Subcutaneous Immunotherapy Research Articles

Cationic liposomes bearing Bet v 1 by coiled coil-formation are hypo-allergenic and induce strong immunogenicity in mice.

Although aluminum hydroxide (alum) is widely accepted and used as safe vaccine adjuvant, there is some concern about possible toxicity upon long-lasting repeated exposure during subcutaneous allergen immunotherapy (SCIT). Our objective was to evaluate allergen-bearing liposomes as possible alternative for alum-adsorption in SCIT. A self-assembling, coiled-coil forming peptide pair was used to anchor the major birch pollen allergen Bet v 1 to the surface of cationic liposomes. The resulting nanoparticulate liposomes were characterized with respect to their physicochemical, allergenic and immunological properties. Allergenicity was studied by ImmunoCAP inhibition and rat basophil leukemia (RBL) cell assays. Immunogenicity (immunoglobulin responses) and immune skewing (cytokine responses) were evaluated upon immunization of naïve mice, and compared to alum-adsorbed Bet v 1. Bet v 1-bearing cationic liposomes with a diameter of ∼200 nm showed a positive zeta potential. The coiled-coil conjugation of Bet v 1 to the surface of liposomes resulted in about a 15-fold lower allergenicity than soluble Bet v 1 as judged by RBL assays. Moreover, the nanoparticles induced Bet v 1-specific IgG1/IgG2a responses in mice that were several orders of magnitude higher than those induced by alum-adsorbed Bet v 1. This strong humoral response was accompanied by a relatively strong IL-10 induction upon PBMC stimulation with Bet v 1. In conclusion, their hypo-allergenic properties, combined with their capacity to induce a strong humoral immune response and a relatively strong IL-10 production, makes these allergen-covered cationic liposomes a promising alternative for aluminum salt-adsorption of allergen currently used in SCIT.

Efficacy and safety of house dust mite subcutaneous immunotherapy in polysensitized children with allergic asthma

IntroductionThe aim of this study was to compare the efficacy and safety of 3 years of HDM subcutaneous immunotherapy (HDM-SCIT) in allergic asthma (AA) children with mono- and polysensitized. MethodsThis was a retrospective observational study, 51 AA children (aged 4–14 years) who had completed 3 years of standardized HDM-SCIT were enrolled in. Based on skin prick tests (SPT) and allergen-specific IgE antibody (sIgE) test results, children were classified into two groups: the monosensitized group (n = 31) and the polysensitized group (n = 20). Total asthma symptoms score (TASS), total medication score (TMS), visual analog scale (VAS) scores, fractional exhaled nitric oxide (FeNO), lung function parameters, and adverse reactions were evaluated before treatment and at 6 months, 1, 2, 3 years of HDM-SCIT. ResultsIn terms of effectiveness, compared to baseline, TASS, TMS, VAS, FeNO and lung function parameters were significantly improved in both groups after 3 years of HDM-SCIT (all P < 0.05). The comparison between the two groups showed that efficacy indicators were no statistically significant difference at follow-up time points (all P > 0.05) except PEF%pred at 6 months (P = 0.048). In terms of security, the number of adverse reactions in both groups also no statistical difference between the two groups (all P > 0.05). ConclusionThis study confirmed that no significant difference was observed in the clinical efficacy and safety of HDM-SCIT between mono-and polysensitized children with allergic asthma.

Evaluation of the safety of dose escalation period of subcutaneous specific allergic immunotherapy in patients with rhino-conjunctivitis or allergic asthma previously vaccinated against SARS-CoV-2

