The effects of grass pollen allergoid immunotherapy on clinical and immunological parameters in children with allergic rhinitis

Abstract

Allergoid immunotherapy is a new form of allergen immunotherapy allowing safe administration of high allergen doses. There is limited information on the effects of allergoid immunotherapy in children with allergic rhinitis. To investigate the immunological and clinical effects of allergoid immunotherapy in children with allergic rhinitis due to grass pollen allergy. Children with allergic rhinitis were assigned to allergoid immunotherapy (n = 27) or control (n = 26, no immunotherapy) groups. Children in the immunotherapy group received seven injections of grass pollen allergoid immunotherapy before grass pollen season and continued to receive maintenance immunotherapy for 27 months. All patients were offered a pharmacotherapy regimen to be used on demand during the pollen seasons. Clinical and laboratory parameters were compared between the immunotherapy and control groups. The rhinoconjunctivitis symptom-medication score and asthma symptom score were lower in the immunotherapy group after 1 yr of maintenance immunotherapy (p < 0.01 for both). Skin test reactivity and nasal reactivity as determined by nasal provocation testing for grass pollen were significantly decreased after 1 yr of immunotherapy (p < 0.001 for both). The seasonal increase in bronchial reactivity and nasal lavage eosinophil cationic protein levels were prevented after the first year of immunotherapy (p < 0.05 for both). The seasonal increase in immunoglobulin (Ig)E decreased (p < 0.05) and grass-specific IgG, IgG(1) and IgG(4) increased significantly already at the end of the seven-injection build-up therapy (p < 0.001, for all). Interleukin (IL)-4 levels in the culture supernatants showed a steady decline from baseline at first and second year of immunotherapy (p < 0.001) but remained unchanged in the control group. Allergoid immunotherapy is an effective method in the treatment of grass pollen-induced allergic rhinitis in children and prevents the seasonal increase in bronchial hyper-reactivity. Changes in specific IgE and IgG levels and decreased IL-4 production in peripheral blood mononuclear cell culture supernatants may account for the observed clinical effects.

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

“…157 Two further open RCTs also suggest that SCIT for grass pollen-driven AR does have a long-term benefit. 63,158 For SLIT, there are more recent pediatric trial data to support this approach. In general, pre-/coseasonal and continuous SLIT is recommended for seasonal AR (Grade A) ( Table 3).…”

Evaluation of Preseasonal Immunotherapy in Patients with Seasonal Allergic Rhinitis

“…Can ve arkadaşllarının yaptığı çalışmada konvansiyonel tedavinin build-up (doz arttırma) fazında IT alan ile idame IT'si tamamlanmış hastalarda, IT sonrası deri reaktivitesine bakılmış ve her iki grupta da azalma saptanmıştur (25). Yine Keskin ve arkadaşlarının yaptığı çalışmada, mevsim öncesi başlanarak 1 yıl süreyle uygulanan allergoid IT'nin deri reaktivitesini anlamlı derecede azalttığı gösterilmiştir (26). Çalışmamızda IT grubundaki hastaların polen mevsimi bitiminde endurasyon çapında anlamlı derecede azalma saptandı.…”

“…Çalışmamızda IT grubundaki hastaların polen mevsimi bitiminde endurasyon çapında anlamlı derecede azalma saptandı. Bulgular önceki çalış-ma sonuçları ile uyumlu bulundu ( 24,25,26). Çalışlma-mızda bu sonuç idame tedavisi olmaksızın elde edilmiştir.…”

Monomeric Allergoid Intragastric Administration Induces Local and Systemic Tolerogenic Response Involving IL-10-Producing CD4+CD25+T Regulatory Cells in Mice

“…Therefore, in the present study monomeric allergoids instead of the native allergens were administered, since they are virtually unmodified when adsorbed (11), as described for Par-j 1 (l0). The monomeric allergoids are chemically modified allergens generated to obtain improved molecules for immunotherapy (10) with a high efficacy and a safety profile in preventive and therapeutic SLIT (18)(19).…”