Lolium perenne peptides for treatment of grass pollen allergy: A randomized, double-blind, placebo-controlled clinical trial

Shamji, Mohamed H.; Ceuppens, Jan L.; Bachert, Claus; Hellings, Peter W.; Placier, Gaël; Thirion, Gaëtan; Bovy, Nicolas; Durham, Stephen R.; Duchateau, Jean; Legon, Thierry; Pirotton, Sabine

doi:10.1016/j.jaci.2017.09.013

Cited by 21 publications

(18 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Injections with whole pollen antigens can cause severe systemic reactions, so injections must be performed under medical supervision where resuscitation equipment is available, and patients need to be monitored for 30‐60 minutes after injections . At the same doses, LPP are less likely than the whole grass pollen allergen protein to cross‐link high‐affinity IgE receptors and cause allergic reactions, although LPP is administered at higher dose to allow for the short‐course treatment regimen . Three patients (<1%) treated with LPP had grades 2‐4 serious systemic hypersensitivity reactions, resulting in discontinuation from the study.…”

Section: Discussionmentioning

confidence: 99%

“…Lolium perenne pollen peptides is an adjuvant‐free mixture of peptides (1‐10 kDa) resulting from the enzymatic hydrolysis of L. perenne purified proteins as described in Shamji et al . LPP was supplied in ready‐to‐use vials containing 1.5 mL of 100 μg/mL grass pollen peptides in sterile aqueous‐buffered solution (pH 7.4).…”

Section: Methodsmentioning

confidence: 99%

“…Adjuvant‐free allergen peptide hydrolysates ranging 1‐10 kDa from Lolium perenne (LPP) for immunotherapy use have been shown to have limited IgE binding, basophil, and mast cell reactivity and hence are considered as a safe alternative that can be administered at higher doses and for a shorter period to improve treatment adherence . Moreover, in a dose‐response, double‐blind, placebo‐controlled study where 198 adults with grass pollen‐induced allergic rhinitis received either placebo, 70, 170, or 370 μg, a cumulative dose of 170 μg of LPP over 3 weeks was the optimal dose in terms of surrogate efficacy and benefit/risk balance .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Short course of grass allergen peptides immunotherapy over 3 weeks reduces seasonal symptoms in allergic rhinoconjunctivitis with/without asthma: A randomized, multicenter, double‐blind, placebo‐controlled trial

Mösges¹,

Bachert

Panzner

et al. 2018

Allergy

View full text Add to dashboard Cite

BackgroundImmunotherapy with peptide hydrolysates from Lolium perenne (LPP) is an alternative treatment for seasonal allergic rhinitis with or without asthma. The aim of this study was to assess the clinical efficacy and safety of a cumulative dose of 170 μg LPP administered subcutaneously over 3 weeks.MethodsIn a randomized, double‐blind, placebo‐controlled trial, 554 adults with grass pollen rhinoconjunctivitis were randomized (1:2 ratio) to receive 8 subcutaneous injections of placebo or 170 μg LPP administered in increasing doses in 4 visits over 3 weeks. The primary outcome was the combined symptom and medication score (CSMS) measured over the peak pollen season. Reactivity to conjunctival provocation test (CPT) and quality of life (QOL) was assessed as secondary endpoints.ResultsThe mean reduction in CSMS in the LPP vs placebo group was −15.5% (P = .041) during the peak period and −17.9% (P = .029) over the entire pollen season. LPP‐treated group had a reduced reactivity to CPT (P < .001) and, during the pollen season, a lower rhinoconjunctivitis QOL global score (P = .005) compared with placebo group. Mostly mild and WAO grade 1 early systemic reaction (ESR) were observed ≤30 minutes in 10.5% of LPP‐treated patients, whereas 3 patients with a medical history of asthma (<1%) experienced a serious ESR that resolved with rescue medication.Conclusion Lolium perenne pollen peptides administered over 3 weeks before the grass pollen season significantly reduced seasonal symptoms and was generally safe and well‐tolerated.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Short course of grass allergen peptides immunotherapy over 3 weeks reduces seasonal symptoms in allergic rhinoconjunctivitis with/without asthma: A randomized, multicenter, double‐blind, placebo‐controlled trial

Mösges¹,

Bachert

Panzner

et al. 2018

Allergy

View full text Add to dashboard Cite

show abstract

“…Accurate and earlier diagnostics for allergic diseases and risk of devel- Allergen-specific immunotherapy (AIT), first described in 1908, has recently been rejuvenated with respect to oral, epicutaneous, sublingual, or subcutaneous modalities for food allergy as well as with the introduction of peptides instead of whole extracts against allergic rhinitis. 6 More child-friendly and better access to AIT is required, as is better standardization and training. Ongoing surveillance of adverse side effects and tolerability as regards quality of life is imperative.…”

