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Development of nasal allergen challenge with cockroach in children with asthma
Author(s) -
Rudman Spergel Amanda K.,
Sever Michelle L.,
Johnson Jacqueline,
Gill Michelle A.,
Schulten Veronique,
Frazier April,
Kercsmar Carolyn M.,
LovinskyDesir Stephanie,
Searing Dan A.,
Sette Alessandro,
Shao Baomei,
Teach Stephen J.,
Gern James E.,
Busse William W.,
Togias Alkis,
Wood Robert A.,
Liu Andrew H.
Publication year - 2021
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.13480
Subject(s) - cockroach , medicine , asthma , immunology , immunoglobulin e , allergen , allergy , german cockroach , sensitization , antibody , biology , ecology
Abstract Background Nasal allergen challenge (NAC) could be a means to assess indication and/or an outcome of allergen‐specific therapies, particularly for perennial allergens. NACs are not commonly conducted in children with asthma, and cockroach NACs are not well established. This study's objective was to identify a range of German cockroach extract doses that induce nasal symptoms and to assess the safety of cockroach NAC in children with asthma. Methods Ten adults (18‐37 years) followed by 25 children (8‐14 years) with well‐controlled, persistent asthma and cockroach sensitization underwent NAC with diluent followed by up to 8 escalating doses of cockroach extract (0.00381‐11.9 µg/mL Bla g 1 ). NAC outcome was determined by Total Nasal Symptom Score (TNSS) and/or sneeze score. Cockroach allergen–induced T‐cell activation and IL‐5 production were measured in peripheral blood mononuclear cells. Results 67% (6/9) of adults and 68% (17/25) of children had a positive NAC at a median response dose of 0.120 µg/mL [IQR 0.0380‐0.379 µg/mL] of Bla g 1 . Additionally, three children responded to diluent alone and did not receive any cockroach extract. Overall, 32% (11/34) were positive with sneezes alone, 15% (5/34) with TNSS alone, and 21% (7/34) with both criteria. At baseline, NAC responders had higher cockroach‐specific IgE ( P = .03), lower cockroach‐specific IgG/IgE ratios (children, P = .002), and increased cockroach‐specific IL‐5–producing T lymphocytes ( P = .045). The NAC was well tolerated. Conclusion We report the methodology of NAC development for children with persistent asthma and cockroach sensitization. This NAC could be considered a tool to confirm clinically relevant sensitization and to assess responses in therapeutic studies.