The Risk and Management of Anaphylaxis in the Setting of Immunotherapy

Lieberman, Phil

doi:10.2500/ajra.2012.26.3811

Cited by 31 publications

(23 citation statements)

References 47 publications

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“…The gold standard for immunotherapy route is the subcutaneous route due to its efficacy (56), but sublingual treatment is on the rise. Our finding with encapsulated OVA is of clinical relevance since one of the major drawbacks of allergen-specific treatment is the development of life-threating anaphylaxis (57). Although treatment of allergic mice with encapsulated allergen alone was effective in attenuating cutaneous anaphylaxis of allergic mice, this treatment was ineffective, in reversing established allergic lung inflammation.…”

Section: Discussionmentioning

confidence: 78%

Allergen-Specific Immunotherapy With Liposome Containing CpG-ODN in Murine Model of Asthma Relies on MyD88 Signaling in Dendritic Cells

et al. 2020

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Changing the immune responses to allergens is the cornerstone of allergen immunotherapy. Allergen-specific immunotherapy that consists of repeated administration of increasing doses of allergen extract is potentially curative. The major inconveniences of allergen-specific immunotherapy include failure to modify immune responses, long-term treatment leading to non-compliance and the potential for developing life-threating anaphylaxis. Here we investigated the effect of a novel liposomal formulation carrying low dose of allergen combined with CpG-ODN, a synthetic TLR9 agonist, on established allergic lung inflammation. We found that challenge with allergen (OVA) encapsulated in cationic liposome induced significantly less severe cutaneous anaphylactic reaction. Notably, short-term treatment (three doses) with a liposomal formulation containing co-encapsulated allergen plus CpG-ODN, but not allergen or CpG-ODN alone, reversed an established allergic lung inflammation and provided long-term protection. This liposomal formulation was also effective against allergens derived from Blomia tropicalis mite extract. The attenuation of allergic inflammation was not associated with increased numbers of Foxp3-positive or IL-10-producing regulatory T cells or with increased levels of IFN-gamma in the lungs. Instead, the anti-allergic effect of the liposomal formulation was dependent of the innate immune signal transduction generated in CD11c-positive putative dendritic cells expressing MyD88 molecule. Therefore, we highlight the pivotal role of dendritic cells in mediating the attenuation of established allergic lung inflammation following immunotherapy with a liposomal formulation containing allergen plus CpG-ODN.

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Section: Discussionmentioning

confidence: 78%

Allergen-Specific Immunotherapy With Liposome Containing CpG-ODN in Murine Model of Asthma Relies on MyD88 Signaling in Dendritic Cells

et al. 2020

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“…Alergi terhadap lateks, bahan yang umumnya ada pada peralatan medis seperti sarung tangan, stetoskop, kateter, respirator, kondom, dan tabung drainase, juga dapat menyebabkan anafilaksis (Nguyen & Kohli, 2020). Penyakit asma tidak meningkatkan resiko untuk terjadinya reaksi, namun berdampak pada tingkat keparahan saat terjadinya reaksi (Lieberman, 2012).…”

Section: Usiaunclassified

Management of Anaphylaxis

Irawan

2019

jppp

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Anafilaksis adalah sebuah reaksi hipersensitivitas tipe I yang melibatkan berbagai sistem organ dengan onset cepat dan mengancam jiwa. Reaksi ini dicirikan dengan adanya gangguan jalan napas, sirkulasi, pencernaan, serta perubahan pada kulit dan mukosa tubuh. Tujuan dilakukannya literature review ini adalah untuk membahas tatalaksana yang tepat pada kasus anafilaksis. Sumber referensi yang digunakan untuk menyusun tulisan ini meliputi 23 artikel yang didapat dengan melakukan literature searching di Sumber NCBI dan 1 buku yang semuanya dipublikasikan dalam rentang tahun 2000-2020. Literature sarching tersebut dilakukan dengan menggunakan kata kunci shock anaphylactic, anaphylaxis, dan therapy dan filter berupa rentang publikasi tahun 2010-2020. Hasil yang ditemukan dari literature searching ini adalah 4666 artikel yang kemudian dipilih 23 artikel berdasarkan informasi yang dibutuhkan. Referensi yang telah dikumpulkan kemudian dianalisis dengan metode systematic literature review yang mencakup kegiatan mengumpulkan, mengevaluasi, dan mengembangkan penelitian dengan topik tertentu secara sistematis. Hasil literature review in menunjukkan bahwa pemberian epinephrine menjadi kunci dalam penanganan anafilaksis. Dekontaminasi, pengamatan tanda-tanda vital, pemosisian, pemberian oksigen, dan cairan juga penting untuk dilakukan. Terapi adjuvant dengan administrasi obat-obat anti-alergi dapat dipertimbangkan untuk mempercepat perbaikan gejala pada pasien.

