Thomas B. Casale | Creighton University School of Medicine | Omaha, NE
Creighton University Medical School | Omaha, NE
University of Wisconsin | Madison WI
University of Iowa | Iowa City, IA
ITN019AD
Completed
Current therapies for seasonal allergic rhinitis (SAR) include allergen avoidance, pharmacologic interventions such as antihistamines, sympathomimetics, topical and systemic corticosteroids, and chromones and immunotherapy. Although pharmacologic agents are effective for some patients, their role is limited by their inability to completely relieve symptoms and, in some cases, the induction of deleterious side effects. Immunotherapy (IT) regimens can be highly effective in controlling symptoms of SAR and can offer advantages over pharmacotherapy for those patients who have symptoms that are refractory to medications or those who cannot tolerate the side effects. However, traditional IT is associated with the risk of allergic reactions to the extract injections and its effectiveness for allergic respiratory disorders is not always evident.
Allergic diseases are mediated by IgE and Th2-type immune responses, which are opposed by Th1-like responses. Omalizumab (anti-IgE) reduces IgE levels thereby leading to decreased FcER1 and CD23 expression on key immune effector cells. These and other changes evoked by omalizumab cause a blunting of allergic respiratory symptoms. In a recent clinical trial, the combination of omalizumab + IT produced a greater reduction in symptoms than IT alone. However, the omalizumab was added to existing IT. This study will examine omalizumab as a pretreatment to IT to condition the recipient in an attempt to suppress Th2-like responses.
Specifically, this study will:
Klunker S, Saggar LR, Seyfert-Margolis V, Asare AL, Casale TB, Durham SR, Francis JN, Immune Tolerance Network Group (2007). Combination treatment with omalizumab and rush immunotherapy for ragweed-induced allergic rhinitis: Inhibition of IgE-facilitated allergen binding. J Allergy Clin Immunol, 120 (3), 688-95.
Casale TB, Busse WW, Kline JN, Ballas ZK, Moss MH, Townley RG, Mokhtarani M, Seyfert-Margolis V, Asare A, Bateman K, Deniz Y, Immune Tolerance Network (2006). Omalizumab pretreatment decreases acute reactions following rush immunotherapy for ragweed-induced seasonal allergic rhinitis. J Allergy Clin Immunol, 117 (1), 134-140.