Double-blind, placebo-controlled rush immunotherapy with a standardized Alternaria extract

Horst, Manfred; Hejjaoui, A.; Horst, Valérie; Michel, François‐Bernard; Bousquet, Jean

doi:10.1016/0091-6749(90)90156-x

Cited by 231 publications

(124 citation statements)

References 44 publications

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“…Although the severity of rhinitis was not exactly based on the ARIA criteria, we proposed a simpler methodology for a study in such a large number of patients. VAS have been extensively used to assess the severity of rhinitis [10, 15,21,22,23] as well as the efficacy of therapeutic interventions [10, 14, 24, 25]. The use of VAS has also been recently proposed by the Joint Task Force on Practice Parameters for the symptom severity assessment of allergic rhinitis [26].…”

Section: Discussionmentioning

confidence: 99%

“…Several signs and symptoms may be used to assess the severity of rhinitis. Since there is no validated objective measure in the assessment of rhinitis severity, patients were categorized into different levels of severity at baseline using visual analogue scales (VAS; scale 0–100 mm with 0 = no symptoms and 100 = severe) for all combined nasal symptoms since it was found to be reliable in previous studies [5, 14, 15] and in the study implementing the International Consensus on Rhinitis [10]. Patients scoring 50 mm or more on the VAS were categorized as having moderate/severe rhinitis.…”

Section: Methodsmentioning

confidence: 99%

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Implementation of Guidelines for Allergic Rhinitis in Specialist Practices

Bousquet

Bodez

Gehano

et al. 2009

Int Arch Allergy Immunol

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Background: Guidelines for allergic rhinitis are more effective than free-treatment choice in the control of seasonal allergic rhinitis. Objective: To validate the ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines in the treatment of intermittent and persistent allergic rhinitis induced by pollens. Design: A multicenter, open-label, parallel, pragmatic randomized study compared two therapeutic strategies during a 2-week treatment course. In the first strategy (‘guidelines group’), 417 patients were treated according to ARIA with ebastine as oral antihistamine. In the second strategy (‘free-choice treatment group’), investigators had a free choice for the treatment of 422 patients. Main Outcome Measures: Quality of life measured using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), work productivity and daily symptom medication scores. Results: 94.2% patients returned the baseline visit questionnaires and 88.6% returned the posttreatment period questionnaires. RQLQ scores were similar in the two groups at baseline. After treatment, there were improvements in the overall score and in all domains in both treatment groups. According to pragmatic methodology, the improvements show that the guidelines group (–1.70 ± 1.20) is more effective than the free-choice treatment group (–1.52 ± 1.22) with a γ risk of 2%. Individual RQLQ scores, work productivity, and daily symptom scores were significantly improved in the guidelines group by comparison to the free-choice treatment group. Conclusion: A treatment based on ARIA guidelines offers patients a significant improvement in comparison to the use of a nonstandardized treatment regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Implementation of Guidelines for Allergic Rhinitis in Specialist Practices

Bousquet

Bodez

Gehano

et al. 2009

Int Arch Allergy Immunol

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“…Additionally, the use of fungal extracts for immunotherapy is hampered by the vast number of fungal species and the lack of knowledge on the degree of exposure to many molds. In the last years, only very few studies reporting a moderate reduction in symptoms have been conducted [25, 175, 176]. In a high-dose (maximal dose of 100,000 biological units), placebo-controlled, double-blind study [177], 81% of the C. herbarum -allergic patients hyposensitized with C. herbarum extract improved their clinical symptoms, whereas 19% showed a deterioration in their symptoms.…”

Section: Therapy Of Fungal Allergymentioning

confidence: 99%

“…C. quadrifidus was associated with F. solani and P. cubensis with A. fumigatus . Thus, cross-reactivity is widespread within the two phyla and is one explanation for the clinical observation that the majority of mold-allergic patients react with several fungal species in vitro and/or in vivo [25]. Interestingly, very often cross-reactive fungal allergens represent intracellular proteins, whereas some species-specific mold allergens tend to be secreted, as it was shown for Asp f 1 [71] from A. fumigatus and Cop c 1 [121] from C. comatus .…”

Section: Fungal Allergensmentioning

confidence: 99%

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The Spectrum of Fungal Allergy

Simon-Nobbe¹,

Denk²,

Pöll³

et al. 2007

Int Arch Allergy Immunol

436

425

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Fungi can be found throughout the world. They may live as saprophytes, parasites or symbionts of animals and plants in indoor as well as outdoor environment. For decades, fungi belonging to the ascomycota as well as to the basidiomycota have been known to cause a broad panel of human disorders. In contrast to pollen, fungal spores and/or mycelial cells may not only cause type I allergy, the most prevalent disease caused by molds, but also a large number of other illnesses, including allergic bronchopulmonary mycoses, allergic sinusitis, hypersensitivity pneumonitis and atopic dermatitis; and, again in contrast to pollen-derived allergies, fungal allergies are frequently linked with allergic asthma. Sensitization to molds has been reported in up to 80% of asthmatic patients. Although research on fungal allergies dates back to the 19th century, major improvements in the diagnosis and therapy of mold allergy have been hampered by the fact that fungal extracts are highly variable in their protein composition due to strain variabilities, batch-to-batch variations, and by the fact that extracts may be prepared from spores and/or mycelial cells. Nonetheless, about 150 individual fungal allergens from approximately 80 mold genera have been identified in the last 20 years. First clinical studies with recombinant mold allergens have demonstrated their potency in clinical diagnosis. This review aims to give an overview of the biology of molds and diseases caused by molds in humans, as well as a detailed summary of the latest results on recombinant fungal allergens.

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Immunotherapy With Allergens

Weber¹

1997

JAMA

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Allergen immunotherapy has been shown to be efficacious in numerous studies for the clinical indications of allergic asthma and rhinitis, as well as hymenoptera venom hypersensitivity. How allergen immunotherapy improves clinical symptoms is still not entirely clear. Decreases in specific IgE follow a complex cascade of effects: a shifting of the cytokine milieu from T(H)2 to T(H)1 predominance, with resultant decrease in interleukin 4, decreased recruitment and activation of eosinophils, and decreased proliferation of mast cells. Allergen exposure has a lessened ability to stimulate an inflammatory cell response, with decreased target organ hyperreactivity. Since allergen immunotherapy is not without risk, the decision needs to be made whether injection therapy is safe and provides benefit not achievable by medical management. The continued clarification of optimal allergen concentrations through careful studies of standardized extracts will allow better control of adverse events by limiting unnecessarily potent mixtures.

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Double-blind, placebo-controlled rush immunotherapy with a standardized Alternaria extract

Cited by 231 publications

References 44 publications

Implementation of Guidelines for Allergic Rhinitis in Specialist Practices

Implementation of Guidelines for Allergic Rhinitis in Specialist Practices

The Spectrum of Fungal Allergy

Immunotherapy With Allergens

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