Potential therapies for peanut allergy.

OBJECTIVE: To review the investigated therapies for peanut allergy beyond avoidance measures and self-injectable epinephrine. DATA SOURCES: A PubMed search was performed using the Keywords peanut allergy and therapy. Additional citations were generated by surveying the reference lists of the pulled articles STUDY SELECTION: More than 120 articles were reviewed and references were selected based on their relevance to the subject matter. RESULTS: Peanut allergy affects more than 1% of the US population and is increasing in prevalence. During the past 15 years multiple therapies have been researched and many have provided promising results. Sustained oral tolerance over desensitization is the goal, and most therapies are unable to demonstrate this because they are currently in their relative infancy. Therapeutic options should be safe, easily administered, and relatively inexpensive. To minimize risk, many therapies will require investigation of combined modalities. CONCLUSIONS: Peanut allergy is a challenging diagnosis for physicians because few treatment options are available. However, it seems plausible that new offerings may become accepted therapy within the next decade. The ability of a patient to tolerate amounts of peanut in an unintentional ingestion without experiencing anaphylaxis would offer peace of mind to patients and families living with peanut allergy.

The evolution of gene therapy in X-linked severe combined immunodeficiency.

OBJECTIVES: To review the evolution of gene therapy in infants with X-linked severe combined immunodeficiency (XL-SCID) and to evaluate the current challenges facing this evolving field. DATA SOURCES: The MEDLINE, OVID, CINAHL, and HealthSTAR databases were searched to identify pertinent articles using the following keywords: gene therapy, XL-SCID, bone marrow transplant, and viral vectors. STUDY SELECTION: Journal articles were selected for their relevance to human gene therapy in patients with XL-SCID. RESULTS: Gene therapy with a retrovirus-derived vector has been used to treat 20 patients with XL-SCID internationally. Although most patients derived improvements in T- and B-cell immune numbers and function, severe adverse effects have occurred. After gene therapy, 5 of the 20 patients developed leukemia. This outcome has been associated with insertion of the corrected gene near the T-cell proto-oncogene LMO2. One of the 5 patients subsequently died. CONCLUSIONS: Within the past decade, effective improvements in vectorology and cell culture conditions have resulted in clinical success in some infants with SCID and have revived interest after many years of setbacks. However, clinical success and significant adverse events have been reported in patients with XL-SCID who have undergone gene therapy using a retroviral vector. As extensive research into improving safety through vector development and monitoring of gene therapy continues, further progress in gene therapy development can be anticipated.

Compatibility of imported fire ant whole body extract with cat, ragweed, Dermatophagoides pteronyssinus, and timothy grass allergens.

BACKGROUND: Recommendations regarding the administration of imported fire ant whole body extract (IFA WBE) combined with aeroallergens or environmental allergens in a single immunotherapy injection are lacking. OBJECTIVE: To evaluate the degradative effect of IFA WBE on cat, ragweed, Dermatophagoides pteronyssinus, and timothy grass allergens. METHODS: Imported fire ant whole body extract was combined with extracts of cat, ragweed, D pteronyssinus, and timothy grass. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was performed on each sample after storage for 0, 1, 3, and 6 months at 4 degrees C. In addition, cat and ragweed combinations were evaluated by radial immunodiffusion (RID); D pteronyssinus by enzyme-linked immunosorbent assay (ELISA) inhibition; and timothy grass by ELISA inhibition and Western blot. RESULTS: Imported fire ant whole body extract combined with timothy grass demonstrated degradation of timothy grass allergens by SDS-PAGE, ELISA inhibition, and Western blot results. Cat and ragweed allergens were stable after mixing with IFA WBE, based on SDS-PAGE and RID analyses. Stability of D pteronyssinus allergens with IFA WBE was evident from SDS-PAGE and ELISA inhibition data. CONCLUSIONS: Imported fire ant whole body extract combined with timothy grass resulted in significant and rapid timothy protein degradation. Imported fire ant whole body extract mixed with cat, ragweed, or D pteronyssinus revealed aeroallergen stability, yielding the possibility of combining these extracts in a single immunotherapy injection. Compatibilities of IFA WBE with other common aeroallergens remain undetermined and thus are not recommended for single-injection immunotherapy formulations.