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Demonstrating the Repeatability of the Nasal Allergen Challenge Protocol Utilized By the Allergic Rhinitis – Clinical Investigator Collaborative (AR-CIC)
Abstracts AB263
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
SEMA4A Contributes Eosinopillic Phenotypes in Asthma and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)
Yohei Maeda1, Masaki Hayama1, Kazuya Takeda1, Atsushi Kumanogoh2, Hidenori Inohara1; 1Osaka university graduate school of medicine, Suita, Japan, 2Osaka University, Suita, Osaka, Japan. RATIONALE: We previously reported that the class IV semaphorin SEMA4A was critical for Th1/Th2 regulation and that eosinophilic airway inflammation was enhanced in SEMA4A-deficient mice. However, the role of SEMA4A in eosinophils and human eosinophilic airway inflammation is still unknown. METHODS: We compared serum SEMA4A levels in patients with asthma and CRSwNP vs healthy individuals by enzyme-linked immunosorbent assay (ELISA), and examined SEMA4A expression in nasal polyps by immunohistochemistry. We cultured bone marrow cells from Wild Type mice (WT mice) and SEMA4A-deficient mice with recombinant IL-5, and evaluated the recovery of the bone marrow-derived eosinophils (BMDEos). In addition, we determined the number of eosinophils in the spleen from WT mice or SEMA4A-deficient mice. RESULTS: Levels of SEMA4A were significantly elevated in sera from patients with asthma and CRSwNP than healthy individuals. (mean6SEM 35886840 and 24036618 versus 4456214). We found that SEMA4A was strongly expressed in eosinophils in the nasal polyps by immunohistochemistry. BMDEos and the number of splenic eosinophils from SEMA4A-deficient mice were significantly lower than those from WT mice (mean6SEM 2.1460.233107 versus 1.4160.103107, 59736189/106 versus 41006750/106, respectively). CONCLUSIONS: Our results suggested that SEMA4A had trophic functions for eosinophils in human and mice. SEMA4A may promote eosinophil survival and disease activity in patients with asthma and CRSwNP.
860
Treatment of Percistent Blepharitis and Keratoconjuctivitis with Intraocular and Topical Use of Tacrolimus 0.03% Ointment
Konstantinos Syrigos1, Nikolaos K. Syrigos2, Maria Vasiliou2, Maria Zande2, Ekaterini I. Syrigou, PhD2; 1Athens School of Medicine, Greece, 2 Department of Allergy, Sotiria General Hospital, Athens, Greece. RATIONALE: To report a case of persistent blepharitis and keratoconjunctivitis despite the oral use of corticosteroids treated at last with topical and intraocular use of tacrolimus 0.03% ointment. METHODS: A male patient, aged 42, presented with persistent blepharitis and limbic keratoconjuctivitis in both eyes. The patient had previously received several treatments (such as topical: steroids and cyclosporine and per os: methylprednisolone, median dose: 32mg, for one year), with no improvement. Clinically he showed blepharitis with burning, itching, abnormally greasy tearing and severe keratoconjunctivitis (tingling, itching, pain in some cases, thick mucous secretions and atopic dermatitis on the eyelids). Because of poor response to initial management, we started treatment with intraocular and topical use of tacrolimus 0.03% twice a day. RESULTS: A week later, the patient appeared with significant clinical improvement. Four weeks later they were no signs of blepharitis and keratoconjuctivitis. Tacrolimus was successfully tapered. There were no side effects. CONCLUSIONS: Intraocular and topical use of tacrolimus 0.03% ointment may be considered an additional treatment option for keratoconjunctivitis.
861
Demonstrating the Repeatability of the Nasal Allergen Challenge Protocol Utilized By the Allergic Rhinitis – Clinical Investigator Collaborative (AR-CIC)
Mena Soliman, MBChB, MSc (candidate)1, Jenny Thiele, MSc1, Daniel Adams, BSc2, Lisa M. Steacy, BSc2, Anne K. Ellis, MD, MSc, FAAAAI1,2; 1Departments of Medicine and Biomedical & Molecular Science, Queen’s University, Kingston, ON, Canada, 2Allergy Research Unit, Kingston General Hospital, Kingston, ON, Canada. RATIONALE: The Allergic Rhinitis – Clinical Investigator Collaborative (AR-CIC) has optimized a Nasal Allergen Challenge (NAC) model for studying AR pathophysiology and evaluating novel therapies. We sought to evaluate the repeatability of the NAC protocol. METHODS: Nine ragweed allergic participants were enrolled out of season. The nasal cavity was washed with saline and diluent control delivered intra-nasally; participants were excluded if their Total Nasal Symptom Scores (TNSS), recorded 15 minutes following each step, were >2. The lowest allergen concentration was delivered and TNSS and Peak Nasal Inspiratory Flow(PNIF) recorded 15 minutes later. Participants _8 and PNIF reduction > _50% were achieved, otherwise qualified if a TNSS> the next higher allergen concentration, (4-fold increase), was administered until criteria were met. Participants returned 21-28 days later for a NAC visit(NAC1), and received an allergen challenge concentration equal to all doses delivered at screening, including the qualifying concentration. TNSS/PNIF were recorded at 15 minutes, 30 minutes, 1 hour, hourly up to 12 hours, and at 24 hours following NAC. A second NAC visit (NAC2) was conducted 21-28 days after NAC1. RESULTS: Participants experienced an initial peak in TNSS at 15 minutes (mean58.0 NAC1; 7.33 NAC2) followed by gradual decline. PNIF changes mirrored TNSS findings, decreasing to a nadir at 30 minutes following NAC, followed by a gradual return to near-baseline. Both NAC visits had similar results, with no statistical difference (two-way ANOVA with Bonferroni corrections and paired t-tests). CONCLUSIONS: The AR-CIC’s NAC protocol reliably reproduces clinical results, ensuring that any change would be purely due to medication under investigation in a clinical trial setting.