BACKGROUND: More than 90% of the Spanish population has been vaccinated against the SARS-CoV-2 virus in our setting. The administration of this vaccine is not contraindicated in allergic subjects; however, it is unknown whether any precaution should be taken when initiating subcutaneous allergen immunotherapy after this vaccination. The objective of the study was to analyze the safety of subcutaneous allergen immunotherapy during the dose escalation phase in subjects sensitized to pollens or mites previously vaccinated against SARS-CoV-2. METHODS: An observational study with retrospective data collection from protocolled patients' medical records was designed. Outpatients older than 12 years with diagnosis of pollen or house dust mite allergic rhinitis with or without bronchial allergic asthma were selected who had completed the subcutaneous immunotherapy dose escalation phase. A complete SARS-CoV-2 vaccination was required for the inclusion. RESULTS: Three hundred and seventy-nine patients were included by 53 investigators. The mean age was 31 years old and 55,9% female. Time from last SARS-Cov-2 vaccination dose to subcutaneous immunotherapy initiation was 4.1 months (95%CI 3.8-4.4). subcutaneous immunotherapy with a pollen allergoid was administered to 135 patients (35.6%) with a total of 739 injections, while subcutaneous immunotherapy using a house dust mite allergoid was administered to 244 patients (64.4%) with a total of 1311 doses. During the dose escalation phase with the pollen allergoid, 45 patients (33.3%) suffered 93 local adverse reactions (12.6% of injections), while 17 patients (12.6%) experienced 17 systemic allergic reactions (2.3% of injections) of them 14 were World Allergy Organization Grade 1 and 3 of Grade 2. During the dose escalation phase with the house dust mite allergoid, 55 patients (22.5%) reported 133 local adverse reactions (10.1% of injections), and 7 patients (2.9%) showed 7 World Allergy Organization Grade 1 systemic reactions (0.5% of injections). No systemic reactions Grade 3 or higher were reported. CONCLUSIONS: The well-known safety profile of the subcutaneous allergen immunotherapy using pollen or house dust mite allergoids has not been changed after the SARS-CoV-2 vaccine administration. No relevant differences in the incidence of local or systemic allergic reactions during the dose escalation phase were identified, so it is considered that the patient’s safety has not been compromised to initiate this treatment after the SARS-CoV-2 vaccine administration.

Retrospective evaluation of adverse reactions after subcutaneous allergen-specific immunotherapy in children with house dust mite allergy.

Although it is accepted as an effective and safe treatment way, side effects can be observed as a result of subcutaneous immunotherapy (SCIT). In our study, it was aimed to evaluate the local and systemic reactions in children after SCIT and the factors that may be associated with these reactions. Our study included 138 house dust mite allergic patients with asthma and/or allergic rhinitis who underwent SCIT in the Pediatric Allergy and Immunology Outpatient Clinic between November 2013 and April 2022. Sociodemographic, clinical, laboratory features, and development of adverse reactions after SCIT were analyzed from patient files. The median age of 138 patients was 9.0 years. About 56.5% (n=78) were male, 43.5% (n=60) were female. Of the patients, 55.1% (n=76) had asthma and allergic rhinitis. A total of 7366 SCIT injections were administered to all patients in our clinic. The total number of observed adverse reaction was 118. 50.7% of the patients (n=70) experienced at least one adverse reaction after SCIT. The rate of development of adverse reactions per injection was 1.6% (local: 1.0%, large local: 0.1%, systemic: 0.5%). Although serious systemic reactions and death were not observed in our patients; care should be taken in terms of the development of adverse reactions during SCIT in children.

Can development of asthma and bronchial hyperreactivity be reduced by subcutaneous immunotherapy in adult patients with allergic rhinitis?

Allergic rhinitis can be associated with bronchial hyperreactivity (BHR) and create an increased risk for allergic asthma development. We aimed to investigate the effects of subcutaneous immunotherapy (SCIT) on BHR and asthma development in adult patients with allergic rhinitis. The retrospective case-control study was carried out between November 2018 and May 2019 in Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital. In this study, data was recorded for patients with a mite and/or grasses/cereals pollen allergy who were tested for BHR before planned SCIT, and who had allergic rhinitis, with or without asthma. The SCIT group was selected as those who received SCIT for at least one year. The control group was selected from those who were scheduled to receive SCIT but were waived and still receiving medication. Symptom scores, prick test results, PC20 levels (methacholine challenge that is a provocative concentration causing a 20% fall in FEV1), and the presence of asthma were recorded and compared with data from at least one year after treatment. A total of sixty-eight subjects (22 males, 46 females; mean age 40.54 ± 12.27 years; SCIT: 40, Control: 28) were enrolled.Although the changes in log PC20 levels were not statistically significant in both SCIT and control groups after an average of 30-35 months of treatment, it was found to be significant in favor of the SCIT group when two groups were compared in terms of the change in log PC20 (p = 0.026). The development and improvement of asthma were not significantly different between the SCIT and control group but tended to increase in the control group. The percentage of patients with progressed/BHR was significantly higher in the controls (70.6% vs. 38.1%, p = 0.046). In our real life study we have demonstrated the preventative effect of SCIT on BHR, but not on asthma developmen.

