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Unproven and epicutaneous and other investigational forms of immunotherapy
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2020
Haig Tcheurekdjian, Abba I. Terr
Three double-blind, placebo-controlled trials from the same research group demonstrated improvement in grass pollen–induced rhinoconjunctivitis symptoms after treatment with epicutaneous allergen immunotherapy [58–60]. The general process involves the administration of a patch loaded with grass pollen to tape-stripped skin on the upper arm. Patches are applied weekly for 6 weeks with patches kept on the skin for 8 hours. Therapy is started prior to the beginning of the grass pollen season. In the latest study [60], subjects treated with grass pollen patches reported 48% improvement in symptoms compared to a 10% improvement in the placebo arm. One year after therapy, the benefits were lost, although this is in contrast to a prior study showing sustained improvement 1 year after therapy [58]. Importantly, a combined endpoint measuring improvement in both symptoms and medication use showed no improvement with grass pollen patch treatment. Likewise, nasal provocation test scores were unchanged in one study [59]. Systemic reactions can occur, especially if the skin is aggressively abraded with a file instead of tape stripping prior to application of patches [61]. Localized reactions, such as eczema at the site of patch placement, are common and occur in most individuals if patches are left in place for 48 hours instead of the shorter 8-hour protocol.
Occupational Rhinitis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Diagnosing occupational rhinitis can be difficult. A combination of history, examination and investigation will aid the diagnosis. Nasal provocation test (NPT) with the suspected agent is particularly central to secure the diagnosis.
Metals as a Cause of Contact Urticaria Syndrome
Published in Ana M. Giménez-Arnau, Howard I. Maibach, Contact Urticaria Syndrome, 2014
Majken G. Hougaard, Jacob P. Thyssen
The frst case report listed [2] describes a 27-year-old woman who worked with manual grinding of metal castings for 2 years. She had previously suffered from ACD from nickel-containing jewelry. She later developed contact urticaria, asthma, and rhinitis at work. The symptoms disappeared on weekends and holidays. Scratch chamber test, open test, specific immunoglobulin E (IgE) determinations (radioallergosorbent test [RAST]), and a RAST inhibition test indicated an IgE-mediated mechanism. A nasal provocation test with nickel sulfate was positive within five minutes. The specific inhalation challenge test with nickel sulfate provoked a late asthmatic reaction.
Allergen immunotherapy: progress and future outlook
Published in Expert Review of Clinical Immunology, 2023
Lara Šošić, Marta Paolucci, Stephan Flory, Fadi Jebbawi, Thomas M. Kündig, Pål Johansen
The efficacy of AIT can be monitored with several in vivo surrogate markers, the most frequently used being allergen provocation tests. Such tests are routinely done in the skin (skin prick test (SPT), intradermal test, epicutaneous test), and less so in the nose (nasal provocation test) and the eyes (conjunctival provocation test). European Medicinal Agency (EMA) recommends testing of respiratory function by rhinomanometry, the measurement of nasal obstruction after allergen challenge, by in proof of concept and in phase II dose-finding trials in AIT for ARC [146]. Bronchial airway inflammation or obstruction can be monitored by spirometry and by measuring fractional exhaled nitric oxide (FeNO) [147,148]. Spirometry can also be performed after an allergen provocation. A review on allergic provocation tests in respiratory research summarized possibilities and limitations of such tests, including their biomarker potential [149]. Controlled allergen exposure in environmental exposure chambers (EECs) has also been included in recent clinical trials for assessment of AIT efficacy [150]. The EECs mimic natural exposure but are designed to allow controlled and quantitative allergen exposure [151]. The EMA guidelines are open to using chambers, but require further validation prior to efficacy Phase II and III trials [146]. Therefore, much effort was made in the last decade to establish and standardize EECs in clinical AIT trials [152–156]. Different provocation tests should not be used interchangeably [157] but rather complemented with other clinical biomarkers, such as subjective composite symptoms and visual analog scale scores, e.g. nasal congestion, rhinorrhea, itching, and sneezing in AR [158].
Recent advances in the diagnosis of allergic rhinitis
Published in Expert Review of Clinical Immunology, 2018
Xiangdong Wang, Kun Du, Wenyu She, Yuhui Ouyang, Yutong Sima, Chengyao Liu, Luo Zhang
Local allergic rhinitis（LAR）is a newly established and progressive disease. It was first defined by Rondón et al [19]. who showed that nasal provocation test (NPT) could detect positive cases in patients diagnosed with nonallergic rhinitis (NAR) depending on the negative results of SPTs or serum IgE [20]. They also reported a similar finding performing a 10-year follow-up study including a cohort of 176 patients with LAR and 115 healthy controls (matched to age and gender). The results showed that 9.7% of LAR patients turned into AR compared to 7.8% of healthy controls [21].
Allergen immunotherapy against house dust mites in patients with local allergic rhinitis and asthma
Published in Journal of Asthma, 2022
Andrzej Bozek,, Beata Galuszka,, Radosław Gawlik,, Maciej Misiolek,, Wojciech Scierski,, Alicja Grzanka,, Giorgio Walter Canonica,
Patients with an LAR diagnosis based on defined criteria (above) and concomitant mild to moderate chronic asthma, positive clinical symptoms indicating HDM allergy (clinical reaction to dust, medical history of worsening of symptoms during the heating season), and positive nasal provocation test (NPT) results for D. pteronyssinus and D. farinae according to the criteria mentioned below but negative SPT and sIgE to these allergens were included in the 12-month course of SLIT or placebo. The patient enrollment process is presented in Figure 1.