862
Patients' Knowledge and Attitude about Allergen Immunotherapy
Young-Hee Nam, MD1, Soo-Keol Lee, MD2, Dong-Sub Jeon1; 1Department of Internal Medicine, College of Medicine, Dong-A University, Busan, South Korea, 2Dong-A University College of Medicine, Pusan, South Korea. RATIONALE: Allergen immunotherapy (AIT) is currently the only immune-modifying treatment for allergic disease. The clinical efficacy of AIT for the treatment of allergic rhinitis and bronchial asthma is well documented. However, many factors including inconvenience, cost, side effects, and adherence influence the initiation and persistence with AIT. We sought to evaluate the AIT practice pattern and patients’ attitude and behavior about AIT. METHODS: We conducted a retrospective analysis of medical records of 157 patients received AIT, and compared the clinical characteristics between conventional (CIT) and rush immunotherapy (RIT). A total of 80 were performed a questionnaire survey. RESULTS: Of 157 patients, 105 (66.9%) were treated with CIT, and 52 (33.1%) with RIT. Frequent hospital visits was the main reason for start RIT. There were no significant differences in allergic diseases, allergens in immunotherapy, and the frequency of adverse reactions during build-up phase. The rate of noncompliance during build-up phase was higher in CIT than RIT (26.7% vs 3.8%). More than half of the patients (67.5%) initiated AIT according to the physician’s recommendation. RIT, initiation of AIT by oneself, longer duration and less allergens of AIT were associated with better treatment satisfaction. CONCLUSIONS: A majority of patients initiated AIT by the physician’s recommendation and showed good treatment satisfaction. Adequate education of patients would improve the effectiveness of AIT.
MONDAY
859
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
SEMA4A Contributes Eosinopillic Phenotypes in Asthma and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)
Yohei Maeda1, Masaki Hayama1, Kazuya Takeda1, Atsushi Kumanogoh2, Hidenori Inohara1; 1Osaka university graduate school of medicine, Suita, Japan, 2Osaka University, Suita, Osaka, Japan. RATIONALE: We previously reported that the class IV semaphorin SEMA4A was critical for Th1/Th2 regulation and that eosinophilic airway inflammation was enhanced in SEMA4A-deficient mice. However, the role of SEMA4A in eosinophils and human eosinophilic airway inflammation is still unknown. METHODS: We compared serum SEMA4A levels in patients with asthma and CRSwNP vs healthy individuals by enzyme-linked immunosorbent assay (ELISA), and examined SEMA4A expression in nasal polyps by immunohistochemistry. We cultured bone marrow cells from Wild Type mice (WT mice) and SEMA4A-deficient mice with recombinant IL-5, and evaluated the recovery of the bone marrow-derived eosinophils (BMDEos). In addition, we determined the number of eosinophils in the spleen from WT mice or SEMA4A-deficient mice. RESULTS: Levels of SEMA4A were significantly elevated in sera from patients with asthma and CRSwNP than healthy individuals. (mean6SEM 35886840 and 24036618 versus 4456214). We found that SEMA4A was strongly expressed in eosinophils in the nasal polyps by immunohistochemistry. BMDEos and the number of splenic eosinophils from SEMA4A-deficient mice were significantly lower than those from WT mice (mean6SEM 2.1460.233107 versus 1.4160.103107, 59736189/106 versus 41006750/106, respectively). CONCLUSIONS: Our results suggested that SEMA4A had trophic functions for eosinophils in human and mice. SEMA4A may promote eosinophil survival and disease activity in patients with asthma and CRSwNP.
