Durchführung des nasalen Provokationstests bei Erkrankungen der oberen Atemwege

Riechelmann, Herbert; Bachert, Claus; Goldschmidt, O.; Hauswald, B.; Klimek, Ludger; Ww, Schlenter; Aj, Tasman; Wagenmann, Martin

doi:10.1055/s-2003-38411

Cited by 77 publications

(49 citation statements)

References 18 publications

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“…A positive NCT was required at inclusion in order to ensure that subjects were sensitive to the test allergen in the applied dose. The NCT was performed in accordance with previously validated protocols [31,32] modified to the position paper of the German Society for Allergology and Clinical Immunology [33] as described below. …”

Section: Methodsmentioning

confidence: 99%

Sublingual Allergen-Specific Immunotherapy Adjuvanted with Monophosphoryl Lipid A: A Phase I/IIa Study

Pfaar

Barth

Jaschke

et al. 2010

Int Arch Allergy Immunol

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Background: Sublingual immunotherapy (SLIT) allergy vaccines have an excellent safety profile, but opinions vary on their efficacy, and treatment regimens are often lengthy. This study assessed the effects of the Toll-like receptor 4 agonist monophosphoryl lipid A (MPL®) on safety/tolerability and clinical and immunological efficacy when combined with grass pollen SLIT formulations in treating patients with seasonal allergic rhinitis. This is the first reported study of adjuvanted SLIT. Methods: In this double-blind placebo-controlled phase I/IIa study, 80 grass pollen-sensitive subjects were randomized into 4 groups of 20 subjects to receive daily treatment for 8 weeks. Sixteen patients per group received SLIT and 4 received placebo. The formulation given to each group varied with respect to grass pollen extract and MPL content. Grass allergen nasal challenge tests (NCTs) were performed prior to dosing and in weeks 4 and 10. Grass pollen-specific immunoglobulin G (IgG) and IgE antibodies were measured at baseline and prior to dosing in weeks 2, 3, 4, 5 and 10. Results: Local and systemic adverse events were generally comparable for patients who received active treatment and placebo. Patients in the 2 groups given SLIT containing the highest amount of MPL experienced the highest proportion of negative NCTs after 10 weeks (47 and 44%, vs. 20% with placebo). These patients also showed earlier median increases in specific IgG and smaller increases in IgE levels than those receiving other formulations. Conclusions: These results suggest that SLIT preparations containing MPL are well tolerated and alter the immunological response to grass antigens after 3 weeks of exposure, with an associated suppression of nasal challenge responses.

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Section: Methodsmentioning

confidence: 99%

Sublingual Allergen-Specific Immunotherapy Adjuvanted with Monophosphoryl Lipid A: A Phase I/IIa Study

Pfaar

Barth

Jaschke

et al. 2010

Int Arch Allergy Immunol

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“…All participants had a history of birch pollen allergy with 1) moderate-to-severe seasonal allergic rhinoconjunctivitis and/or mild-to-moderate allergic asthma, 2) positive SPT reactivity to birch pollen extracts (ALK Prick SQ, ALK-Abelló, Hørsholm, Denmark), 3) serum IgE reactive with birch pollen extracts and rBet v 1 (Phadia ImmunoCAP System, Phadia, Uppsala, Sweden), and 4) a positive NPT to aqueous birch pollen extracts (ALK-depot SQ, ALKAbelló). NPT was performed with Rhinotest2000 (Allergopharma, Reinbek, Germany), according to the guidelines of the German Society for Allergy and Clinical Immunology (36). Exclusion criteria were polysensitization with perennial symptoms, clinically relevant allergies against additional pollen allergens, and chronic nonallergic asthma.…”

Section: Patientsmentioning

confidence: 99%

Birch Pollen Immunotherapy Leads to Differential Induction of Regulatory T Cells and Delayed Helper T Cell Immune Deviation

