A multi-institutional trial of polymerized whole ragweed for immunotherapy of ragweed allergy

Background: Four administration schedules of immunotherapy have been reported: conventional, cluster, rush and ultra-rush. Objectives: To evaluate the safety and the clinical advantage of using standardized modified allergen extracts in an ultra-rush protocol without premedication and/or hospitalization. Material and Methods: One thousand and sixty-eight patients with rhinoconjunctivitis and/or asthma sensitized to mites and/or pollen were included in a prospective observational study. Patients received a therapeutic vaccine containing depigmented and glutaraldehyde-modified extracts (mites and/or pollens) adsorbed onto alum prescribed by a specialist. The schedule of administration consisted of injecting 0.2 and 0.3 ml of the vial of maximum concentration during the first day of immunotherapy, separated by a time interval of 30 min. All patients reached the maximum dose (0.5 ml) after 2 injections. Tolerance was assessed by recording all side reactions related to immunotherapy, classified according to the criteria of the EAACI. Results: The total number of injections was 2,136. All patients reached the maximum established dose on the 1st day. No premedication was used. Seven clinically relevant local reactions were recorded. The systemic reactions were 5 grade-1 (2 immediate and 3 delayed) and 3 delayed grade-2 reactions. Conclusions: The therapeutic vaccines containing chemically modified extracts can be administered using an alternative ultra-rush schedule in an immunotherapy unit, reaching the maximum dose on the 1st day with 2 injections, without the need of premedication and/or hospitalization.

Section: Discussionmentioning

confidence: 99%

Safety of an Ultra-Rush Immunotherapy Build-Up Schedule with Therapeutic Vaccines Containing Depigmented and Polymerized Allergen Extracts

Casanovas¹,

Martin²,

Jiménez³

et al. 2006

“…The reduction in allergenicity by 1,000 to 10,000 times further corroborates poly merization. The 3 to 4 log reduction in cutaneous end point titer is similar to that observed after polymeriza tion of mixed tree pollens [4], The reduction of aller genicity is, of course, the safety factor that permits high doses to be given to patients in a short time peri od [1][2][3].…”

Section: Discussionmentioning

confidence: 50%

“…Efficacy and safety of polymerized ragweed aller gens [1,2] and polymerized grass allergens [3] have been demonstrated. A preparation of polymerized tree allergens has been reported using a mixture of tree allergens and the standardized chromatographic fractionation procedures developed for ragweed [4].…”

Section: Introductionmentioning

confidence: 99%

Polymerization of Individual Species of Tree Pollen Allergens

Patterson¹,

Suszko²,

Grammer

1984

Self Cite

This report describes the preparation of individual tree pollen allergen polymers in contrast to our previous description of the polymerization of a mixture of tree pollens. These individual polymers may be used for immunotherapy as indicated by the IgE-mediated reactivity of each patient. A modified chromatographic fractionation process was used which results in tree polymers with skin reactivity 1,000- to 10,000-fold less from monomers and with a defined lower molecular weight limit. The modified preparative methodology results in polymer preparations as safe but with greater ease of production than polymers prepared with previous methodologies.

“…As the molecular dimension of a substance can in general hinder its ability to cross the mucosal membrane, it is reasonable to imagine that polymerized allergoids could encounter some obstacles in passing through mucosal tissue and be adsorbed. This fact raised many doubts about the potential usefulness of administering polymeric allergoids by the sublingual route in the SIT approach; moreover, it constitutes the reason why polymerized allergoids are nowadays administered only by the subcutaneous route to express their optimal clinical effectiveness [41,42,43]. The existence of a unique paper that dates back more than 20 years, describing the clinical efficacy of polymerized allergoids when administered by the intranasal route, does not seem enough to eliminate existing doubts about their use by ways of administration different from the subcutaneous one [44].…”

Section: Discussionmentioning

confidence: 99%

Date Palm Pollen Allergoid: Characterization of Its Chemical-Physical and Immunological Properties

Mistrello

Harfi

Roncarolo

et al. 2007

Background: Date palm (DP) pollen can cause allergic symptoms in people living in different countries. Specific immunotherapy with allergenic extracts by subcutaneous route is effective to cure allergic people. However, the risk of side effects has led to explore safer therapeutic modalities. The aim of our work was to evaluate IgE cross-reactivity between DP and autochthonous palm (European fan palm, EFP) pollen extracts, to chemically modify DP extract with potassium cyanate in order to obtain an allergoid, and to characterize it. Methods: By radioallergosorbent test inhibition, immunoblotting (IB) and skin prick test, in vitro and in vivo allergenic activities of native and modified DP extracts were compared. By SDS-PAGE and IB, we compared the protein profile and IgE-binding capacity of both native and modified DP, as well as of EFP extracts. By IB inhibition, IgE cross-reactivity of native DP and EFP extracts was evaluated. By ELISA, the capacity of modified DP-induced IgG to react with native DP extract was determined. Results: Radioallergosorbent test inhibition, IB and skin prick test results demonstrated that modified DP was significantly less allergenic than native DP extract. The SDS-PAGE profile showed that potassium cyanate treatment of DP extract did not alter the molecular weight of its components. In addition, no difference was observed between native DP and EFP extracts. Subsequent IB inhibition data evidenced the existence of a strong IgE cross-reactivity between native DP and EFP extracts. ELISA results indicated that the administration of modified DP in mice was able to induce specific IgG also recognizing native DP extract. Conclusions: Modified DP extract (allergoid) seems to be a good candidate for immunotherapy of patients affected by specific allergy.