860
Treatment of Percistent Blepharitis and Keratoconjuctivitis with Intraocular and Topical Use of Tacrolimus 0.03% Ointment
Konstantinos Syrigos1, Nikolaos K. Syrigos2, Maria Vasiliou2, Maria Zande2, Ekaterini I. Syrigou, PhD2; 1Athens School of Medicine, Greece, 2 Department of Allergy, Sotiria General Hospital, Athens, Greece. RATIONALE: To report a case of persistent blepharitis and keratoconjunctivitis despite the oral use of corticosteroids treated at last with topical and intraocular use of tacrolimus 0.03% ointment. METHODS: A male patient, aged 42, presented with persistent blepharitis and limbic keratoconjuctivitis in both eyes. The patient had previously received several treatments (such as topical: steroids and cyclosporine and per os: methylprednisolone, median dose: 32mg, for one year), with no improvement. Clinically he showed blepharitis with burning, itching, abnormally greasy tearing and severe keratoconjunctivitis (tingling, itching, pain in some cases, thick mucous secretions and atopic dermatitis on the eyelids). Because of poor response to initial management, we started treatment with intraocular and topical use of tacrolimus 0.03% twice a day. RESULTS: A week later, the patient appeared with significant clinical improvement. Four weeks later they were no signs of blepharitis and keratoconjuctivitis. Tacrolimus was successfully tapered. There were no side effects. CONCLUSIONS: Intraocular and topical use of tacrolimus 0.03% ointment may be considered an additional treatment option for keratoconjunctivitis.
861
Demonstrating the Repeatability of the Nasal Allergen Challenge Protocol Utilized By the Allergic Rhinitis – Clinical Investigator Collaborative (AR-CIC)
Mena Soliman, MBChB, MSc (candidate)1, Jenny Thiele, MSc1, Daniel Adams, BSc2, Lisa M. Steacy, BSc2, Anne K. Ellis, MD, MSc, FAAAAI1,2; 1Departments of Medicine and Biomedical & Molecular Science, Queen’s University, Kingston, ON, Canada, 2Allergy Research Unit, Kingston General Hospital, Kingston, ON, Canada. RATIONALE: The Allergic Rhinitis – Clinical Investigator Collaborative (AR-CIC) has optimized a Nasal Allergen Challenge (NAC) model for studying AR pathophysiology and evaluating novel therapies. We sought to evaluate the repeatability of the NAC protocol. METHODS: Nine ragweed allergic participants were enrolled out of season. The nasal cavity was washed with saline and diluent control delivered intra-nasally; participants were excluded if their Total Nasal Symptom Scores (TNSS), recorded 15 minutes following each step, were >2. The lowest allergen concentration was delivered and TNSS and Peak Nasal Inspiratory Flow(PNIF) recorded 15 minutes later. Participants _8 and PNIF reduction > _50% were achieved, otherwise qualified if a TNSS> the next higher allergen concentration, (4-fold increase), was administered until criteria were met. Participants returned 21-28 days later for a NAC visit(NAC1), and received an allergen challenge concentration equal to all doses delivered at screening, including the qualifying concentration. TNSS/PNIF were recorded at 15 minutes, 30 minutes, 1 hour, hourly up to 12 hours, and at 24 hours following NAC. A second NAC visit (NAC2) was conducted 21-28 days after NAC1. RESULTS: Participants experienced an initial peak in TNSS at 15 minutes (mean58.0 NAC1; 7.33 NAC2) followed by gradual decline. PNIF changes mirrored TNSS findings, decreasing to a nadir at 30 minutes following NAC, followed by a gradual return to near-baseline. Both NAC visits had similar results, with no statistical difference (two-way ANOVA with Bonferroni corrections and paired t-tests). CONCLUSIONS: The AR-CIC’s NAC protocol reliably reproduces clinical results, ensuring that any change would be purely due to medication under investigation in a clinical trial setting.
862
Patients' Knowledge and Attitude about Allergen Immunotherapy
Young-Hee Nam, MD1, Soo-Keol Lee, MD2, Dong-Sub Jeon1; 1Department of Internal Medicine, College of Medicine, Dong-A University, Busan, South Korea, 2Dong-A University College of Medicine, Pusan, South Korea. RATIONALE: Allergen immunotherapy (AIT) is currently the only immune-modifying treatment for allergic disease. The clinical efficacy of AIT for the treatment of allergic rhinitis and bronchial asthma is well documented. However, many factors including inconvenience, cost, side effects, and adherence influence the initiation and persistence with AIT. We sought to evaluate the AIT practice pattern and patients’ attitude and behavior about AIT. METHODS: We conducted a retrospective analysis of medical records of 157 patients received AIT, and compared the clinical characteristics between conventional (CIT) and rush immunotherapy (RIT). A total of 80 were performed a questionnaire survey. RESULTS: Of 157 patients, 105 (66.9%) were treated with CIT, and 52 (33.1%) with RIT. Frequent hospital visits was the main reason for start RIT. There were no significant differences in allergic diseases, allergens in immunotherapy, and the frequency of adverse reactions during build-up phase. The rate of noncompliance during build-up phase was higher in CIT than RIT (26.7% vs 3.8%). More than half of the patients (67.5%) initiated AIT according to the physician’s recommendation. RIT, initiation of AIT by oneself, longer duration and less allergens of AIT were associated with better treatment satisfaction. CONCLUSIONS: A majority of patients initiated AIT by the physician’s recommendation and showed good treatment satisfaction. Adequate education of patients would improve the effectiveness of AIT.
MONDAY
859