for these clinical benefits, with decreased allergic cytokines and allergic cells seen after AIT. The benefits of AIT have been shown to last for years after the cessation of treatment. AIT has traditionally been done via injections, but other formulations, such as sublingual immunotherapy in tablet form, are also available. Efficacy of next-generation AIT concepts, including DNA recombinant proteins is currently being investigated and efficacy remains to be seen in future head-to-head trials.
Guidelines for the prescription of allergen immunotherapy and patient follow-up — Clinical questions and revision of the literature
2021, Revue Francaise d'Allergologie
L’immunothérapie allergénique (ITA) aux allergènes respiratoires est à ce jour le seul traitement curatif des allergies. Nous avons précédemment publié la liste des recommandations pour la pratique cliniques (RPC) nationales pour la prescription de l’ITA et le suivi du patient. Pour la réalisation de ce travail, un groupe de plus de 50 allergologues français a rédigé un texte exhaustif basé sur 50 questions cliniques pratiques pour les prescripteurs d’ITA. Ces questions ont été classées en 7 groupes, pour focaliser l’attention sur le choix du patient, les indications et modalité de prescription d’une ITA, les schémas thérapeutiques, les voies d’administration de l’ITA, son efficacité et sécurité, le choix de l’allergène, le suivi du patient et sur d’autres aspects pratiques sur lesquels les allergologues peuvent s’interroger lors de la prescription d’un tel traitement. Les réponses aux 50 questions sont basées sur les résultats des études publiées dans la littérature, et, en cas d’impossibilité à repérer des données solides, sur l’avis des experts. Le but principal de ce travail est de donner aux prescripteurs un tableau clair des données les plus récentes et de les guider dans le choix du traitement optimal pour leur patients allergiques, en tenant compte de l’utilité pratique des questions, qui incluent aussi un regard sur le contexte clinique actuel de pandémie à SARS-CoV-2.
Allergen immunotherapy (AIT) for respiratory allergens is the only curative treatment for allergies. We previously published the list of the French National Clinical Practice Guidelines for AIT prescription and patient's monitoring. To carry out this work, a group of more than 50 French allergists wrote an exhaustive text answering 50 clinical questions that meet the specific needs of AIT prescribers. These questions have been classified into 7 groups, to focus on patient's choice, the indications and modalities of AIT prescription, treatment regimens, the routes of administration of AIT, its efficacy and safety, the choice of the allergen, patients’ follow-up and on other practical aspects that allergists may wonder about when prescribing such treatment. Answers to the 50 questions are based on the results of studies published in the literature, and, if hard data could not be found, on experts’ advice. The main goal of this work is to provide prescribers a clear picture of the most recent data and to guide them in choosing the optimal treatment for their allergic patients, taking into account the practical questions, which also include a look to the current clinical context, due to the SARS-CoV-2 pandemic.
Clinical aspects of sublingual immunotherapy tablets and drops
2020, Annals of Allergy, Asthma and Immunology
Sublingual immunotherapy (SLIT) is administered via tablets (SLIT-T) or liquid drops (SLIT-D). In North America, currently 4 SLIT-T formulations are approved by the US Food and Drug Administration for allergy immunotherapy, and SLIT-D is an off-label use of subcutaneous immunotherapy (SCIT) extracts.
To compare and contrast aspects of SLIT-T and SLIT-D, including physical characteristics, mechanism of action, dosing, efficacy, safety, adherence, and cost.
PubMed literature review (no limits), product prescribing information, and manufacturer websites.
Publications related to physical characteristics, mechanism of action, dosing, efficacy, safety, and adherence.
Published evidence indicates that tablet and drop formulations differ in regard to physical characteristics, dosing, and strength of evidence for efficacy. Whether there are any differences in absorption and mechanism of action between the 2 formulations is currently unknown. Optimal dosing, efficacy, and safety have been established for SLIT-T. In contrast, in North America there is little support for efficacy of SLIT-D from randomized double-blind, placebo-controlled trials, and dose ranges have not been appropriately evaluated. SLIT-T treats a single allergen, whereas in the United States SLIT-D often contains multiple allergens to treat polysensitization. The safety profiles of SLIT-T and SLIT-D appear similar, and both formulations are considered safer than SCIT.
Professional guidelines should make a clear distinction between SLIT-T and SLIT-D in their recommendations to minimize confusion with the umbrella term SLIT.
Approach to Patients with Allergic Rhinitis: Testing and Treatment
2020, Medical Clinics of North America
Safety profile and immunological response of dual sublingual immunotherapy with house dust mite tablet and Japanese cedar pollen tablet
2020, Allergology International
There have been no studies of dual administration of sublingual immunotherapy (SLIT) tablets for perennial and seasonal allergic rhinitis. This trial (JapicCTI-184014) was conducted to investigate the safety profile and immunological response during dual therapy with SQ house dust mite (HDM) and Japanese cedar pollen (JCP) SLIT tablets.
This was a multicenter, open-label, randomized trial of 109 Japanese patients with coexisting HDM and JCP allergic rhinitis who had positive tests for HDM- and JCP specific IgE (≥0.7 kU/L). Patients were allocated to receive HDM (N = 54) or JCP (N = 55) SLIT tablets alone for 4 weeks followed by 8 weeks of dual therapy with both SLIT tablets administered within 5 min of each other. Adverse events (AEs), adverse drug reactions (ADRs), and serum IgE and IgG4 specific for HDM (Dermatophagoides farinae, Dermatophagoides pteronyssinus) and JCP were recorded.
The percentage of subjects with AEs and ADRs was similar between the two groups and between the two periods of monotherapy and dual therapy. Most AEs and ADRs were mild in severity, and no serious events were observed. The most common ADRs were local events in the oral cavity. Levels of IgE and IgG4 specific for HDM (D. farinae, D. pteronyssinus) and JCP were increased after treatment with HDM and JCP SLIT tablets, respectively.
Dual therapy with both SLIT tablets administered within 5 min after 4 weeks of monotherapy with HDM or JCP tablet was well tolerated and induced the expected immunological responses.

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: Editorial support was funded by Greer Laboratories, Inc.

: Disclosure of potential conflict of interest: H. S. Nelson is a principal investigator on research protocols for Schering-Plough, Boehringer-Ingelheim, TEVA, Novartis, Critical Therapeutics, AstraZeneca, Wyeth, Sepracor, Altana, and Genentech and has provided consultation to Genentech/Novartis, Curalogic, GlaxoSmithKline, Schering-Plough, Astellas, Ception, Boehringer-Ingelheim, AstraZeneca, Dey Laboratories, Dynavax Technologies, Abbott Laboratories, MediciNova, Johnson & Johnson, VentiRx, and Dyson.

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Reviews and feature articleMultiallergen immunotherapy for allergic rhinitis and asthma

Section snippets

Methods

Results

Discussion

Lancet

Lancet

Clin Ther

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Allergol Immunopathol (Madr)

J Allergy Clin Immunol

Allergol Immunopathol (Madr)

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Allergen injection immunotherapy for seasonal allergic rhinitis

Cochrane Database Syst Rev

Allergen immunotherapy for asthma

Cochrane Database Syst Rev

Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis

Allergy

Reviews and feature article
Multiallergen immunotherapy for allergic rhinitis and asthma