Technical standards in allergen exposure chambers worldwide – an EAACI Task Force Report

Pfaar, Oliver; Bergmann, Karl‐Christian; Бонини, С.; Compalati, E; Domis, Nathalie; Blay, F. De; Kam, PJ de; Devillier, Philippe; Durham, SR; Ellis, AK; Gherasim, Alina; Haya, Laura; Hohlfeld, JM; Horák, F.; Iinuma, Tomohisa; Rl, Jacobs; Jacobi, HH; Jutel, Marek; Kaul, Susanne; Kelly, Suzanne M.; Klimek, Ludger; Larché, Mark; Lemell, Patrick; Mahler, Vera; Nolte, Hendrik; Okamoto, Yoshitaka; Patel, Piyush M.; Rabin, RL; Rather, Cynthia G.; Sager, Angelika; Salapatek, A.; Sigsgaard, Torben; Togias, A.; Willers, Christoph; Yang, Jimmy; Zieglmayer, René; Zuberbier, Torsten; Zieglmayer, Petra

doi:10.1111/all.14957

Cited by 31 publications

(55 citation statements)

References 49 publications

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“…Standardized and validated allergen exposures in state-of-the-art AECs are an impressive tool to study allergic diseases [21,23]. As a limitation of the first study we discussed in the previous paper [2] the missing control group, habituation effects of undergoing a chamber exposure for the third time, and the relatively low number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The exposure was carried out under exactly the same protocol as in the previous study in the same allergen exposure chamber [2]. In brief, exposure was done in the mobile, standardised and validated GA 2 LEN AEC (ECARF) [21,[23][24][25]. After an acclimatisation period (20 min), the exposure was performed with 250 μg/m 3 HDM raw material (whole culture mite: Dermatophagoides pteronyssinus and Dermatophagoides farinae body and faeces allergen K Long-term benefits of targeted micronutrition with the holoBLG lozenge in house dust mite allergic patients original article 50:50; Allergon AB, Ängelholm, Sweden) for 120 min at 20 °C and 55% relative air moisture.…”

Section: Aecmentioning

confidence: 99%

“…The second proof-of-concept study investigated the effects of the holoBLG lozenge on symptoms of house dust mite (HDM) allergic patients by a controlled and standardised provocation in a validated allergen exposure chamber (AEC) [2,21]. Thirty-two HDM-allergic patients were included in this study (NCT04477382), which was conducted at the AEC of the ECARF Institute in Berlin (Germany).…”

Section: Introductionmentioning

confidence: 99%

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Long-term benefits of targeted micronutrition with the holoBLG lozenge in house dust mite allergic patients

Bergmann

Raab²,

Krause

et al. 2022

Allergo J Int

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Summary Purpose The long-term effects of targeted micronutrition with the holoBLG lozenge in house dust mite (HDM) allergic rhinoconjunctivitis (ARC) patients were evaluated at a follow-up visit in an allergen exposure chamber (AEC). Methods Patients who were supplemented for 3‑months with the holoBLG lozenge in a previous study with two controlled HDM-AEC challenges [visits: V1, V3] were recruited for a third AEC challenge (V5) 7–8 months after cessation of supplementation. Symptoms (nose, conjunctival, bronchial, others), well-being, and lung function parameters were recorded exactly as in the previous study. Primary endpoint was change in median Total Nasal Symptom Score (TNSS) at V5 compared to V1. Secondary endpoints included e.g. change in median Total Symptom Score (TSS) and the exploratory analysis of temporal evolution of symptom scores using linear mixed effects models. Results Of the 32 patients included in the original study, 27 could be recruited for the follow-up visit with a third AEC challenge. An improvement of 20% (p = 0.15) in the primary endpoint TNSS [V1: 2.5 (interquartile range [IQR]: 1–4), V5: 2.0 (IQR: 1–3)] was observed; 40% (p = 0.04) improvement was seen for the TSS [V1: 5.0 (IQR: 3–9), V5: 3.0 (IQR: 2–5.5)]. Analysis of temporal evolution of all symptom scores, and the personal well-being revealed sustained, clinically meaningful improvement at V5 compared to V1. No relevant lung function parameter differences were observed. Conclusions Sustained long-term reduction of TNSS (primary endpoint) and sustained long-term improvement of secondary endpoints (temporal evolution of all symptom scores and well-being) were demonstrated 7–8 months after cessation of holoBLG supplementation, indicative of a long-lasting nature of immune resilience induced by holoBLG. Trial registration The study was registered at clinicaltrials.gov (NCT04872868).

