Basic and clinical immunologyCombination treatment with omalizumab and rush immunotherapy for ragweed-induced allergic rhinitis: Inhibition of IgE-facilitated allergen binding
Section snippets
Patients
Patients (21-51 years of age) with a minimum 2-year history of ragweed-induced allergic rhinitis and no recent immunotherapy were selected (Table I). Subject groups showed similar baseline characteristics, except for total IgE, which was lower in the omalizumab-only group compared with the immunotherapy-only group (P < .05). Patients were required to have a positive skin prick test result to short ragweed extract (ALK-Abelló, Round Rock, Tex), as defined by a wheal 3 mm greater in diameter than
Characterization of the ragweed-FAB assay
Initial experiments were aimed to validate the FAB assay (Fig 1) in the context of ragweed allergy. We identified sera from subjects with ragweed allergy containing high ragweed-specific IgE levels that could facilitate binding of allergen to CD23+ (FcɛRII) EBV-transformed B cells. Fig 2, A, shows that binding occurs in an allergen-dependent manner, and optimal binding occurs between 1 and 3 μg/mL. We next investigated the effect of diluting the ragweed-specific high-IgE “indicator” serum in
Discussion
Ragweed immunotherapy was associated with increases in allergen-specific IgG4 levels and increased serum inhibitory activity, as measured by the facilitated antigen binding assay. Treatment with omalizumab completely inhibited facilitated antigen binding but did not influence IgG4 levels. The inhibitory effects of omalizumab alone were observed for up to 30 weeks after discontinuation of treatment. Combination treatment with omalizumab and immunotherapy enhanced the serum inhibitory properties
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Supported by the Immune Tolerance Network.
Disclosure of potential conflict of interest: T. B. Casale has consultant arrangements with Genentech and Novartis; has received research support from Genentech and Novartis; and has served on the speakers' bureau for Genentech and Novartis. S. R. Durham has consultant arrangements with ALK-Abelló, GlaxoSmithKline, and Novartis; has received research support from ALK-Abelló, GlaxoSmithKline, and UCB Pharma; and has served on the speakers' bureau for ALK-Abelló and Allergy Therapeutics. The rest of the authors have declared that they have no conflict of interest.