Sublingual Desensitization: A New Approach to Latex Allergy Problem

Patriarca, Giampiero; Nucera, Eleonora; Pollastrini, Emanuela; Roncallo, Chiara; Buonomo, Alessandro; Bartolozzi, Francesco; Pasquale, Tiziana Maria De; Gasbarrini, Giovanni; Schiavino, Domenico

doi:10.1213/00000539-200210000-00031

Cited by 50 publications

(38 citation statements)

References 14 publications

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“…L atex allergy is a major cause of occupational asthma among health care workers (HCW) 3 (1), largely associated with the use of latex gloves to minimize infection risk in the workplace. Avoidance of exposure and symptomatic treatment for adverse reactions form the mainstay of management for latex allergy with no currently available licensed extract for specific immunotherapy.…”

Section: Hypoallergenic Variants Of the Major Latex Allergen Hev B 6mentioning

confidence: 99%

“…Avoidance of exposure and symptomatic treatment for adverse reactions form the mainstay of management for latex allergy with no currently available licensed extract for specific immunotherapy. The extreme anaphylactic potential of currently available unmodified natural rubber latex extracts has limited trials of conventional latex specific immunotherapy due to the high incidence of adverse events (2)(3)(4)(5)(6)(7)(8).…”

Section: Hypoallergenic Variants Of the Major Latex Allergen Hev B 6mentioning

confidence: 99%

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Hypoallergenic Variants of the Major Latex Allergen Hev b 6.01 Retaining Human T Lymphocyte Reactivity

Drew

Eusebius

Kenins

et al. 2004

The Journal of Immunology

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Hev b 6.01 is a major allergen of natural rubber latex with sensitization of 70–86% of latex glove-allergic subjects. Recently, we mapped the immunodominant T cell sites of Hev b 6.01 to the highly IgE-reactive hevein (Hev b 6.02) domain. Hev b 6.01 contains 14 cysteine residues with multiple disulphide bridges stabilizing tertiary conformation. With the goal of a standardized specific immunotherapy we developed hypoallergenic Hev b 6.01 mutants by site-directed mutagenesis of selected cysteine residues (3, 12, 17, and 41) within the Hev b 6.02 domain. Peptides corresponding to the Hev b 6.02 domain of two of the mutants were also synthesized. These mutants and peptide variants showed markedly decreased or ablated latex-allergic patient serum IgE binding by immunoblotting and ELISA. Basophil activation testing confirmed markedly decreased activation with successive cysteine substitutions of the mutants and complete abrogation with the Hev b 6.02 (Cys 3, 12, 17, 41 Ala) peptide. Retention of T cell reactivity is crucial for effective specific immunotherapy and all mutants and peptide variants maintained their latex-specific T cell reactivity. The ablated allergenicity but retained T cell reactivity of the Hev b 6.02 (Cys 3, 12, 17, 41 Ala) peptide suggests this peptide is a suitable candidate for inclusion in a latex immunotherapy preparation.

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Section: Hypoallergenic Variants Of the Major Latex Allergen Hev B 6mentioning

confidence: 99%

Section: Hypoallergenic Variants Of the Major Latex Allergen Hev B 6mentioning

confidence: 99%

Hypoallergenic Variants of the Major Latex Allergen Hev b 6.01 Retaining Human T Lymphocyte Reactivity

Drew

Eusebius

Kenins

et al. 2004

The Journal of Immunology

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“…Whether SLIT is able or not to modify the immunological response is still matter of debate: in fact, some papers did not show any modifications of specific IgG4 during sublingual immunotherapy with pollen allergens, with house dust mites and with latex, even in pediatric patients (31)(32)(33)(34)(35). On the contrary, other works underlined the capability of SLIT with pollen allergens or with house dust mites to induce an increase of specific IgG4 (36)(37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

Sublingual Desensitization in Patients with Wasp Venom Allergy: Preliminary Results

Patriarca¹,

Nucera²,

Roncallo³

et al. 2008

Int J Immunopathol Pharmacol

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The aim ofthis paper is to assess in an open prospective pilot case-control study the tolerability, safety and efficacy of an ultra-rush sublingual immunotherapy (SLIT) protocol with Vespula venom in wasp allergic patients compared to subcutaneous immunotherapy (SCIT). Forty-one wasp allergic patients were treated with sublingual (SLIT group) or subcutaneous (SCIT group) ultrarush immunotherapy with Vespula venom extract. All patients underwent skin tests and serum specific IgE and IgG 4 detection before enrolment and after 6, 12 and 24 months of immunotherapy. The SLIT group consisted of 21 (6 females and 15 males) patients who received increasing doses of Vespula venom (Aquagen, ALK-AbeIl6) until the final dose of 30 drops of extract in 3 hours, containing 100,000 SQ-U/ml. The maintenance dose was of 10 drops of pure venom extract 3 times a week, for a total dose of 100,000 SQ-U weekly (corresponding to 100 JIg of venom extract). The SCIT group consisted of 20 patients (16 males and 4 females) who were treated with subcutaneous ultrarush immunotherapy with Vespula venom extract (Pharmalgen, Alk-AbeIl6). Patients received 101.1 j..lg of Vespula venom in 3 hours and were treated with 100 ug of wasp venom monthly. During the ultrarush sublingual treatment 2 patients (9.5%) experienced mild side-effects. Specific IgE and specific IgG to wasp venom did not show any significant modification. Four patients were field-stung by a wasp during the treatment (for a total of 6 stings). Two patients (3 stings), with a previous clinical history of a grade III and IV reaction, did not experience any reaction. One patient, with a previous grade II reaction, showed a large local reaction. The fourth patient, with a previous grade III reaction, was re-stung twice (after 12 and 24 months) with two systemic reactions (SR) (mild throat constriction). During the ultrarush SCIT phase, 3 (15%) patients experienced side-effects: 2 of them showed a large local reaction and 1 had headache and stomach ache. Specific IgE showed a significant (P=O.OOI) increase after 6 months of treatment and then returned to baseline levels while specific IgG showed a significant (P=O.OOI) increase after 6, 12 and 24 months in comparison with baseline. Nine patients were field-stung during the treatment: 8 of them experienced large local reactions; one patient (11%) experienced an SR (dizziness). Our results, even if in a small number of patients, suggest that in patients with Hymenoptera sting allergy SLIT could be efficacious with a good tolerability profile when compared to SCIT. Larger studies are needed to assess efficacy, safety and tolerability profile of wasp venom SLIT.

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“…[25][26][27][28][29] After delivery, latex specific immunotherapy may represent an interesting new therapeutic approach to manage latex-allergic patients. 30,31 It may lead to a relatively rapid tolerance to latex exposure and allow patients to undergo surgical procedures without symptoms. In particular, a case was reported of a patient who became pregnant after desensitizing treatment and successfully delivered a baby in a latex-containing delivery room.…”

Section: Discussionmentioning

confidence: 99%