Autologous Blood Therapy Abstracts 1

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Subcutaneous Autologous Serum Therapy in Chronic Spontaneous Urticaria.
            (Godse et al., 2017) Download
BACKGROUND:  There is a felt need for trying newer therapeutic modalities in patients with chronic spontaneous urticaria, especially in the subset of patients classified as non-responders to antihistamines. Autologous serum therapy is an upcoming modality of treatment, and we decided to study its efficacy by subcutaneous route. AIMS:  To evaluate the effectiveness of subcutaneous autologous serum therapy (AST) in CSU. METHODS:  This was a single blind, placebo-controlled parallel group, randomized, controlled study. Twenty-four patients with CSU (11M: 13 F) were given subcutaneous AST and seventeen patients (7 M: 10F) patients were given subcutaneous injection normal saline (placebo), along with levocetirizine in an on-demand basis in both groups. RESULTS:  Urticaria activity score (UAS) came down from 35.74 to 7 at the end of 9 weeks and the patients' requirement of antihistamines also reduced remarkably from 5.8 to 1.7 per week in the serum group. Sub-cutaneous saline group did not show statistically significant fall in UAS. Saline group showed UAS 32.8 at zero week to 22.1 at the end of 9 weeks. DLQI showed significant fall in serum group, from 14.26 to 4 at the end of 9 weeks. CONCLUSION:  Subcutaneous autoserum therapy is effective in treatment of CSU.

Autologous blood therapy for common cold--a randomized, double-blind, placebo-controlled trial.
            (Hensler et al., 2009) Download
BACKGROUND:  In Germany autologous blood therapy (ABT) is a widespread therapy for infectious diseases in complementary medicine. Clinical data for its use for common cold is lacking. METHODS:  In a double-blind randomized controlled trial 139 patients with common cold were enrolled either to ABT (gluteal intramuscular reinjection of venous blood three times a week) or to placebo (sterile sodium chloride solution). Main criterion was time period of illness after initiation of treatment, measured by a modified symptom diary adapted from Jackson. RESULTS:  58 and 56 patients completed therapy. In both groups illness duration was 7 days (5.0-10.0 for verum and 5.25-9.0 for placebo). CONCLUSIONS:  This trial found no effect of ABT as treatment for common cold. Because of a rather highly selected patient sample another RCT on this topic is reasonable. Further research to analyse the effect of other doses or of autologous blood therapy in addition to homeopathic preparations or vitamin preparations is needed.
Autologous immunoglobulin therapy in patients with severe recalcitrant atopic dermatitis: a preliminary report.
            (Nahm et al., 2014) Download
The management of severe recalcitrant atopic dermatitis (AD) is a challenging issue for clinicians and patients. We hypothesized that repeated intramuscular injections of autologous immunoglobulin (autologous immunoglobulin therapy: AIGT) might induce clinical improvements in patients with AD by stimulation of the active immune response to antigen-binding-site of pathogenic antibodies. We tried AIGT in 3 adult patients with severe recalcitrant AD whose clinical conditions could not be effectively controlled by medical treatments (including oral cyclosporine) for more than 2 years. Autologous immunoglobulin was purified from the autologous plasma by affinity chromatography using Protein A. The patients were treated by an intramuscular injection of 50 mg of autologous immunoglobulin twice a week for 4 weeks. A clinical severity score of AD (SCORAD value) showed a decrease greater than 30% at 8 weeks after the initiation of AIGT compared with the baseline before the initiation of AIGT in all 3 patients with severe recalcitrant AD. No significant side effects from treatment were observed. Further studies with larger numbers of patients are required to evaluate the clinical usefulness of AIGT for AD.

Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: Long-Term Changes of Clinical Severity and Laboratory Parameters.
            (Nahm et al., 2016a) Download
This report evaluated long-term changes in clinical severity and laboratory parameters in 3 adult patients with severe recalcitrant atopic dermatitis (AD) who were treated with intramuscular injections of 50 mg of autologous immunoglobulin G (IgG) twice a week for 4 weeks (autologous immunoglobulin therapy, AIGT) and followed up for more than 2 years after the treatment. We observed the following 4 major findings in these 3 patients during the long-term follow-up after AIGT. (1) Two of the 3 patients showed a long-term clinical improvement for more than 36 weeks after AIGT with a maximum decrease in clinical severity score greater than 80% from baseline. (2) These 2 patients also showed long-term decreases in serum total IgE concentrations and peripheral blood eosinophil count for more than 36 weeks after AIGT with a maximum decrease in the two laboratory parameters of allergic inflammatory greater than 70% from baseline. (3) No significant side effect was observed during the 2 years of follow-up period after the AIGT in all 3 patients. (4) Serum levels of IgG anti-idiotype antibodies to the F(ab')₂ fragment of autologous IgG administered for the treatment were not significantly changed after AIGT in all 3 patients. These findings suggest that AIGT has long-term favorable effects on both clinical severity and laboratory parameters in selected patients with severe recalcitrant AD. Further studies are required to evaluate the clinical usefulness and therapeutic mechanism of AIGT for AD.