Evaluation of Eosinophil-to-Lymphocyte Ratio before and after Immunotherapy in Pediatric Allergic Rhinitis Patients

Objective: The aim of this study is to calculate the eosinophil-to-lymphocyte ratio (ELR) before and after the treatment with subcutaneous immunotherapy (SCIT) and to investigate if ELR decreases after the treatment. The results will support our hypothesis of using the ELR as a diagnostic and prognostic parameter in allergic rhinitis (AR) patients. Study Design: This study was planned and performed as a case–control study. Materials and Methods: In this prospective study, we have collected the data from 68 pediatric patients (aged between 9 and 18 years) who have been treated with 4-year SCIT and whose skin prick test was negative after treatment of AR. ELRs were compared based on the hemogram results before SCIT and approximately 4 years later. Patients who have the inflammatory disease were eliminated from the study since lymphocytes were increased in the blood biochemistry tests. Results: When the eosinophil counts were compared before and after the immunotherapy, it was observed that the eosinophil ratios were decreased from 7.14 ± 4.63 to 4.55 ± 2.98; (P = 0.000) after treatment. Lymphocyte count also decreased from 34.8 ± 10.3 to 32.9 ± 8.3 (P = 0.091). After SCIT, ELRs were significantly lower (P &lt; 0.001). While the mean ± standard deviation (SD) value of ELR was 0.18 (0–0.66) before the treatment, the mean ± SD value after SCIT was 0.11 (0.01–0.67). Total immunoglobulin E decreased from 96.9 ± 10 to 82 ± 11, which was not statistically significant (P = 0.058). Conclusion: A statistically significant decrease in ELR was observed in patients whose skin prick test was negative after immunotherapy. ELR would be as valuable as a skin prick test for diagnostic and prognostic purposes.

A single center retrospective study of systemic reactions’ distribution and risk factors to subcutaneous immunotherapy with dust mite extract in patients with allergic rhinitis and/ or asthma

ObjectiveTo analyze various risk factors including causes that may lead to adverse reactions, especially systemic adverse reactions（SRs）, before and after mite allergen subcutaneous immunotherapy (SCIT), so as to provide real-world reference data for further improving the safety of mite allergen SCIT. Methods: The local adverse reactions（LRs）and SRs of 230 patients with allergic rhinitis and/or asthma who received SCIT in Weifang people's hospital were analyzed retrospectively. The data of patient characteristics, drug factors and environmental elements of adverse reactions were collected and statistically analyzed. Results: There were 28 cases (12.2%) of SRs in 230 patients. All the patients received a total of 7515 injections and 37 SRs (0.49%) were observed. 32.4% (12/37) of SRs could identify their external and subjective triggers. SRs patients had higher 2-year SCIT compliance than no-SRs patients (p = 0.026). The prevalence of SRs in SCIT patients with atopic dermatitis or simple allergic asthma are no statistical significance (P = 0.111). Conclusion: the incidence of SRs in this study is within an ideal range. Through professional patient education and pre injection risk factor assessment, Compliance is still well-controlled and guaranteed although SRs occurred.

Effects of subcutaneous immunotherapy in allergic rhinitis children sensitive to dust mites.

Subcutaneous immunotherapy (SCIT) is now the only treatment that can modify the natural course of allergic rhinitis (AR). However, not all children with AR benefit from SCIT. To evaluate the efficacy of SCIT in dust-mites-induced AR children and explore correlative factors predicting treatment response to SCIT. 225 children aged 4-17 years old with AR were recruited from January 2016 to September 2019, and monitored at baseline, 4, 12, and 24 months after the start of SCIT treatment. The visual-analogue-score (VAS) was used to assess the clinical symptoms. Multivariate binary logistic regression analyses and receiver operating characteristic curves were used to explore correlative factors in predicting the efficacy of SCIT. The significant declines in VAS started after 4 months of SCIT and continued to improve throughout the study compared with baseline. An increase in children's age (OR=0.688, 95%CI: 0.479-0.988) and those with allergic history (OR=0.097, 95%CI: 0.009-1.095) were negatively associated with the risk of poor efficacy. Polysensitized children were more likely to suffer poor efficacy (OR=15.511 95%CI: 1.319-182.355). The clinical response at month 4 (r=0.707) and month 12 (r=0.925) was related to that at month 24. The area under the curve (AUC) for improvement at month 4 and month 12 was 0.746 and 0.860, respectively. Our study confirmed the clinical efficacy of SCIT in AR children. Children with younger age, negative allergic history, and multiple allergens may predict a worse efficacy. The onset of action and the clinical response to SCIT in the second year can be predicted as early as by month 4.

