Robert A Wood1, Alkis Togias2, Jeremy Wildfire3, Cynthia M Visness3, Elizabeth C Matsui4, Rebecca Gruchalla5, Gurjit Hershey6, Andrew H Liu7, George T O'Connor8, Jacqueline A Pongracic9, Edward Zoratti10, Frederic Little8, Mark Granada8, Suzanne Kennedy3, Stephen R Durham11, Mohamed H Shamji11, William W Busse12. 1. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: rwood@jhmi.edu. 2. Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md. 3. Rho Federal Systems Division, Chapel Hill, NC. 4. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md. 5. Departments of Medicine and Pediatrics, University of Texas Southwestern Medical School, Dallas, Tex. 6. Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio. 7. National Jewish Health and University of Colorado Denver School of Medicine, Denver, Colo. 8. Department of Medicine, Boston University School of Medicine, Boston, Mass. 9. Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill. 10. Department of Medicine, Henry Ford Health System, Detroit, Mich. 11. Imperial College, London, United Kingdom. 12. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Abstract
BACKGROUND: Cockroach allergy is a key contributor to asthma morbidity in children living in urban environments. OBJECTIVE: We sought to document immune responses to cockroach allergen and provide direction for the development of immunotherapy for cockroach allergy. METHODS: Four pilot studies were conducted: (1) an open-label study to assess the safety of cockroach sublingual immunotherapy (SLIT) in adults and children; (2) a randomized, double-blind biomarker study of cockroach SLIT versus placebo in adults; (3) a randomized, double-blind biomarker study of 2 doses of cockroach SLIT versus placebo in children; and (4) an open-label safety and biomarker study of cockroach subcutaneous immunotherapy (SCIT) in adults. RESULTS: The adult SLIT trial (n = 54; age, 18-54 years) found a significantly greater increase in cockroach-specific IgE levels between the active and placebo groups (geometric mean ratio, 1.92; P < .0001) and a trend toward increased cockroach-specific IgG4 levels in actively treated subjects (P = .09) but no evidence of functional blocking antibody response. The pediatric SLIT trial (n = 99; age, 5-17 years) found significant differences in IgE, IgG, and IgG4 responses between both active groups and the placebo group but no consistent differences between the high- and low-dose groups. In the SCIT study the treatment resulted in significant changes from baseline in cockroach IgE, IgG4, and blocking antibody levels. The safety profile of cockroach immunotherapy was reassuring in all studies. CONCLUSIONS: The administration of cockroach allergen by means of SCIT is immunologically more active than SLIT, especially with regard to IgG4 levels and blocking antibody responses. No safety concerns were raised in any age group. These pilot studies suggest that immunotherapy with cockroach allergen is more likely to be effective with SCIT. Published by Mosby, Inc.
BACKGROUND: Cockroach allergy is a key contributor to asthma morbidity in children living in urban environments. OBJECTIVE: We sought to document immune responses to cockroach allergen and provide direction for the development of immunotherapy for cockroach allergy. METHODS: Four pilot studies were conducted: (1) an open-label study to assess the safety of cockroach sublingual immunotherapy (SLIT) in adults and children; (2) a randomized, double-blind biomarker study of cockroach SLIT versus placebo in adults; (3) a randomized, double-blind biomarker study of 2 doses of cockroach SLIT versus placebo in children; and (4) an open-label safety and biomarker study of cockroach subcutaneous immunotherapy (SCIT) in adults. RESULTS: The adult SLIT trial (n = 54; age, 18-54 years) found a significantly greater increase in cockroach-specific IgE levels between the active and placebo groups (geometric mean ratio, 1.92; P < .0001) and a trend toward increased cockroach-specific IgG4 levels in actively treated subjects (P = .09) but no evidence of functional blocking antibody response. The pediatric SLIT trial (n = 99; age, 5-17 years) found significant differences in IgE, IgG, and IgG4 responses between both active groups and the placebo group but no consistent differences between the high- and low-dose groups. In the SCIT study the treatment resulted in significant changes from baseline in cockroach IgE, IgG4, and blocking antibody levels. The safety profile of cockroach immunotherapy was reassuring in all studies. CONCLUSIONS: The administration of cockroach allergen by means of SCIT is immunologically more active than SLIT, especially with regard to IgG4 levels and blocking antibody responses. No safety concerns were raised in any age group. These pilot studies suggest that immunotherapy with cockroach allergen is more likely to be effective with SCIT. Published by Mosby, Inc.
Entities:
Keywords:
Cockroach; immunotherapy; inner city asthma; subcutaneous immunotherapy; sublingual immunotherapy
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