ABSTRACT
BACKGROUND: Treatment with omalizumab has shown a positive effect on food allergies, but no dosages are established. Basophil allergen threshold sensitivity (CD-sens) can be used to objectively measure omalizumab treatment efficacy and correlates with the outcome of double-blind placebo-controlled food challenge to peanut. OBJECTIVE: To evaluate whether individualized omalizumab treatment monitored by CD-sens could be an effective intervention for suppression of allergic reactions to peanut. METHODS: Severely peanut allergic adolescents (n = 23) were treated with omalizumab for 8 weeks, and CD-sens was analysed before and after. Based on whether CD-sens was suppressed after 8 weeks, the patients either were subject to a peanut challenge or received eight more weeks with increased dose of omalizumab, followed by peanut challenge or another 8-week cycle of omalizumab. IgE and IgE-antibodies to peanut and its components were analysed before treatment. RESULTS: After individualized omalizumab treatment (8-24 weeks), all patients continued with an open peanut challenge with no (n = 18) or mild (n = 5) objective allergic symptoms. Patients (n = 15) needing an elevated omalizumab dose (ED) to suppress CD-sens had significantly higher CD-sens values at baseline 1.49 (0.44-20.5) compared to those (n = 8) who managed with normal dose (ND) 0.32 (0.24-5.5) (P < 0.01). Median ratios for Ara h 2 IgE-ab/IgE were significantly higher in the ED group (17%) compared to the ND group (11%). CONCLUSIONS AND CLINICAL RELEVANCE: Individually dosed omalizumab, monitored by CD-sens, is an effective and safe treatment for severe peanut allergy. The ratio of IgE-ab to storage protein Ara h 2/IgE as well as CD-sens to peanut may predict the need of a higher omalizumab dose. Clinical trials numbers: EudraCT; 2012-005625-78, ClinicalTrials.gov; NCT02402231.
Subject(s)
Anti-Allergic Agents/administration & dosage , Omalizumab/administration & dosage , Peanut Hypersensitivity/drug therapy , Adolescent , Allergens/immunology , Anaphylaxis/diagnosis , Anaphylaxis/drug therapy , Anaphylaxis/immunology , Arachis/immunology , Basophils/immunology , Child , Comorbidity , Female , Humans , Immunoglobulin E/blood , Immunoglobulin E/immunology , Male , Peanut Hypersensitivity/diagnosis , Peanut Hypersensitivity/immunology , Precision Medicine , ROC Curve , Severity of Illness Index , Skin Tests , Treatment Outcome , Young AdultABSTRACT
Prostitutes who operate in the refinery town of St. Nicholas, the second largest urban center in Aruba, Netherlands Antilles, fall into two categories: temporary migrants from Colombia, who live and work for 3-month periods in the saloon-cribs along the main street; and permanently resident Dominican Republicans, who live and work in the village ghetto. The Colombians receive encomia, the Dominican Republicans, opprobria. In addition to addressing the differential statuses, prognoses, and earnings of the two groups, this paper also examines the historical background to the development of the differential assessments and offers ethnographic support for the continuation of the structural oppositions that separate the two groups. It is suggested that local perceptions of "other" people (including prostitutes) are tied to specific social and economic circumstances. Variables such as economic competition, ethnicity, length of employment in a low-status occupation, and the generally favored position accorded to "people like us," in contrast to the negative attitude held toward "people like them," are examined in terms of their relevance to the differential status of the two groups. It is also suggested that the underlying as well as the overt bases for these stereotypical ascriptions may have broader applicability: differential rather than unilateral assessments may indeed be the norm rather than a peculiarly Antillean perception.
