Development of cockroach immunotherapy by the Inner-City Asthma Consortium

Robert A. Wood, Alkis Togias, Jeremy Wildfire, Cynthia M. Visness, Elizabeth C. Matsui, Rebecca Gruchalla, Gurjit Hershey, Andrew H. Liu, George T. O'Connor, Jacqueline A. Pongracic, Edward Zoratti, Frederic Little, Mark Granada, Suzanne Kennedy, Stephen R. Durham, Mohamed H. Shamji, William W. Busse

Research output: Contribution to journalArticle

Abstract

Background Cockroach allergy is a key contributor to asthma morbidity in children living in urban environments. Objective We sought to document immune responses to cockroach allergen and provide direction for the development of immunotherapy for cockroach allergy. Methods Four pilot studies were conducted: (1) an open-label study to assess the safety of cockroach sublingual immunotherapy (SLIT) in adults and children; (2) a randomized, double-blind biomarker study of cockroach SLIT versus placebo in adults; (3) a randomized, double-blind biomarker study of 2 doses of cockroach SLIT versus placebo in children; and (4) an open-label safety and biomarker study of cockroach subcutaneous immunotherapy (SCIT) in adults. Results The adult SLIT trial (n = 54; age, 18-54 years) found a significantly greater increase in cockroach-specific IgE levels between the active and placebo groups (geometric mean ratio, 1.92; P <.0001) and a trend toward increased cockroach-specific IgG4 levels in actively treated subjects (P =.09) but no evidence of functional blocking antibody response. The pediatric SLIT trial (n = 99; age, 5-17 years) found significant differences in IgE, IgG, and IgG4 responses between both active groups and the placebo group but no consistent differences between the high- and low-dose groups. In the SCIT study the treatment resulted in significant changes from baseline in cockroach IgE, IgG4, and blocking antibody levels. The safety profile of cockroach immunotherapy was reassuring in all studies. Conclusions The administration of cockroach allergen by means of SCIT is immunologically more active than SLIT, especially with regard to IgG4 levels and blocking antibody responses. No safety concerns were raised in any age group. These pilot studies suggest that immunotherapy with cockroach allergen is more likely to be effective with SCIT.

Original languageEnglish (US)
Pages (from-to)846
Number of pages1
JournalJournal of Allergy and Clinical Immunology
Volume133
Issue number3
DOIs
StatePublished - Mar 2014

Keywords

  • Cockroach
  • immunotherapy
  • inner city asthma
  • subcutaneous immunotherapy
  • sublingual immunotherapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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    Wood, R. A., Togias, A., Wildfire, J., Visness, C. M., Matsui, E. C., Gruchalla, R., Hershey, G., Liu, A. H., O'Connor, G. T., Pongracic, J. A., Zoratti, E., Little, F., Granada, M., Kennedy, S., Durham, S. R., Shamji, M. H., & Busse, W. W. (2014). Development of cockroach immunotherapy by the Inner-City Asthma Consortium. Journal of Allergy and Clinical Immunology, 133(3), 846. https://doi.org/10.1016/j.jaci.2013.08.047