Safety of House Dust Mite Subcutaneous Immunotherapy with a rush and cluster combination protocol in the build-up phase.

Conventional and cluster subcutaneous immunotherapy (SCIT) are effective but may be time-consuming. Rush SCIT may offer a more convenient treatment option to patients and be of shorter duration; however, it is also associated with a higher incidence of systemic adverse reactions. Therefore, a combination of protocols between rush and cluster SCIT could have a superior risk-benefit ratio. To determine the safety of the combination of rush and cluster HDM-SCIT and to identify the risk factors for local and systemic adverse reactions. We retrospectively reviewed the charts of patients who received HDM-SCIT, with rush and cluster combination protocols, at a tertiary care hospital between January 2009 and December 2020. Data were collected at the initial visit (demographic data; underlying allergic disease; current medication; and laboratory investigation results including skin prick test, serum specific IgE (sIgE) levels to aeroallergen, total IgE, and eosinophil count) and follow-up visits (rate and severity of local and systemic adverse reactions). In total, 698 injections (28 patients) were reviewed. Overall, 13 patients developed systemic adverse reactions, at 3% (21/698) per injection visit. All reactions occurred within 60 minutes. In total, 6 patients experienced large local reactions, at 1.1% (8/698) per injection visit. A high level of sIgE to D. pteronyssinus was significantly associated with systemic adverse reactions (HR = 1.02; P = 0.009). HDM-SCIT with a combination of rush and cluster schedules in the build-up phase could be used as an alternative protocol, given its acceptable systemic adverse reaction rate and shortened duration.

Knowledge mapping of immunotherapy for allergic rhinoconjunctivitis

Allergic rhinoconjunctivitis (ARC) is a common chronic inflammatory disease. Numerous studies on the treatment of ARC have been published. By contrast, there are few bibliometric studies on immunotherapy for ARC. The purpose of this article is to describe the current treatments for ARC and to identify the trends in immunotherapy for ARC. Publications were searched from the Web of Science (WOS) Core Collection on April 25, 2022. CiteSpace and Microsoft Excel software were used for further bibliometric analysis. A total of 969 publications on immunotherapy for ARC in English were retrieved. The number of relevant publications has been continuously increasing over the past 20 years, with many of the publications coming from Germany and the United States of America. In terms of institutions, the ALK Company in Denmark, Imperial College London in United Kingdom, and Charite-Universitatsmedizin Berlin in Germany published the most articles on immunotherapy for ARC. Meanwhile, Allergy and Journal of Allergy and Clinical Immunology published the most number of studies, and Oliver Pfaar from Germany authored the most number of articles. "Subcutaneous immunotherapy," "international consensus," "allergen immunotherapy," and "recommendation" were the most popular subjects. Thus, directions in research can be predicted as studies regarding mechanisms of ARC, clinical trials, and extracts have reported high-quality results. Over the past 20 years, the overall quality of research on immunotherapy for ARC has gradually improved, allowing the introduction of specific and targeted treatment. Currently, the main focus of ARC research is the novel routes of drug delivery and combined treatment with biological agents.

