Clinical and immunological effects of immunotherapy with alum‐absorbed grass allergoid in grass‐pollen‐induced hay fever

Abstract

A double-blind, placebo-controlled study of immunotherapy was conducted in 19 patients with grass-pollen hay fever to evaluate the efficacy and safety of a formalinized depot grass allergoid. The patients were assessed before and during IT by clinical (symptom-medication scores during the grass- pollen season, specific nasal and skin reactivity) and immunological (specific IgE, IgG, IgG1 and IgG4 antibodies) parameters. High doses of grass allergoid, corresponding to a cumulative pre-seasonal dosage of 46,050 PNU, were administered, with only one systemic reaction. The actively treated patients had significantly lower symptom-medication scores than placebo (p less than 0.01) during the month of May and showed a significant decrease in specific skin (p less than 0.01) and nasal (p less than 0.05) reactivity, and a significant early increase in specific IgE (p less than 0.01), IgG (p less than 0.0005), IgG1 (p less than 0.001) and IgG4 (p less than 0.05), with a subsequent decrease of IgE and IgG1. No differences were detected in any of these parameters in the placebo group. A correlation was found between high IgG4/IgG1 ratio and the specific skin reactivity decrease (r = 0.691, p less than 0.05), whereas a high IgG4/IgG1 ratio was associated with higher symptom-medication scores (r = 0.654, p less than 0.05). Possible explanations of these apparent discrepancies are proposed.

Desensitization Effect of Preseasonal Seven-Injection Allergoid Immunotherapy with Olive Pollen on Basophil Activation: The Efficacy of Olive Pollen-Specific Preseasonal Allergoid Immunotherapy on Basophils

“…However, results of specific IgE levels were inconsistent after SIT with different allergoids. For example, Guerra et al [35] reported no change in specific IgE levels 1 year after pollen allergoid immunotherapy, whereas Pastorello et al [36] observed a significant increase in mean specific IgE levels after 3 and 4 months of pollen SCIT. Keskin et al [13] did not detect any differences in grass pollen-specific IgE between levels at baseline and after 1 year of immunotherapy.…”

Immunotherapy as an effective tool in allergy treatment

“…These studies can be subdivided into 13 studies (5,7,9,11,12,15,17,19,22,32,35,36,39) investigating ragweed allergy (nine showing clinically relevant efficacy, i.e., symptom/medication scores diminished by >30% in the actively treated). Fifteen studies investigated the efficacy of immunotherapy in grass-pollen allergy (8,13,16,18,20,21,23,25,30,34,37,38,40,44,47), of which 14 proved efficacy. Nine studies investigated other pollen allergens: mountain cedar (10,27,29), Parietaria (42,43,46), Cupressus (45), Cocos (41), and mixtures (6); efficacy was demonstrated in six.…”

Towards evidence‐based medicine in specific grass pollen immunotherapy

“…The main reasons for excluding studies were lack of double-blinding/ randomization, review articles, multiple allergen extracts, outcomes unrelated to efficacy and preparations that are not commercially available. These criteria excluded early allergoid studies (51)(52)(53)(54)(55), a study with a recombinant allergen (which is not commercially available) (56), a paediatric SCIT study in which a combined asthma symptom-medication score was the primary outcome measure (57) and, regretfully, the 'Preventive Allergy Treatment' (PAT) study (58). Even though the 10-year PAT study was well designed and asked an important clinical question (does SCIT for allergic rhinoconjunctivitis prevent the development of asthma?…”