For details, see the Methods section in this articles Online Repository atwww
For details, see the Methods section in this articles Online Repository atwww.jacionline.org. Prior to the NAC, baseline steps of nasal symptoms were recorded using a visual analog score (VAS) (110) for nasal congestion, rhinorrhea, burning or pain in the nose, and itching in the nose (maximal score 40).17A baseline sneeze count over CD248 10 minutes was also recorded. by mid-study NAC relative to baseline NAC. In contrast, steps of mast cell response (SPTT and nasal lavage PGD2) were only significantly reduced by the final NAC. Subjects on placebo (n=4) did not experience a shift in basophil, NAC symptom, or mast cell steps. == CONCLUSIONS == Reduction in nasal symptom scores occurred when the basophil, but not mast cell, response was reduced on omalizumab, implicating a role for basophils in the acute NAC response. Keywords:IgE, IgE receptors, omalizumab, basophils, mast cells, basophil histamine release, skin prick test titration, nasal allergen challenge, cat allergy == Introduction == At least 20% of individuals in the United States suffer from some form of allergic disease. At the root of these allergic disorders are IgE antibodies that are crucial to the induction and perpetuation of allergic responses. IgE arms mast cells and basophils to become capable of activation within seconds of exposure to small quantities of allergens. While the detection of allergen-specific IgE, either by skin screening orin vitroassays, is usually a useful marker of allergic sensitivity, the quantitative relationship between specific IgE levels and allergic responses is far from clear. In addition, the relevance of the percentage of total IgE directed to a particular allergen remains unclear in diagnosing or predicting allergic responses.1 Omalizumab is a monoclonal antibody directed against IgE and is SPP FDA-approved for use in allergic asthma.2It binds IgE on the same site of the Fc domain as the alpha chain of the high affinity FcRI, and therefore, blocks the interaction between IgE and mast cells or basophils.3,4As IgE levels are reduced with omalizumab treatment, FcRI expression on human basophils is reduced, which leads to eventual reductions in allergen-mediated SPP activation.5This reduction of basophil receptors is pronounced within 7 days of the initial administration5and is reversible once omalizumab is discontinued.6In contrast, omalizumab-induced reductions in skin mast cell FcRI expression and function is unchanged at day 7 and significantly reduced by day 70.7These actions of omalizumab allow its use as a mechanistic tool in the study of IgE. While these early studies utilized intravenously administered omalizumab (0.0150.03 mg/kg/IgE (IU/mL)); comparable kinetics of reduction of skin test early phase reactions have been seen with subcutaneous dosing (0.016 mg/kg/IgE (IU/mL), where a more careful kinetic revealed significant reductions in skin test responses by day 56.8 Nasal allergen challenge (NAC) has been used to study both the acute and late cellular, biochemical, and physiologic events that are elicited by localized SPP allergen challenge.9,10These models implicated basophils rather than mast cells in the late phase response based on mediator release signatures, namely a second SPP wave of histamine release (HR) in the absence of PGD2.11Using a NAC model, omalizumab significantly suppressed the acute nasal volume reduction induced by NAC after 2 weeks of treatment.12In contrast, acute NAC SPP symptoms, such as nasal congestion, are suppressed by 11 weeks13and are more impressive than effects on nasal mediators of the allergic response such as histamine.14 In this study, we exploited the faster onset of omalizumabs effects on circulating blood basophils surface IgE and FcRI relative to tissue mast cells to elucidate the role of the basophil versus the tissue mast cell in a nasal airway allergen. This study is designed to define the kinetics of omalizumab-induced switch in basophil allergen-mediated function while monitoring allergen-induced skin.