Specific immunoglobulin G4 correlates with Th2 cytokine reduction in patients with allergic asthma treated by Dermatophagoides pteronyssinus subcutaneous immunotherapy

BackgroundThe modulations of lymphocyte subsets and cytokine production due to subcutaneous allergen immunotherapy (SCIT) are not fully clarified. ObjectiveWe investigated the changes in T-lymphocyte subsets and serum Dermatophagoides pteronyssinus-specific immunoglobulin G4 (Der-p sIgG4), as well as cytokine production during Der-p SCIT, in patients with allergic asthma. MethodsThis study involved 20 patients with allergic asthma who were receiving 156-week Der-p SCIT and 20 patients without SCIT (non-SCIT). We measured symptom and medication scores (SMS), serum Der-p sIgG4 levels, CD4+CD25+Foxp3+ T regulatory (Treg), CD4+IL-4−IFN-γ+ T-helper (Th) 1, and CD4+IL-4+IFN-γ− Th2 lymphocyte percentages in peripheral blood mononuclear cells (PBMCs) with/without Der-p extract stimulation at weeks 0, 4, 12, 16, 52, 104, and 156. Cytokine release inhibition assays were performed by incubation with serum from SCIT and non-SCIT patients, Der-p allergen, and PBMCs. Levels of interleukin (IL)-4, IL-5, IL-10, IL-13, IL-17, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β1 were evaluated in supernatant. ResultsWe found that SCIT patients had significantly lower SMS after week 52. Der-p sIgG4 levels in SCIT patients significantly increased at week 16 compared with non-SCIT subjects. CD4+IL-4+IFN-γ− Th2% in SCIT patients showed a significant decrease from weeks 104–156 compared with week 0, while no change was observed in CD4+CD25+Foxp3+ Treg and CD4+IL-4−IFN-γ+ Th1 percentages. IL-5, IL-13, IL-4, IL-17, and TNF-α levels in supernatant of PBMCs cultured with serum of SCIT patients after 16 weeks showed significant lower levels compared with non-SCIT patients, and showed significant reverse associations with Der-p sIgG4 levels. ConclusionSCIT induced Dep-p sIgG4 may be involved in downregulating Th2 cytokine production in Der-p allergic asthma patients.

Update on allergenic immunotherapy for asthma and rhinoconjunctivitis

Allergenic immunotherapy consists of repeated administration of allergenic extracts to which an individual is allergic. It is currently the only treatment that modifies the course of allergic disease and induces short- as well as long-term remission of symptoms. Two formulations are currently available: subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT), with comparable efficacy. In specific situations, it can be used in combination with the new approved biologic therapies for asthma to improve tolerance of immunotherapy.

Subcutaneous allergen specific immunotherapy with gramineae pollen in children with allergic rhinoconjunctivitis

Background/aim: Allergen specific immunotherapy (ASIT) should be considered in patients with moderate to severe allergic rhinoconjunctivitis, whose complaints persists despite symptomatic treatment. The aim of this study is to evaluate the efficacy and safety of ASIT with gramineae pollen in children with allergic rhinoconjunctivitis. Materials and methods: The patients aged 5-18 years with allergic rhinoconjunctivitis were included in the study. The patients were divided in two groups. One group received ASIT, the other was control group that did not. The control group, in which participant have similar age and similar duration of disease. Visual analogue score (VAS), daily symptom score (dSS), daily medications score (dMS) and combined symptom and medication score (CSMS) were evaluated at three times points: baseline, after ASIT for first and second year. Results: 188 children with a diagnosis of allergic rhinoconjunctivitis were included in the study. 94 of the patients had received immunotherapy.105 (55.9%) of the patients were male, the median age was 14 (min-max: 7-18 years). In the group of patients who received ASIT; there was statistically significant decreases in VAS, dSS, dMS and CSMS through one and two years therapy in comparison to the baseline values (p &lt; 0.001). When the group of patients receiving ASIT was compared with the control group after two years of follow-up, there was a significant decrease in VAS, dSS, dMS and CSMS (p &lt;0.001). Systemic reaction was occurred in five (5.3%) patients. Conclusion: The current study demonstrated that ASIT with gramineae pollen is clinically effective in patients with graminae pollen induced allergic rhinoconjunctivitis.

KAAACI Allergic Rhinitis Guidelines: Part 2. Update in Non-pharmacological Management.

