Randomised Placebo Controlled Study of Effects of Therapeutic Hookworm Infection in Asthma

Epidemiological evidence suggests that human hookworm infection is associated with a reduced risk of asthma and allergic disease. This association is potentially important not only to understanding the aetiology of asthma and allergic disease, but also because it suggests that hookworms or their products might be therapeutically effective in these conditions. To test the hypothesis that hookworms protect against asthma ultimately requires a clinical trial.

We have carried out a dose-ranging study to establish the dose of hookworm larvae necessary to generate infection at the intensity shown to be protective in epidemiological studies, with acceptable side effects. We have also completed a randomized controlled clinical trial of hookworm infection in people with allergic rhinoconjunctivitis and have shown that there is no significant change in airway responsiveness during the lung migration phase of the hookworm life cycle. We are now performing the definitive study which is a randomized placebo-controlled trial of the effects of therapeutic hookworm infection in people with asthma. During this study, we will be monitoring various indicators of asthma control but will also be able to measure a range of relevant immunological parameters to explore the relation between these parameters and expression of the allergic and asthmatic phenotypes

Inclusion criteria

• Clinical diagnosis of asthma
• Use of regular inhaled corticosteroid treatment to a maximum of 1000mcg beclomethasone or equivalent per day
• Measurable airway responsiveness to AMP
• Negative hookworm serology
• Positive skin prick tests to D.pteronyssinum, cat fur or grass pollen

Exclusion criteria

• Possible or planned pregnancy or breastfeeding
• Use of regular oral corticosteroids or immunosuppressive medication
• Anemia
• History of anaphylaxis