TY - JOUR
T1 - A pediatric randomized, controlled trial of German cockroach subcutaneous immunotherapy
AU - Inner-City Asthma and Childhood Asthma in Urban Settings Consortia
AU - Zoratti, Edward
AU - Wood, Robert
AU - Pomés, Anna
AU - Da Silva Antunes, Ricardo
AU - Altman, Matthew C.
AU - Benson, Basilin
AU - Wheatley, Lisa M.
AU - Cho, Kate
AU - Calatroni, Agustin
AU - Little, Frederic F.
AU - Pongracic, J.
AU - Makhija, Melanie
AU - Khurana Hershey, Gurjit K.
AU - Sherenian, Michael G.
AU - Rivera-Spoljaric, Katherine
AU - Stokes, Jeffrey R.
AU - Gill, Michelle A
AU - Gruchalla, Rebecca S.
AU - Chambliss, Jeffrey
AU - Liu, Andrew H.
AU - Kattan, Meyer
AU - Busse, Paula J.
AU - Bacharier, Leonard B.
AU - Sheehan, William
AU - Kim, Haejin
AU - Glesner, Jill
AU - Gergen, Peter J.
AU - Togias, Alkis
AU - Baucom, Jessica L.
AU - Visness, Cynthia M.
AU - Sette, Alessandro
AU - Busse, William W.
AU - Jackson, Daniel J.
N1 - Publisher Copyright:
© 2024 American Academy of Allergy, Asthma & Immunology
PY - 2024/9
Y1 - 2024/9
N2 - Background: Cockroach allergy contributes to morbidity among urban children with asthma. Few trials address the effect of subcutaneous immunotherapy (SCIT) with cockroach allergen among these at-risk children. Objectives: We sought to determine whether nasal allergen challenge (NAC) responses to cockroach allergen would improve following 1 year of SCIT. Methods: Urban children with asthma, who were cockroach-sensitized and reactive on NAC, participated in a year-long randomized double-blind placebo-controlled SCIT trial using German cockroach extract. The primary endpoint was the change in mean Total Nasal Symptom Score (TNSS) during NAC after 12 months of SCIT. Changes in nasal transcriptomic responses during NAC, skin prick test wheal size, serum allergen-specific antibody production, and T-cell responses to cockroach allergen were assessed. Results: Changes in mean NAC TNSS did not differ between SCIT-assigned (n = 28) versus placebo-assigned (n = 29) participants (P = .63). Nasal transcriptomic responses correlated with TNSS, but a treatment effect was not observed. Cockroach serum-specific IgE decreased to a similar extent in both groups, while decreased cockroach skin prick test wheal size was greater among SCIT participants (P = .04). A 200-fold increase in cockroach serum-specific IgG4 was observed among subjects receiving SCIT (P < .001) but was unchanged in the placebo group. T-cell IL-4 responses following cockroach allergen stimulation decreased to a greater extent among SCIT versus placebo (P = .002), while no effect was observed for IL-10 or IFN-γ. Conclusions: A year of SCIT failed to alter NAC TNSS and nasal transcriptome responses to cockroach allergen challenge despite systemic effects on allergen-specific skin tests, induction of serum-specific IgG4 serum production and down-modulation of allergen-stimulated T-cell responses.
AB - Background: Cockroach allergy contributes to morbidity among urban children with asthma. Few trials address the effect of subcutaneous immunotherapy (SCIT) with cockroach allergen among these at-risk children. Objectives: We sought to determine whether nasal allergen challenge (NAC) responses to cockroach allergen would improve following 1 year of SCIT. Methods: Urban children with asthma, who were cockroach-sensitized and reactive on NAC, participated in a year-long randomized double-blind placebo-controlled SCIT trial using German cockroach extract. The primary endpoint was the change in mean Total Nasal Symptom Score (TNSS) during NAC after 12 months of SCIT. Changes in nasal transcriptomic responses during NAC, skin prick test wheal size, serum allergen-specific antibody production, and T-cell responses to cockroach allergen were assessed. Results: Changes in mean NAC TNSS did not differ between SCIT-assigned (n = 28) versus placebo-assigned (n = 29) participants (P = .63). Nasal transcriptomic responses correlated with TNSS, but a treatment effect was not observed. Cockroach serum-specific IgE decreased to a similar extent in both groups, while decreased cockroach skin prick test wheal size was greater among SCIT participants (P = .04). A 200-fold increase in cockroach serum-specific IgG4 was observed among subjects receiving SCIT (P < .001) but was unchanged in the placebo group. T-cell IL-4 responses following cockroach allergen stimulation decreased to a greater extent among SCIT versus placebo (P = .002), while no effect was observed for IL-10 or IFN-γ. Conclusions: A year of SCIT failed to alter NAC TNSS and nasal transcriptome responses to cockroach allergen challenge despite systemic effects on allergen-specific skin tests, induction of serum-specific IgG4 serum production and down-modulation of allergen-stimulated T-cell responses.
KW - Allergen immunotherapy
KW - antibody
KW - asthma
KW - cockroach allergy
KW - nasal allergen challenge
KW - skin prick test
KW - T-cell response
KW - transcriptome
KW - urban
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UR - http://www.scopus.com/inward/citedby.url?scp=85195063666&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2024.04.022
DO - 10.1016/j.jaci.2024.04.022
M3 - Article
C2 - 38718950
AN - SCOPUS:85195063666
SN - 0091-6749
VL - 154
SP - 735-744.e10
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 3
ER -