Allergic rhinitis is the most common chronic disease worldwide. Various upper airway symptoms lower quality of life, and due to the recurrent symptoms, multiple treatments are usually attempted rather than one definitive treatment. There are alternatives to medical (medication-based) and non-medical treatments. A guideline is needed to understand allergic rhinitis and develop an appropriate treatment plan. We have developed guidelines for medical treatment based on previous reports. The current guidelines herein are associated with the "KAAACI Evidence-Based Guidelines for Allergic Rhinitis in Korea, Part 1: Update in pharmacotherapy" in which we aimed to provide evidence-based recommendations for the medical treatment of allergic rhinitis. Part 2 focuses on non-pharmacological management, including allergen-specific immunotherapy, subcutaneous or sublingual immunotherapy, nasal saline irrigation, environmental management strategies, companion animal management, and nasal turbinate surgery. The evidence to support the treatment efficacy, safety, and selection has been systematically reviewed. However, larger controlled studies are needed to elevate the level of evidence to select rational non-medical therapeutic options for patients with allergic rhinitis.

Oral mite anaphylaxis (pancake syndrome) caused by storage mite Acarus siro and its treatment with allergen immunotherapy

A 10-year-old atopic patient with asthma, peanut, and house dust mite allergy developed frequent episodes with symptoms including abdominal pain, nausea, vomiting, dizziness, drop of blood pressure, and occasionally shortness of breath and wheezing. After detailed diagnostics including an ISAC test and several other specific IgE blood tests, which could not explain the symptoms, the patient tested positive for specific IgE to Acarus siro (flour mites) (9.2 kU/L). As no oral food challenge with Acarus siro was available, the patient's family implemented avoidance measures by storing food containing flour in the refrigerator, and the patient started subcutaneous immunotherapy (SCIT) with Depigoid Acarus siro. The implementation of avoidance measures led to an immediate improvement of symptoms, and after 3 years of treatment, products containing flour, stored at room temperature, are tolerated again.

Direct Costs and Time-Use Related to Subcutaneous Immunotherapy in Spanish Patients with Allergic Rhinitis: Across-Sectional Survey

Literature has shown that subcutaneous immunotherapy (SCIT) is time-consuming and costly for patients in Canadian and US settings. However, there is no evidence of the patient time-use and direct patient costs related to SCIT in a Spanish setting.

Observational Study on The Efficacy and Effects in The Quality of Life of Cluster Immunotherapy Schedule in Patients with Asthma Sensitized to House Dust Mites

Background: The conventional schedule administration of subcutaneous allergen immunotherapy (SCIT) for Acaroid®, requires eight weeks to get the maintenance dose. To reduce the duration of the build-up phase, the cluster schedules have been introduced. The objective was to analyze the one-year efficacy of Acaroid® in a cluster schedule, as well as the effect on the patient’s quality of life. Methods: A real-world observational study was designed, with one-year follow-up. Patients 5-65 years-old with allergic bronchial asthma, sensitized to house dust mites and treated with Acaroid®, in cluster schedule 2/2/2 were included. The main efficacy endpoint was the Asthma Control Test (ACT) score at month 12 compared to baseline. The patient’s quality of life was measured with the Asthma Quality of Life Questionnaire (AQLQ) and ESPRINT-15 questionnaire. Results: A total of 81 patients, 55.6% female, were included with a mean age of 29.7 years old. The ACT score from baseline-12 months significantly improved (p=0.003) 1.4 points (95%CI 0.4-2.4). The proportion of patients with a good asthma control increased significantly from baseline-6-12 months (p&lt;0.05). AQLQ (p=0.014) and ESPRINT-15 quality of life domains significantly improved at 12 months. Conclusions: The cluster schedule 2/2/2 of SCIT with Acaroid® was effective and allowed shortening the build-up phase to three weeks, instead of the conventional schedule of eight weeks. This resulted in the benefit of the patient in terms of comfort and could reduce the costs related to SCIT administration while maintaining patient efficacy and safety of the conventional schedules.

Topical cyclosporine versus allergen specific immunotherapy in perennial allergic conjunctivitis.

