Which patients with asthma are most likely to benefit from allergen immunotherapy?

Blay, F. De; Gherasim, Alina; Casale, T.; Doyen, Virginie; Bernstein, David I.

doi:10.1016/j.jaci.2022.01.011

Cited by 14 publications

(10 citation statements)

References 107 publications

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“…Limited data are available on the response of FeNO and eosinophil levels after AIT. However, some studies have consistently reported a decrease in (seasonal) levels of both blood eosinophils and FeNO after AIT treatment in asthma patients 109–112 . Studies correlating FeNO and blood eosinophils with clinical outcome of AIT in asthma patients are necessary to elaborate on the applicability of these biomarkers.…”

Section: Resultsmentioning

confidence: 99%

Standardization of clinical outcomes used in allergen immunotherapy in allergic asthma: An EAACI position paper

Kappen

Diamant

Agache

et al. 2023

Allergy

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IntroductionIn allergic asthma patients, one of the more common phenotypes might benefit from allergen immunotherapy (AIT) as add‐on intervention to pharmacological treatment. AIT is a treatment with disease‐modifying modalities, the evidence for efficacy is based on controlled clinical trials following standardized endpoint measures. However, so far there is a lack of a consensus for asthma endpoints in AIT trials. The aim of a task force (TF) of the European Academy of Allergy and Clinical Immunology (EAACI) is evaluating several outcome measures for AIT in allergic asthma.MethodsThe following domains of outcome measures in asthmatic patients have been evaluated for this position paper (PP): (i) exacerbation rate, (ii) lung function, (iii) ICS withdrawal, (iv) symptoms and rescue medication use, (v) questionnaires (PROMS), (vi) bronchial/nasal provocation, (vii) allergen exposure chambers (AEC) and (viii) biomarkers.ResultsExacerbation rate can be used as a reliable objective primary outcome; however, there is limited evidence due to different definitions of exacerbation. The time after ICS withdrawal to first exacerbation is considered a primary outcome measure. Besides, the advantages and disadvantages and clinical implications of further domains of asthma endpoints in AIT trials are elaborated in this PP.ConclusionThis EAACI‐PP aims to highlight important aspects of current asthma measures by critically evaluating their applicability for controlled trials of AIT.

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Section: Resultsmentioning

confidence: 99%

Standardization of clinical outcomes used in allergen immunotherapy in allergic asthma: An EAACI position paper

Kappen

Diamant

Agache

et al. 2023

Allergy

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“…In contrast, follicular regulatory T (T FR ) cells, a specialized subset of T REG cells resident in B-cell follicles, restrict T FH cell-mediated help in extrafollicular antibody production, germinal centre formation, immunoglobulin affinity maturation and long-lived, high-affinity plasma and memory B-cell differentiation. 38 Upregulation of T FH cell activities, including a skewing toward Type 2 T FH (T FH 2) and IL-13 producing T FH (T FH 13) phenotypes, and defects in T FR cells have been identified in patients with allergic diseases. AIT reinstates the balance between T FH and T FR cells in patients with allergic diseases, resulting in clinical benefits.…”

Section: Modulation Of Allergen-specific Ige and Igg Responses During...mentioning

confidence: 99%

“…226 Research suggests that polysensitized patients with allergic rhinitis and class 2-4 asthma, according to the Global Initiative for Asthma (GINA) guidelines, as well as those with a high eosinophilic response, are likely good responders to AIT. 13 After successful trials with HDM-SLIT tablets, current guidelines recommend AIT for patients with controlled or partially controlled HDM allergic asthma. 227 Using a biologic can improve asthma control and may allow more patients to be eligible for AIT.…”

Section: Ait For Allerg I C a S Thmamentioning

confidence: 99%

“…2 The core strength of AIT lies in its ability to provide sustained relief from symptoms and prevent the progression from allergic rhinitis to asthma-particularly crucial in paediatric populations. 12,13 This enduring impact can be attributed to AIT's unique ability to trigger a cascade of desensitization mechanisms, which can be achieved by modulating both innate and adaptive immunity. 14 The effectiveness assessment evokes the concept of theratypes, which delineate therapy responders and non-responders based on a comprehensive understanding of pathophysiological mechanisms dictating disease manifestation and response to therapy in various patient groups.…”

Section: Introductionmentioning

confidence: 99%

“…The core strength of AIT lies in its ability to provide sustained relief from symptoms and prevent the progression from allergic rhinitis to asthma—particularly crucial in paediatric populations 12,13 . This enduring impact can be attributed to AIT's unique ability to trigger a cascade of desensitization mechanisms, which can be achieved by modulating both innate and adaptive immunity 14 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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The Role of Innate Immune Cells in Allergen Immunotherapy

Jin

Zhu

2023

Curr Treat Options Allergy

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Which patients with asthma are most likely to benefit from allergen immunotherapy?

Cited by 14 publications

References 107 publications

Standardization of clinical outcomes used in allergen immunotherapy in allergic asthma: An EAACI position paper

Standardization of clinical outcomes used in allergen immunotherapy in allergic asthma: An EAACI position paper

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

The Role of Innate Immune Cells in Allergen Immunotherapy

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