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Safety of hookworm infection in individuals with measurable airway responsiveness: a randomized placebo-controlled feasibility study.
Clin Exp Allergy. 2009 Jul; 39(7):1060-8.CE

Abstract

BACKGROUND

Epidemiological evidence suggests that hookworm infection protects against asthma. However, for ethical and safety reasons, before testing this hypothesis in a clinical trial in asthma it is necessary to establish whether experimental hookworm infection might exacerbate airway responsiveness during larval lung migration.

OBJECTIVE

To determine whether hookworm larval migration through the lungs increases airway responsiveness in allergic individuals with measurable airway responsiveness but not clinical asthma, and investigate the general tolerability of infection and effect on allergic symptoms.

METHODS

Thirty individuals with allergic rhinoconjunctivitis and measurable airway responsiveness to adenosine monophosphate (AMP) but not clinically diagnosed asthma were randomized, double-blind to cutaneous administration of either 10 hookworm larvae or histamine placebo, and followed for 12 weeks. The primary outcome was the maximum fall from baseline in provocative dose of inhaled AMP required to reduce 1-s forced expiratory volume by 10% (PD(10)AMP) measured at any time over the 4 weeks after active or placebo infection. Secondary outcomes included peak flow variability in the 4 weeks after infection, rhinoconjunctivitis symptom severity and adverse effect diary scores over the 12-week study period, and change in allergen skin test responses between baseline and 12 weeks.

RESULTS

Mean maximum change in PD(10)AMP from baseline was slightly but not significantly greater in the hookworm than the placebo group (-1.67 and -1.16 doubling doses; mean difference -0.51, 95% confidence interval -1.80 to 0.78, P=0.42). Symptom scores of potential adverse effects were more commonly reported in the hookworm group, but infection was generally well tolerated. There were no significant differences in peak-flow variability, rhinoconjunctivitis symptoms or skin test responses between groups.

CONCLUSION

Hookworm infection did not cause clinically significant exacerbation of airway responsiveness and was well tolerated. Suitably powered trials are now indicated to determine the clinical effectiveness of hookworm infection in allergic rhinoconjunctivitis and asthma.

Authors+Show Affiliations

Division of Epidemiology and Public Health, University of Nottingham, UK. johanna.feary@nottingham.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19400893

Citation

Feary, J, et al. "Safety of Hookworm Infection in Individuals With Measurable Airway Responsiveness: a Randomized Placebo-controlled Feasibility Study." Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, vol. 39, no. 7, 2009, pp. 1060-8.
Feary J, Venn A, Brown A, et al. Safety of hookworm infection in individuals with measurable airway responsiveness: a randomized placebo-controlled feasibility study. Clin Exp Allergy. 2009;39(7):1060-8.
Feary, J., Venn, A., Brown, A., Hooi, D., Falcone, F. H., Mortimer, K., Pritchard, D. I., & Britton, J. (2009). Safety of hookworm infection in individuals with measurable airway responsiveness: a randomized placebo-controlled feasibility study. Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, 39(7), 1060-8. https://doi.org/10.1111/j.1365-2222.2009.03187.x
Feary J, et al. Safety of Hookworm Infection in Individuals With Measurable Airway Responsiveness: a Randomized Placebo-controlled Feasibility Study. Clin Exp Allergy. 2009;39(7):1060-8. PubMed PMID: 19400893.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety of hookworm infection in individuals with measurable airway responsiveness: a randomized placebo-controlled feasibility study. AU - Feary,J, AU - Venn,A, AU - Brown,A, AU - Hooi,D, AU - Falcone,F H, AU - Mortimer,K, AU - Pritchard,D I, AU - Britton,J, Y1 - 2009/04/20/ PY - 2009/4/30/entrez PY - 2009/4/30/pubmed PY - 2009/10/31/medline SP - 1060 EP - 8 JF - Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology JO - Clin. Exp. Allergy VL - 39 IS - 7 N2 - BACKGROUND: Epidemiological evidence suggests that hookworm infection protects against asthma. However, for ethical and safety reasons, before testing this hypothesis in a clinical trial in asthma it is necessary to establish whether experimental hookworm infection might exacerbate airway responsiveness during larval lung migration. OBJECTIVE: To determine whether hookworm larval migration through the lungs increases airway responsiveness in allergic individuals with measurable airway responsiveness but not clinical asthma, and investigate the general tolerability of infection and effect on allergic symptoms. METHODS: Thirty individuals with allergic rhinoconjunctivitis and measurable airway responsiveness to adenosine monophosphate (AMP) but not clinically diagnosed asthma were randomized, double-blind to cutaneous administration of either 10 hookworm larvae or histamine placebo, and followed for 12 weeks. The primary outcome was the maximum fall from baseline in provocative dose of inhaled AMP required to reduce 1-s forced expiratory volume by 10% (PD(10)AMP) measured at any time over the 4 weeks after active or placebo infection. Secondary outcomes included peak flow variability in the 4 weeks after infection, rhinoconjunctivitis symptom severity and adverse effect diary scores over the 12-week study period, and change in allergen skin test responses between baseline and 12 weeks. RESULTS: Mean maximum change in PD(10)AMP from baseline was slightly but not significantly greater in the hookworm than the placebo group (-1.67 and -1.16 doubling doses; mean difference -0.51, 95% confidence interval -1.80 to 0.78, P=0.42). Symptom scores of potential adverse effects were more commonly reported in the hookworm group, but infection was generally well tolerated. There were no significant differences in peak-flow variability, rhinoconjunctivitis symptoms or skin test responses between groups. CONCLUSION: Hookworm infection did not cause clinically significant exacerbation of airway responsiveness and was well tolerated. Suitably powered trials are now indicated to determine the clinical effectiveness of hookworm infection in allergic rhinoconjunctivitis and asthma. SN - 1365-2222 UR - https://www.unboundmedicine.com/medline/citation/19400893/Safety_of_hookworm_infection_in_individuals_with_measurable_airway_responsiveness:_a_randomized_placebo_controlled_feasibility_study_ L2 - https://doi.org/10.1111/j.1365-2222.2009.03187.x DB - PRIME DP - Unbound Medicine ER -