Symptom control in the long-term with less side effects is important in perennial allergic conjunctivitis, since would improve quality of life. This study aimed to assess the clinical efficacies of topical cyclosporin A and subcutaneous allergen immunotherapy (SCIT) in terms of sign control in perennial allergic conjunctivitis. This retrospective study included 20 adult patients with perennial allergic conjunctivitis and confirmed sensitization to house dust mites with skin prick test. Patients were assigned to either topical cyclosporine A treatment or SCIT. The participants were followed for 6months, and signs scores were recorded at 1, 3 and 6months. Overall, both cyclosporine and immunotherapy groups showed significant improvements in papillary reaction (p = 0.011 and 0.003, respectively), limbal involvement (p = 0.031 and 0.001), and conjunctival hyperemia (p = 0.001 and p < 0.001) scores during the 6-month follow-up. However, only cyclosporine group showed a significant improvement in corneal involvement scores (p = 0.015) during the study period. When scores at different time points were compared, significant improvement in conjunctival hyperemia was evident at 6months in both groups when compared to baseline (cyclosporine group, 0.7 ± 0.68 vs. 2.4 ± 0.84, 70.8% decrease, p = 0.01; immunotherapy group, 0.3 ± 0.48 vs. 2.3 ± 0.95, 87.0% decrease, p = 0.004), whereas for limbal involvement such an improvement was only evident in the immunotherapy group (0.1 ± 0.32 vs. 1.3 ± 0.95, 92.3% decrease, p = 0.01). Allergen immunotherapy and cyclosporin A treatment may provide effective sign relief in perennial allergic conjunctivitis. It may represent an encouraging treatment option particularly for cases with perennial allergic conjunctivitis refractive to other treatments and positive skin prick test to a specific allergen (house dust in the present study). Long-term relief by SCIT would reduce the side effects of polypharmacotherapy. Larger studies with longer follow-up are warranted to confirm our findings.

Risk of anaphylaxis in cluster vs standard subcutaneous multiallergen immunotherapy

BackgroundCluster schedules for subcutaneous allergen immunotherapy (AIT) require significantly fewer injections, but there have been conflicting reports regarding the risk of systemic reactions (SR). ObjectiveTo compare the incidence of SRs during the build-up stages of multiallergen standard vs cluster immunotherapy. MethodsData on SRs were collected prospectively from 91 urban adult patients who underwent either standard or cluster AIT at the Johns Hopkins Allergy and Asthma Center from 2014 to 2022. The SRs were recorded during the build-up phase and compared for both protocols using Pearson's χ2, Fisher exact test, and multivariate logistic regression models. ResultsOverall, SR rates were 21% for patients in the standard schedule and 37% for patients in the cluster immunotherapy schedule, which was not statistically different (P = .08). However, the SR rate for each injection was 0.69% per injection in the standard protocol and 2.29% per injection in the cluster schedule (incident rate ratio = 3.3). All SRs (100%) in both groups occurred in the second half of the build-up phase. Multivariate regression revealed that the target prescription protein nitrogen units and the number of allergens in the treatment vial did not influence SR rates (odds ratio = 1.00 and 1.06, respectively). ConclusionThe overall incidence of SR was not statistically different for cluster and standard AIT protocols. However, because cluster patients received approximately half the number of injections, the risk for SR per individual injection is more than 3-fold higher than that of standard immunotherapy.

Real-Life Effectiveness of Subcutaneous Immune Therapy with Carbamylated Monomeric Allergoids on Mite, Grass, and Pellitory Respiratory Allergy: A Retrospective Study.

Background: real-life studies are encouraged to evaluate the effectiveness and safety of allergen immunotherapy (AIT). In this context, a retrospective cohort study was conducted to assess the effectiveness and safety of carbamylated monomeric allergoid subcutaneous immunotherapy (MA-SCIT), along with patient satisfaction. Methods: a total of 291 patients with rhinoconjunctivitis with or without asthma with inhalant (house dust mite, grass, and pellitory) allergies were enrolled in this study. Perceived efficacy and perceived satisfaction with MA-SCIT, symptom score by VAS, ARIA classification of rhinitis, drug consumption, number of asthma worsening episodes, and asthma symptom control were evaluated by questionnaires before, after one year, at the end of treatment, and after one or two years of MA-SCIT. Results: the overall symptom score significantly decreased over the years of MA-SCIT, irrespective of specific sensitization (p < 0.01). There was a substantial amelioration of rhinitis severity, with a significant reduction (p < 0.01) in drug use. A significant reduction was observed in the asthma symptom VAS score and asthma-worsening episodes requiring systemic steroids. None of the patients reported any severe adverse reactions. Finally, 90% of the patients reported full satisfaction with the treatment. Conclusions: the study showed that AIT with carbamylated monomeric allergoids of grass, pellitory, and mites was effective and well tolerated by patients.