Sustained unresponsiveness to peanut after long-term peanut epicutaneous immunotherapy

Brown-Whitehorn, Terri F.; Blay, F. De; Spergel, Jonathan M.; Green, Todd D.; Peillon, Aurélie; Sampson, Hugh A.; Campbell, Dianne E.

doi:10.1016/j.jaip.2020.08.017

Cited by 11 publications

(4 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This long-lasting protection may have clinical correlates in establishing a state of non-responsiveness to allergens, whereby patients remain desensitized despite discontinuation of AIT. Promisingly, two initial studies of patients with peanut allergy who had been treated with long-term EPIT and then discontinued for 2 months demonstrated transient non-responsiveness of peanut after treatment [ 97 , 99 ]. Of note, the duration of protection after discontinuation of therapy demonstrated in this setting is limited in comparison to the long-term protection conferred by SCIT and SLIT in grass pollen allergy.…”

Section: Epicutaneous Immunotherapymentioning

confidence: 99%

“…The bystander effect was hypothesized to be linked to the hypermethylation of the Gata3 promoter, involved in Th2 differentiation, with consequent downregulation of Th2 cytokines including IL-4, IL-5, and IL-13, as well as hypomethylation and upregulation of Foxp3 . These epigenetic modulations are also hypothesized to mechanistically influence the durable clinical protection conferred by EPIT [ 99 ].…”

Section: Epicutaneous Immunotherapymentioning

confidence: 99%

See 1 more Smart Citation

Immunology of allergen immunotherapy

Rahman

Wesemann

2022

Immunotherapy Advances

View full text Add to dashboard Cite

Summary Allergen immunotherapy (AIT) is the only disease-modifying therapy for allergic disease. Through repeated inoculations of low doses of allergen—either as whole proteins or peptides—patients can achieve a homeostatic balance between inflammatory effectors induced and/or associated with allergen contact, and mediators of immunologic non-responsiveness, potentially leading to sustained clinical improvements. AIT for airborne/respiratory tract allergens and insect venoms have traditionally been supplied subcutaneously, but other routes and modalities of administration can also be effective. Despite differences of allergen administration, there are some similarities of immunologic responses across platforms, with a general theme involving the restructuring and polarization of adaptive and innate immune effector cells. Here we review the immunology of AIT across various delivery platforms, including subcutaneous, sublingual, epicutaneous, intradermal, and intralymphatic approaches, emphasizing shared mechanisms associated with achieving immunologic non-responsiveness to allergen.

show abstract

Section: Epicutaneous Immunotherapymentioning

confidence: 99%

Section: Epicutaneous Immunotherapymentioning

confidence: 99%

Immunology of allergen immunotherapy

Rahman

Wesemann

2022

Immunotherapy Advances

View full text Add to dashboard Cite

show abstract

“…EPIT was generally well-tolerated apart from moderate local skin reactions [49 ▪ ]. Sustained unresponsiveness to peanut has also been demonstrated following two to three years of EPIT [50 ▪▪ ].…”

Section: Gut–skin Axis In Therapeutic Interventionsmentioning

confidence: 96%

Role of the gut–skin axis in IgE-mediated food allergy and atopic diseases

Suaini

Siah

Tham

2021

Current Opinion in Gastroenterology

View full text Add to dashboard Cite

Purpose of review In recent years, landmark clinical trials investigating the role of early oral exposure to food antigens for food allergy (FA) prevention have highlighted the importance of immunoregulatory pathways in the ‘gut–skin axis’. This review highlights recent literature on the mechanisms of the immune system and microbiome involved in the gut–skin axis, contributing to the development of atopic dermatitis (AD), FA, allergic rhinitis (AR) and asthma. Therapeutic interventions harnessing the gut–skin axis are also discussed. Recent findings Epicutaneous sensitization in the presence of AD is capable of inducing Th2 allergic inflammation in the intestinal tract and lower respiratory airways, predisposing one to the development of AR and asthma. Probiotics have demonstrated positive effects in preventing and treating AD, though there is no evident relationship of its beneficial effects on other allergic diseases. Prophylactic skin emollients use has not shown consistent protection against AD, whereas there is some evidence for the role of dietary changes in alleviating AD and airway inflammation. More randomized controlled trials are needed to clarify the potential of epicutaneous immunotherapy as a therapeutic strategy for patients with FA. Summary The growing understanding of the gut–skin interactions on allergic disease pathogenesis presents novel avenues for therapeutic interventions which target modulation of the gut and/or skin.

show abstract

“…After 12 months of treatment, nearly twice as many participants treated with the peanut patch had a maximum symptom severity of “none” or “mild” compared with placebo participants (31.1% vs. 16.5%, respectively), and fewer subjects treated with the peanut patch had a maximum severity score of “severe” across these systems (16.2% vs. 27.5% of placebo participants, p = 0.019). There is also evidence from a small group of patients in both VIPES and PEPITES that EPIT with Viaskin may induce sustained unresponsiveness in a subgroup of patients ( 106 , 112 ). In both studies, a subgroup of eligible participants treated with the peanut patch for 36 months underwent 2 months without treatment, followed by a DBPCFC.…”

Section: Viaskin As the Most Clinically Advanced Approach To Epitmentioning

confidence: 99%

Recent advances in epicutaneous immunotherapy and potential applications in food allergy

Hervé,

Dioszeghy,

Matthews

et al. 2023

Front. Allergy

Self Cite

View full text Add to dashboard Cite

Given the potent immunological properties of the skin, epicutaneous immunotherapy (EPIT) emerges as a promising treatment approach for inducing immune tolerance, particularly for food allergies. Targeting the highly immunocompetent, non-vascularized epidermis allows for the application of microgram amounts of allergen while significantly reducing the risk of allergen passage into the bloodstream, thus limiting systemic allergen exposure and distribution. This makes EPIT highly suitable for the treatment of potentially life-threatening allergies such as food allergies. Multiple approaches to EPIT are currently under investigation for the treatment of food allergy, and these include the use of allergen-coated microneedles, application of allergen on the skin pretreated by tape stripping, abrasion or laser-mediated microperforation, or the application of allergen on the intact skin using an occlusive epicutaneous system. To date, the most clinically advanced approach to EPIT is the Viaskin technology platform. Viaskin is an occlusive epicutaneous system (patch) containing dried native allergen extracts, without adjuvants, which relies on frequent application for the progressive passage of small amounts of allergen to the epidermis through occlusion of the intact skin. Numerous preclinical studies of Viaskin have demonstrated that this particular approach to EPIT can induce potent and long-lasting T-regulatory cells with broad homing capabilities, which can exert their suppressive effects in multiple organs and ameliorate immune responses from different routes of allergen exposure. Clinical trials of the Viaskin patch have studied the efficacy and safety for the treatment of life-threatening allergies in younger patients, at an age when allergic diseases start to occur. Moreover, this treatment approach is designed to provide a non-invasive therapy with no restrictions on daily activities. Taken together, the preclinical and clinical data on the use of EPIT support the continued investigation of this therapeutic approach to provide improved treatment options for patients with allergic disorders in the near future.

show abstract

Sustained unresponsiveness to peanut after long-term peanut epicutaneous immunotherapy

Cited by 11 publications

References 9 publications

Immunology of allergen immunotherapy

Immunology of allergen immunotherapy

Role of the gut–skin axis in IgE-mediated food allergy and atopic diseases

Recent advances in epicutaneous immunotherapy and potential applications in food allergy

Contact Info

Product

Resources

About