Möbs

Slotosch

Löffler

et al. 2010

The Journal of Immunology

120

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Correction of an imbalance between allergen-specific T cell subsets is considered a critical event in establishing allergen tolerance by specific immunotherapy (SIT). In a comprehensive, longitudinal study, distinct T cell populations and Ig subtypes were analyzed in subjects allergic to birch pollen during decisive time points of SIT (i.e., induction and maintenance phase), as well as in and out of birch pollen season. An increase in Bet v 1-specific, IL-10–secreting T cells, fulfilling the criteria of inducible type 1 regulatory T (Tr1) cells, was observed by the end of the induction phase; this resulted in a decreased ratio of allergen-specific IL-5+ Th2/Tr1 cells. In contrast, CD4+CD25+CD127low regulatory T cell numbers did not change. Furthermore, enhanced concentrations of allergen-specific IgG Abs were observed, whereas allergen-specific IgE and IgA levels remained unchanged. After 1 y of SIT, a reduced ratio of allergen-specific Th2/IFN-γ+ Th1 cells was apparent. Although untreated and SIT-treated allergic subjects developed enhanced Th2 cell responses during birch pollen season, only SIT-treated patients experienced elevated numbers of allergen-specific Tr1 cells, which were associated with reduced skin prick test reactivity and diminished clinical symptoms. In coculture assays, allergen-specific Tr1 cells showed an IL-10– and dose-dependent inhibition of CD4+CD25− T effector cells. Thus, SIT has differential effects on regulatory T cell subsets, resulting in an early induction of allergen-specific Tr1 cells associated with an increase in allergen-specific IgG, and it leads to a delayed shift from an allergen-specific Th2- to a Th1-dominated immune response.

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“…However, none of these methods is a generally accepted tool for interpreting CPT results [10]. On the contrary, the nasal provocation test is mentioned in the literature as the approved mucosal provocation tool [21] and is consistently defined in detail by international guidelines [6,11,22,23]. However, methods used to evaluate nasal provocation test results, e.g.…”

Section: Introductionmentioning

confidence: 99%

“…However, methods used to evaluate nasal provocation test results, e.g. anterior rhinomanometry, lack in sufficient reproducibility [24,25,26] and depend greatly on the examiner's experience and on the patient's compliance [7,22]. …”

Section: Introductionmentioning

confidence: 99%

Objectifying the Conjunctival Provocation Test: Photography-Based Rating and Digital Analysis

Dogan

Astvatsatourov

Deserno

et al. 2013

Int Arch Allergy Immunol

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Background: Patients with allergic rhinoconjunctivitis are susceptible to both nasal and ocular symptoms. The conjunctival provocation test (CPT) is an established diagnostic procedure used in allergic rhinoconjunctivitis, particularly to document a patient's current reactivity to allergens. To date, there are no international guidelines defining the CPT. No approved evaluation method exists for interpreting CPT results. This paper aims to establish the digital analysis of macroimages as an objective, validated and standardized method for interpreting CPT results. Methods: In a clinical immunotherapy trial with 155 patients, treatment progress was documented based on the CPT. Local investigators used a symptom score to grade tearing, reddening and the patients' subjective perception of symptoms (mucosal irritation). A central observer rated conjunctival hyperemia via digital photography. Digital image analysis software was utilized to determine conjunctival hyperemia. Results: Spearman's correlation between the local investigators' and the central observer's ratings was r = 0.729 (p < 0.001); the percentage of total agreement was 48% (based on 739 photos). Digital image analysis (based on 48 photos) had a high percentage of total agreement with the central observer's ratings (69%) but a low percentage of total agreement with the investigators' ratings (38%). The corresponding correlations were r = 0.264 and 0.064, respectively. Conclusion: Photography-based rating by a central observer may represent a valuable supplement to the local investigator's assessment for making an objective evaluation of CPT results. Digital image analysis possesses the potential of being an objective evaluation method compared to the wide-spread subjective evaluation by the investigators.

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Durchführung des nasalen Provokationstests bei Erkrankungen der oberen Atemwege

Cited by 77 publications

References 18 publications

Sublingual Allergen-Specific Immunotherapy Adjuvanted with Monophosphoryl Lipid A: A Phase I/IIa Study

Sublingual Allergen-Specific Immunotherapy Adjuvanted with Monophosphoryl Lipid A: A Phase I/IIa Study

Birch Pollen Immunotherapy Leads to Differential Induction of Regulatory T Cells and Delayed Helper T Cell Immune Deviation

Objectifying the Conjunctival Provocation Test: Photography-Based Rating and Digital Analysis

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