Update on the use of allergen challenge chambers in immunotherapy: clinical implications

Zieglmayer, Petra; Pfaar, Oliver

doi:10.1097/aci.0000000000000808

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…Several confounders impact clinical trials in AIT development programs, such as false reporting of PROMs, imputation of missing data or the role of natural (non‐standardized) allergen exposure impacting the outcome of a (field‐) trial 116 . Allergen provocation under standardized conditions in so‐called allergen exposure chambers (AECs) may overcome methodological flaws 127 . Still, to date, this technology is not clinically validated to replace ‘classical’ field trials under natural exposure, as emphasized by EMA in the aforementioned guideline 128 .…”

Section: Methods In Ait Development Programs: Current Standards and F...mentioning

confidence: 99%

“…116 Allergen provocation under standardized conditions in so-called allergen exposure chambers (AECs) may overcome methodological flaws. 127 Still, to date, this technology is not clinically validated to replace 'classical' field trials under natural exposure, as emphasized by EMA in the aforementioned guideline. 128 However, an EAACI task force comprising worldwide clinicians, AEC providers and delegates from regulatory authorities has provided overviews of the similarities and differences of current AEC facilities with the aim of further harmonization.…”

Section: Me Thods In Ait De Velopment Prog R Ams: Current S Tandards ...mentioning

confidence: 99%

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Hot topics in allergen immunotherapy, 2023: Current status and future perspective

Zemelka‐Wiacek,

Agache,

Akdis

et al. 2023

Allergy

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The importance of allergen immunotherapy (AIT) is multifaceted, encompassing both clinical and quality‐of‐life improvements and cost‐effectiveness in the long term. Key mechanisms of allergen tolerance induced by AIT include changes in memory type allergen‐specific T‐ and B‐cell responses towards a regulatory phenotype with decreased Type 2 responses, suppression of allergen‐specific IgE and increased IgG1 and IgG4, decreased mast cell and eosinophil numbers in allergic tissues and increased activation thresholds. The potential of novel patient enrolment strategies for AIT is taking into account recent advances in biomarkers discoveries, molecular allergy diagnostics and mobile health applications contributing to a personalized approach enhancement that can increase AIT efficacy and compliance. Artificial intelligence can help manage and interpret complex and heterogeneous data, including big data from omics and non‐omics research, potentially predict disease subtypes, identify biomarkers and monitor patient responses to AIT. Novel AIT preparations, such as synthetic compounds, innovative carrier systems and adjuvants, are also of great promise. Advances in clinical trial models, including adaptive, complex and hybrid designs as well as real‐world evidence, allow more flexibility and cost reduction. The analyses of AIT cost‐effectiveness show a clear long‐term advantage compared to pharmacotherapy. Important research questions, such as defining clinical endpoints, biomarkers of patient selection and efficacy, mechanisms and the modulation of the placebo effect and alternatives to conventional field trials, including allergen exposure chamber studies are still to be elucidated. This review demonstrates that AIT is still in its growth phase and shows immense development prospects.

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Section: Methods In Ait Development Programs: Current Standards and F...mentioning

confidence: 99%

Section: Me Thods In Ait De Velopment Prog R Ams: Current S Tandards ...mentioning

confidence: 99%

Hot topics in allergen immunotherapy, 2023: Current status and future perspective

Zemelka‐Wiacek,

Agache,

Akdis

et al. 2023

Allergy

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“…Comparable clinical scores were achieved in a study conducted by ECC with an allergen dose similar to environmental exposure. For AIT, further validation of the treatment effect size as assessed in the EEC challenges is needed to relate it to effect sizes found under natural exposure in field trials [ 80 , 81 , 82 ].…”

Section: Biomarkers For Aitmentioning

confidence: 99%

“…79,[81][82][83][85][86][87][88][89][90] AIT: Allergen immunotherapy, CCR3: C-C chemokine receptor type 3, ECP: Eosinophilic cationic protein, ELIFAB: Enzyme-linked immunosorbent-facilitated antigen-binding assay, DAO: Diamine oxidase, IgE-BF: IgE-blocking factor, FAB: facilitated antigen binding, IFN-γ: Interferon-gamma, ILCs: Innate lymphoid cells, SPT: Skin prick tests, TARC: thymus and activation regulated protein, TGF-β: Transforming growth factor-beta.…”

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confidence: 99%

Mechanisms of Allergen Immunotherapy and Potential Biomarkers for Clinical Evaluation

Şahiner

Giovannini

Escribese

et al. 2023

JPM

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Allergen-immunotherapy (AIT) is an efficacious and disease-modifying treatment option for IgE-mediated diseases. Among these allergic rhinitis, insect venom allergy, food allergy, and allergic asthma are the most common candidates for AIT. AIT gives rise to clinical immunotolerance which may last for years after the treatment cessation. Mechanisms of AIT include suppression of allergic inflammation in target tissues and stimulation of the production of blocking antibodies, especially IgG4 and IgA. These mechanisms are followed by a reduction of underlying allergen-specific Th2 cell-driven responses to the allergens. Tolerance induction takes place through the desensitization of effector cells and stimulation of regulatory T cells that show their effects by mechanisms involving cell-cell cross-talk, but also other mechanisms, e.g., by the production of immunomodulatory cytokines such as, e.g., IL-10 and TGF-beta. From a personalized medical perspective, there is a need for clinical biomarkers of value in selecting responders and optimizing patient care during AIT. Also, a deeper understanding of underlying mechanistic processes will improve AIT’s future outcomes. In this paper, the current knowledge of mechanisms in AIT is reviewed with a special focus on biomarkers of this therapy.

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“… 14 For the performance of pivotal immunotherapy trials, regulatory authorities require harmonization of clinical assessments and documentation between clinical outcomes obtained using EECs versus environmental exposure. 15 …”

Section: Introductionmentioning

confidence: 99%

Birch-induced allergic rhinitis: Results of exposure during nasal allergen challenge, environmental chamber, and pollen season

Gherasim¹,

Dietsch²,

Beck³

et al. 2023

World Allergy Organization Journal

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Update on the use of allergen challenge chambers in immunotherapy: clinical implications

Cited by 6 publications

References 27 publications

Hot topics in allergen immunotherapy, 2023: Current status and future perspective

Hot topics in allergen immunotherapy, 2023: Current status and future perspective

Mechanisms of Allergen Immunotherapy and Potential Biomarkers for Clinical Evaluation

Birch-induced allergic rhinitis: Results of exposure during nasal allergen challenge, environmental chamber, and pollen season

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