Effect of modified immunotherapy with an allergen–pullulan conjugate in patients with Japanese cedar pollinosis

Abstract

Immunologic mechanisms of allergen immunotherapy are still incompletely understood. Immunotherapy of a higher maximum tolerance dose with reduced risks of systemic reactions, such as anaphylaxis, needs to be developed. Seasonal allergic rhinitis (SAR) is a type I allergic disease characterized by typical seasonal symptoms of rhinitis and an increase in mast cells and T helper (Th) 2‐type cells, as well as tissue eosinophilia. The present study was designed to investigate the effect of a modified immunotherapy (IT) with an allergen–pullulan conjugate (CS‐560) in patients with SAR to Japanese cedar pollen (Japanese cedar pollinosis) using objective parameters, such as analyzing the alteration in the proportion of effector cells like mast cells, eosinophils and T cells, and the Th2 and Th1 cytokine profile. We also analyzed the efficacy of modified IT on the severity of symptoms, using subjective parameters, such as the symptom–medication score. Immunotherapy for 15 months duration with the modified drug CS‐560 in patients with Japanese cedar pollinosis induced an immune deviation from a Th2‐ to a Th1‐type cytokine profile and inhibited the in‐season increase in the proportion of intraepithelial mast cells and eosinophils. These changes were associated with a reduction in the symptom–medication score. These data suggest that this modified IT with an allergen– pullulan conjugate (CS‐560) is an effective mode of treatment of patients with Japanese cedar pollinosis.

Pullulan and pullulan derivatives as promising biomolecules for drug and gene targeting

“…Immunotherapy is a technique which helps in treatment of immune diseases. Pawankar et al (2001) modified immunotherapy by conjugating allergens with pullulan (CS-560) to have effective treatment of Japanese cedar pollinosis patients. In Japanese cedar pollinosis mast cells and T helper cells (type 2, Th2) increase in number seasonally.…”

Polysaccharide-based materials in macromolecular prodrug design and development

“…A modified immunotherapy for seasonal allergic rhinitis was developed by conjugation of allergen onto pullulan. 131 A 15-month therapy with the conjugate resulted in inhibition of the in-season over expression of mast cells and eosinophils. The effect of modified immunotherapy on severity of symptoms was also investigated.…”