Clinical Efficacy of Subcutaneous Allergen Immunotherapy in Patients with Atopic Dermatitis.
            (Nahm et al., 2016b) Download
PURPOSE:  The clinical usefulness of subcutaneous allergen immunotherapy (SCIT) in the treatment of atopic dermatitis (AD) is still controversial. We analyzed the clinical efficacy of SCIT in patients with AD and the clinical characteristics of patients showing a favorable clinical response to the treatment. MATERIALS AND METHODS:  Two hundred and fifty one patients with AD sensitized to house dust mite (HDM) were treated by SCIT using HDM extract. The clinical severity of AD was measured using the standardized clinical severity scoring system for AD (SCORAD) at baseline and 12 months. A favorable clinical response to SCIT was defined as a decrease in SCORAD value at 12 months greater than 50% compared to baseline value. Severe AD was defined as a baseline SCORAD value above 50. RESULTS:  A favorable clinical response to SCIT was observed in 73.6% of patients. The proportion of patients showing a favorable clinical response to SCIT was significantly higher in patients with severe AD (90.6%) than patients with mild to moderated AD (63.7%) (p<0.001). Patients with severe AD showing a favorable clinical response had a significantly shorter duration of AD (12.3±8.5 years; mean±SD) than patients with severe AD showing no significant clinical response (20.6±10.9 years) (p<0.05) at baseline. CONCLUSION:  SCIT could be a clinically useful therapeutic option for patients with severe AD sensitized to HDM. Early initiation of SCIT might provide a favorable clinical outcome in patients with severe AD sensitized to HDM.

Activated autologous blood therapy in recurrent spontaneous abortion--results of a pilot study.
            (Pfeiffer et al., 1998) Download
This study was undertaken to investigate the influence of activated autologous blood therapy on immunological parameters and on the clinical outcome in patients with recurrent spontaneous abortion. In a prospective trial, 36 women with recurrent spontaneous abortion were treated with intramuscular reinjections of extracorporally haemolysed and ultraviolet irradiated autologous blood. A comprehensive immunological investigation revealed significant changes in lymphocyte subpopulations, plasma complement levels, mitogen stimulation and immunoglobulin levels during the treatment period. No side-effects were reported by the patients. From June 1994 to November 1995, 22 intrauterine and one extrauterine pregnancies occurred, resulting in 19 (86%) live births, two (9%) spontaneous abortions and one (4%) artificial abortion compared with a 64% live birth rate in the historical control group. We conclude that activated autologous blood therapy has detectable effects on the immune system, and seems to be promising for further investigation concerning the treatment of idiopathic recurrent spontaneous abortion.

Randomized, double-blind, placebo-controlled trial of autologous blood therapy for atopic dermatitis.
            (Pittler et al., 2003) Download
BACKGROUND:  Autologous blood therapy (ABT) is used for treating atopic dermatitis (AD) in some European countries and is promoted on internet sites for this condition. However, there is little evidence from rigorous clinical trials to suggest that it is effective. OBJECTIVES:  To test the effectiveness of ABT for the symptomatic treatment of patients with AD. METHODS:  Fifty subjects responded to press advertisements, and 31 were randomized within strata of severity at recruitment. Patients were included into a double-blind, placebo-controlled trial and received ABT or placebo once weekly for 5 weeks. Assessments were performed at baseline, at weekly intervals and after a 5-week follow up. The Six Area, Six Sign AD (SASSAD) severity index was predefined as the primary outcome measure. The Dermatology Life Quality Index and patient ratings of pruritus, quality of sleep and skin appearance on 100-mm visual analogue scales were defined as secondary outcome measures. Success of patient blinding and adverse events were assessed. RESULTS:  Data were analysed on an intention-to-treat basis. Analysis of covariance suggested a significant differential change of the SASSAD score between baseline and the end of the follow-up period in favour of ABT. The mean reduction in SASSAD score was 13.5 points (95% confidence interval, CI 6.6-20.4, P < 0.001) over and above placebo; the corresponding value at the end of treatment was 9.6 (95% CI 4.2-14.9, P = 0.001). No clear significant intergroup differences in any of the secondary outcome measures were found. Six patients in the ABT group and seven in the placebo group reported minor and transient adverse events. CONCLUSIONS:  These data suggest that, according to the SASSAD score, ABT has beneficial effects in the treatment of AD, although this was not confirmed by the patient-rated assessments. The improvement in observer-rated skin condition suggested by this study needs confirmation in larger trials.