Section: Diagnostic Tools and Management In Pamentioning

confidence: 99%

Current state and future of pediatric allergology in Europe: A road map

Tsilochristou

Maggina

Zolkipli

et al. 2018

Pediatric Allergy Immunology

View full text Add to dashboard Cite

The history of pediatric allergology (PA) in Europe is relatively youthful, dating back to 1984, when a small group of pediatricians founded the European Working Group on Pediatric Allergy and Immunology—later giving rise to ESPACI (European Society on Pediatric Allergology and Clinical Immunology). In 1990, the first dedicated journal, Pediatric Allergy and Immunology (PAI), was founded. There are striking differences across Europe, and even within European countries, in relation to the training pathways for doctors seeing children with allergic disease(s). In 2016, the EAACIClemens von Pirquet Foundation (CvP) organized and sponsored a workshop with the European Academy of Allergy and Clinical Immunology (EAACI) Pediatric Section. This collaboration focussed on the future of PA and specifically on education, research, and networking/ advocacy. The delegates representing many countries across Europe have endorsed the concept that optimal care of children with allergic diseases is delivered by pediatricians who have received dedicated training in allergy, or allergists who have received dedicated training in pediatrics. In order to meet the needs of children and families with allergic disease(s), the pediatric allergist is highly encouraged to develop several networks. Our challenge is to reinforce a clear strategic approach to scientific excellence to across our member base and to ensure and enhance the relevance of European pediatric research in allergy. With research opportunities in basic, translational, clinical, and epidemiologic trials, more trainees and trained specialists are needed and it is an exciting time to be a pediatric allergologist.

show abstract

“…Lolium perenne peptides immunotherapy has been shown to have limited IgE binding, basophil and mast cell reactivity and hence is considered as a safe alternative that can be administered at higher doses and for a shorter period to improve treatment adherence . Here, we report a proof‐of‐concept study, which involved an up‐dosing regimen with the primary aim to assess safety and to identify an individual maximum tolerated cumulative dose for patients with different statuses of allergen sensitization.…”

Section: Introductionmentioning

confidence: 99%

Lolium perenne peptide immunotherapy is well tolerated and elicits a protective B‐cell response in seasonal allergic rhinitis patients

Mösges

Koch

Raskopf

et al. 2018

Allergy

View full text Add to dashboard Cite

BackgroundSystemic allergic reactions are a risk for allergen immunotherapy that utilizes intact allergen preparations. We evaluated the safety, efficacy and immune mechanisms of short‐course treatment with adjuvant‐free Lolium perenne peptides (LPP) following a 6‐week dose‐escalation protocol.MethodsIn a prospective, dose‐escalation study, 61 grass pollen–allergic patients received 2 subcutaneous injections of LPP once weekly for 6 weeks. Safety was assessed evaluating local reactions, systemic reactions and adverse events. The clinical effect of LPP was determined by reactivity to the conjunctival provocation test (CPT). Specific IgE, IgG4 and blocking antibodies were measured at baseline (V1), during (V6) and after treatment (V8).ResultsNo fatality, serious adverse event or epinephrine use was reported. Mean wheal diameters after injections were <0.6 cm and mean redness diameters <2.5 cm, independent of dose. Transient and mostly mild adverse events were reported in 33 patients. Two patients experienced a grade I and 4 patients a grade II reaction (AWMF classification). At V8, 69.8% of patients became nonreactive to CPT. sIgG4 levels were higher at V6 (8.1‐fold, P < .001) and V8 (12.2‐fold, P < .001) than at V1. The sIgE:sIgG4 ratio decreased at V6 (−54.6%, P < .001) and V8 (−71.6%, P < .001) compared to V1. The absolute decrease in IgE‐facilitated allergen binding was 18% (P < .001) at V6 and 25% (P < .001) at V8.ConclusionIncreasing doses of subcutaneous LPP appeared safe, substantially diminished reactivity to CPT and induced blocking antibodies as early as 4 weeks after treatment initiation. The benefit/risk balance of LPP immunotherapy remains to be further evaluated in large studies.

show abstract

Lolium perenne peptides for treatment of grass pollen allergy: A randomized, double-blind, placebo-controlled clinical trial

Cited by 21 publications

References 10 publications

Short course of grass allergen peptides immunotherapy over 3 weeks reduces seasonal symptoms in allergic rhinoconjunctivitis with/without asthma: A randomized, multicenter, double‐blind, placebo‐controlled trial

Short course of grass allergen peptides immunotherapy over 3 weeks reduces seasonal symptoms in allergic rhinoconjunctivitis with/without asthma: A randomized, multicenter, double‐blind, placebo‐controlled trial

Current state and future of pediatric allergology in Europe: A road map

Lolium perenne peptide immunotherapy is well tolerated and elicits a protective B‐cell response in seasonal allergic rhinitis patients

Contact Info

Product

Resources

About