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Section: Discussionmentioning

confidence: 99%

Section: Aecmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term benefits of targeted micronutrition with the holoBLG lozenge in house dust mite allergic patients

Bergmann

Raab²,

Krause

et al. 2022

Allergo J Int

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“…In contrast, allergen exposure chambers (AEC) mimic natural exposure while controlling all environmental variables, allowing for more precise and controlled distribution of allergen. They are specialized facilities, requiring trained staff, and are limited in number ( 11 ). AECs are ideal for representing longer-lasting exposures to allergen, whereas the nasal allergen challenge (NAC) is an acute and localized model ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Study of Cat Allergy Using Controlled Methodology—A Review of the Literature and a Call to Action

et al. 2022

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The prevalence of cat allergen-induced AR is increasing worldwide, prompting its study using controlled methodology. Three general categories of allergen exposure models currently exist for the study of cat allergen-induced AR: natural exposure cat rooms, allergen exposure chambers (AEC), and nasal allergen challenges (NAC). We evaluated existing literature surrounding the use of these models to study cat allergen induced AR using online research databases, including OVID Medline, Embase, and Web of Science. We report that natural exposure cat rooms have been important in establishing the foundation for our understanding of cat allergen-induced AR. Major limitations, including variable allergen ranges and differing study designs highlight the need for a more standardized protocol. In comparison, AECs are an exceptional model to mimic real-world allergen exposure and study long-term implications of AR with large sample sizes. Existing AECs are limited by heterogeneous facility designs, differing methods of cat allergen distribution, and issues surrounding cost and accessibility. Conversely, NACs allow for smaller participant cohorts for easier biological sampling and are ideal for phase I, phase 2 or proof-of-concept studies. NACs generally have a standardized protocol and are less expensive compared to AECs. Nevertheless, NACs solely capture acute allergen exposure and have the further limitation of using allergen extracts rather than natural allergen. As the use of combined controlled methodologies is sparse, we recommend concurrent use of AECs and NACs to study short- and long-term effects of AR, thereby providing a more holistic representation of cat allergen-induced AR.

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“…In mice, pollen grain suspensions were used [ 15 ], but these contain extracted pollen in their solution. Newer studies with humans performed in exposure chambers use natural pollen grains [ 9 , 16 – 20 ], and for registration of an ASIT by medical authorities studies, real-life data with exposure to whole pollen are essential.…”

Section: Introductionmentioning

confidence: 99%

Dosing intact birch pollen grains at the air-liquid interface (ALI) to the immortalized human bronchial epithelial cell line BEAS-2B

2021

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In real life, humans are exposed to whole pollen grains at the air epithelial barrier. We developed a system for in vitro dosing of whole pollen grains at the Air-Liquid Interface (ALI) and studied their effect on the immortalized human bronchial epithelial cell line BEAS-2B. Pollen are sticky and large particles. Dosing pollen needs resuspension of single particles rather than clusters, and subsequent transportation to the cells with little loss to the walls of the instrumentation i.e. in a straight line. To avoid high speed impacting insults to cells we chose sedimentation by gravity as a delivery step. Pollen was resuspended into single particles by pressured air. A pollen dispersion unit including PTFE coating of the walls and reduced air pressure limited impaction loss to the walls. The loss of pollen to the system was still about 40%. A linear dose effect curve resulted in 327-2834 pollen/cm2 (± 6.1%), the latter concentration being calculated as the amount deposited on epithelial cells on high pollen days. After whole pollen exposure, the largest differential gene expression at the transcriptomic level was late, about 7 hours after exposure. Inflammatory and response to stimulus related genes were up-regulated. We developed a whole pollen exposure air-liquid interface system (Pollen-ALI), in which cells can be gently and reliably dosed.

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Technical standards in allergen exposure chambers worldwide – an EAACI Task Force Report

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 31 publications

References 49 publications

Long-term benefits of targeted micronutrition with the holoBLG lozenge in house dust mite allergic patients

Long-term benefits of targeted micronutrition with the holoBLG lozenge in house dust mite allergic patients

Study of Cat Allergy Using Controlled Methodology—A Review of the Literature and a Call to Action

Dosing intact birch pollen grains at the air-liquid interface (ALI) to the immortalized human bronchial epithelial cell line BEAS-2B

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