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“…In SCIT induction phases, the rate of systemic reactions is approximately 0.1–0.2% of injections and 2–5% of patients , while for SLIT, according to a review, the rate was 0.056% of doses . Uncontrolled asthma has been identified as an independent risk factor for serious adverse effects ; therefore, it is of major importance to assess asthma status initially upon prescription of AIT, and thereafter, before administration, as recommended by national and international guidelines .…”

Section: Safety Outcomes Of Aitmentioning

confidence: 99%

Immunotherapy in allergic rhinitis and lower airway outcomes

Cardona

Luengo

Labrador‐Horrillo

2016

Allergy

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Allergic rhinitis and asthma constitute two clinical expressions of a single-condition, respiratory allergy. Allergen immunotherapy (AIT) is a form of treatment specifically aimed at modifying the response to sensitizing allergens. The inherent potential benefit of AIT is the simultaneous treatment of all clinical expressions of respiratory allergy. Current data support the effectiveness of subcutaneous and sublingual immunotherapy in rhinitis. Studies also provide proof for a beneficial effect in allergic asthma. Even more, substantial evidence points to the preventive effect on the progression from rhinitis to asthma. Despite the current knowledge on the basic mechanisms underlying the immunological effect of AIT is vast, the specific mechanisms for the preventive effect of primary sensitization or new sensitizations are poorly understood. This review aimed to provide a critical overview of the current knowledge on the effectiveness of AIT and its potential role in secondary prevention of respiratory allergy progression.Respiratory allergy is nowadays considered a single condition which affects both upper and lower airways, integrated in the 'one-airway' concept. The association of allergic rhinitis (AR) and asthma has been extensively established, and the common mechanistic pathways leading to inflammation also share multiple characteristics. Also, it is well known that rhinitis frequently precedes the onset of asthma, allowing a window of opportunity for intervention (1). Initially, allergen immunotherapy (AIT) was empirically developed to treat AR in 1911, mirroring the emergence of the first vaccines in infectious diseases. Nowadays, we understand that one of the inherent potential benefits of AIT is the simultaneous treatment of all clinical expressions of respiratory allergy, that is from rhinoconjunctivitis to asthma (2). This is a major advantage, compared to some of the other pharmacological therapies which selectively treat one of the target organs. Also, data indicate that AIT has a carry-over effect beyond the period during which it is administered, somehow reverting the clinical expression of the disease. Furthermore, it may also be able to exert a preventive effect in two modes: decreasing the risk of developing asthma in patients who only suffer AR and diminishing the tendency of the allergic patients to become sensitized to further allergens (3). This review aimed to provide a critical overview of the current knowledge on the effectiveness of AIT and its potential role in secondary prevention of respiratory allergy progression. Does immunotherapy for AR treat associated asthma?Subcutaneous allergen immunotherapy (SCIT) has extensively been evaluated in AR, as this has been the primary indication of AIT. Data provided by different meta-analysis of published trials have shown that it is an effective treatment, decreasing both symptom and medication scores (4, 5). In the last decades, sublingual immunotherapy (SLIT) has become a widely used form of AIT. Again, meta-analysis of studies has ...

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The Risk and Management of Anaphylaxis in the Setting of Immunotherapy

Abstract: ABSTRACT

Cited by 31 publications

References 47 publications

Allergen-Specific Immunotherapy With Liposome Containing CpG-ODN in Murine Model of Asthma Relies on MyD88 Signaling in Dendritic Cells

Allergen-Specific Immunotherapy With Liposome Containing CpG-ODN in Murine Model of Asthma Relies on MyD88 Signaling in Dendritic Cells

Management of Anaphylaxis

Immunotherapy in allergic rhinitis and lower airway outcomes

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