A Future for Autologous Hematopoietic Stem Cell Transplantation in Type 1 Diabetes.
            (van Megen et al., 2018) Download
Until today, autologous hematopoietic stem cell transplantation (aHSCT) proved to be the only intervention therapy for T1D reaching complete and sometimes even lasting remission (2–7). In spite of many other immunotherapies assessed around the globe, none matched the clinical efficacy of aHSCT (8, 9). Indeed, aHSCT had insulin-independency as primary end-point, rather than delayed loss of insulin production or decreased insulin needs. aHSCT is already widely and successfully used as a treatment for hematological malignancies (10, 11). Interestingly, one diabetic patient, when treated with aHSCT for multiple myeloma, became insulin independent (12). aHSCT was evaluated as a treatment for several autoimmune disorders as well, such as rheumatoid arthritis (13), systemic sclerosis (14, 15), multiple sclerosis (16), and juvenile idiopathic arthritis (17). By 2012, up to 3,000 aHSCT had been performed for autoimmune diseases (18). Yet, in the case of T1D, aHSCT remains controversial (19–21).

Autologous Whole Blood Injection for the Treatment of Antihistamine-Resistant Chronic Spontaneous Urticaria.
            (You et al., 2015) Download
The aim of this study was to evaluate the efficacy of Autologous Whole Blood (AWB) injection in treating chronic spontaneous urticaria (CSU) , and to compare its efficacy on chronic autoimmune urticaria (CAU) and chronic idiopathic urticaria (CIU).  We treated 22 patients with CSU, who had uncontrolled urticaria most days of the week despite antihistamine therapy for >6 weeks, by administering AWB injections for 8 consecutive weeks. The patients were classified into two groups after autologous serum skin test (ASST): positive (CAU) and neg- ative (CIU). After the cessation of antihistaminic treatment for at least 3 days, ASST was performed. In total, 8 of 22 patients (36.4%) with CSU were res- ponders to AWB injection; 2 of 7 (28.6%) CAU and 6 of 15 (40.0%). CSU patients with a high baseline UAS improved markedly after repeated AWB injections. No patients experienced serious adverse events; however, minor adverse events such as bruising and injection pain were noted.

 


References

Godse, KV, et al. (2017), ‘Subcutaneous Autologous Serum Therapy in Chronic Spontaneous Urticaria.’, Indian J Dermatol, 62 (5), 505-7. PubMed: 28979013
Hensler, S, et al. (2009), ‘Autologous blood therapy for common cold--a randomized, double-blind, placebo-controlled trial.’, Complement Ther Med, 17 (5-6), 257-61. PubMed: 19942104
Nahm, DH, et al. (2014), ‘Autologous immunoglobulin therapy in patients with severe recalcitrant atopic dermatitis: a preliminary report.’, Allergy Asthma Immunol Res, 6 (1), 89-94. PubMed: 24404399
Nahm, DH, et al. (2016a), ‘Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: Long-Term Changes of Clinical Severity and Laboratory Parameters.’, Allergy Asthma Immunol Res, 8 (4), 375-82. PubMed: 27126731
Nahm, DH, et al. (2016b), ‘Clinical Efficacy of Subcutaneous Allergen Immunotherapy in Patients with Atopic Dermatitis.’, Yonsei Med J, 57 (6), 1420-26. PubMed: 27593870
Pfeiffer, KA, et al. (1998), ‘Activated autologous blood therapy in recurrent spontaneous abortion--results of a pilot study.’, Hum Reprod, 13 (2), 491-97. PubMed: 9557863
Pittler, MH, et al. (2003), ‘Randomized, double-blind, placebo-controlled trial of autologous blood therapy for atopic dermatitis.’, Br J Dermatol, 148 (2), 307-13. PubMed: 12588384
van Megen, KM, et al. (2018), ‘A Future for Autologous Hematopoietic Stem Cell Transplantation in Type 1 Diabetes.’, Front Immunol, 9 690. PubMed: 29696017
You, HS, et al. (2015), ‘Autologous Whole Blood Injection for the Treatment of Antihistamine-Resistant Chronic Spontaneous Urticaria.’, Ann Dermatol, 27 (6), 784-86. PubMed: 26719660