Molecular approaches for characterization, diagnosis and therapy of allergy to pets

Allergy to furred animals is a common affliction, where up to 20% of the population in affluent countries are sensitized to one or more pet allergens. Several causative allergens from an array of species have been identified, but there are still gaps in our knowledge. This complicates diagnosis and treatment of allergy to pets. Conventional methods rely on naturally derived allergen extracts, with poor characterization and lack of broadly accepted standards. Due to the nature of the extracts, some allergens could be missing or present in clinically non-significant concentrations. The aim of the thesis is to improve diagnostics by characterizing extracts and evaluating component based microarrays to conventional methods. Further, to identify new allergens as well as describe previously only partially characterized allergens, their distribution and properties. Paper I compares two multiplex microarray assays in allergy diagnostics to the standard methods ImmunoCAP and skin prick test with doctor’s diagnosis in a cohort of children with persistent asthma (n=71). The results showed that 75% of all children were sensitized to at least one allergen and that nearly half was multisensitized to three or more allergens. The accuracy of the methods was comparable, they all had a pair-wise concordance of 90% and above. However, the microarray assays contributed with positive IgE responses to new allergens not described in the diagnosis in almost half the patients (47%). The added value of microarray analysis in multisensitized patients is not to belittle. In paper II, an analysis of the content and composition of dog dander extracts for skin prick test is conducted. Results from five commercial manufacturers display a large variation, not only between the different suppliers, but also between batches albeit to a lesser extent. Anatomical location of the source material also differs, hair, dander and epithelia was analyzed. Two of the allergens were detected only at low amounts and patient sera sensitized to these failed to induce an allergic response to the extracts in a basophil activation test. Moreover, a population of dogs was investigated in regard to their allergen profile, also resulting in a substantial divergence between individuals. The heterogeneity of the extracts calls for better content characterization and standardization. Substandard quality could render flawed diagnosis and jeopardize patient safety. Paper III characterizes sensitization to horse allergens, where several allergens are only described partially, or analysis of IgE binding performed in a small cohort. We present sensitization data for four horse allergens including a novel protein, designated Equ c 7, with a prevalence of 38%. Equ c 7 is a homologue to the cat allergen Fel d 1, suggesting possible cross-reactivity. Further, we describe two forms of full-length Equ c 2 and the potential roles of isoforms. Here we contribute to the panel of horse allergens. Allergy to horse is less investigated than to other pets and likely more allergens await discovery. Aerodynamic properties of allergens are investigated in paper IV, where three dog allergens were sampled, however, only two could be detected. Particles associated with airborne allergen differed in size. Can f 1 was only detected on particles larger than 2.8 μm, diversely from Can f 4 which was found on particles of all sampled sizes >8.3-<0.34 μm. Smaller particles reach the small airways and are causative of inflammation and airway responsiveness. Different sampling methods also yielded different proportions of the allergens, indicating that they possess different airborne properties. To summarize, furred animals produce a wide array of allergens and there is a large individual variation in expression levels/profiles. This is mirrored in the extracts used for diagnosing allergy, where poor quality counteracts correct diagnosis. Characterization of novel allergens and production of recombinant equivalents could improve the accuracy of diagnostics and therapy

Clinical and Immunologic Changes due to Subcutaneous Immunotherapy With Cat and Dog Extracts Using an Ultrarush Up-Dosing Phase: A Real-Life Study

Objective: We aimed to evaluate the efficacy of and immunologic changes caused by subcutaneous immunotherapy (SCIT) in patients with allergy to cat and dog. Methods: The study population comprised patients with rhinitis and/or asthma and allergy to cat or dog from a previous safety study. All patients had specific IgE to cat and/or dog. The SCIT maintenance dose was administered using an infusion pump over a single 4-hour session, followed by monthly administration over 6 months. Data were gathered on clinical outcomes, pulmonary function, FeNO, rhinitis and asthma symptoms, quality of life (QOL), and scores for the Asthma Control Test and symptom visual analog scale were recorded at baseline and then at 1, 3, and 6 months. Specific IgE and IgG antibody responses to cat and dog allergens were determined. Results: The study population comprised 61 patients with a mean age of 35.6 (9.7) years, of whom 40 underwent SCIT for at allergy. A significant improvement was observed in rhinitis and asthma symptoms and in QOL, use of medication, visual analog scale score, and Asthma Control Test score at 1 month; these improvements persisted at month 6. The clinical improvement with cat extract was significantly more marked than with dog extract. Nearly half of the patients (49.09%) had an increase of &gt;0.9 in the ESPRINT-15 QOL in allergic rhinitis questionnaire, and 58.18% had an increase of &gt;0.5 in the Asthma Quality of Life Questionnaire score at month 6. Both differences represent the minimal clinical important difference. A significant increase was observed in specific IgG and IgE to different allergens at 3 and/or 6 months. Conclusions: Ultrarush SCIT with cat and dog extracts has substantial clinical value for many patients.</jats:p

Sublingual allergen immunotherapy with recombinant dog allergens prevents airway hyperresponsiveness in a model of asthma marked by vigorous T_H2 and T_H17 cell responses

Allergy to dogs affects around ten percent of the population in developed countries. Immune therapy of allergic patients with dog allergen extracts has shown limited therapeutic benefit. Herein, we established a mouse model of dog allergy and tested the efficacy of a recombinant protein containing Can f 1, f 2, f 4 and f 6 as a sublingual immune therapy (SLIT). Repeated inhalation of dog extracts induced infiltration of the airways by T H 2 cells, eosinophils and goblet cells, reminiscent of the house dust mite (HDM) model of asthma. However, dog allergen extracts also induced robust T H 17 cell responses, which was associated with a high neutrophilic infiltration of the airways and promoted airway hyperresponsiveness more potently than HDM allergens. scRNA-Seq analysis of T helper cells responding to dog allergens identified several unique clusters with T H 17 cells being hallmarked by the expression of several receptors including IL-17RE. Analysis of T cell receptors also depicted a high frequency of clones that were shared between T H 17, T H 2 and suppressive Treg cells, indicative of the plasticity of T helper cells in this model. Importantly, prophylactic SLIT reduced airway hyperresponsiveness and type 2-mediated inflammation in this model supporting the use of recombinant allergens in immune therapy

Sublingual allergen immunotherapy with recombinant dog allergens prevents airway hyperresponsiveness in a model of asthma marked by vigorous T_H2 and T_H17 cell responses

AbstractAllergy to dogs affects around ten percent of the population in developed countries. Immune therapy of allergic patients with dog allergen extracts has shown limited therapeutic benefit. Herein, we established a mouse model of dog allergy and tested the efficacy of a recombinant protein containing Can f 1, f 2, f 4 and f 6 as a sublingual immune therapy (SLIT). Repeated inhalation of dog extracts induced infiltration of the airways by TH2 cells, eosinophils and goblet cells, reminiscent of the house dust mite (HDM) model of asthma. However, dog allergen extracts also induced robust TH17 cell responses, which was associated with a high neutrophilic infiltration of the airways and promoted airway hyperresponsiveness more potently than HDM allergens. scRNA-Seq analysis of T helper cells responding to dog allergens identified several unique clusters with TH17 cells being hallmarked by the expression of several receptors including IL-17RE. Analysis of T cell receptors also depicted a high frequency of clones that were shared between TH17, TH2 and suppressive Treg cells, indicative of the plasticity of T helper cells in this model. Importantly, prophylactic SLIT reduced airway hyperresponsiveness and type 2-mediated inflammation in this model supporting the use of recombinant allergens in immune therapy.</jats:p