Use of Glutaraldehyde-Modified Timothy Grass Pollen Extract in Nasal Hyposensitisation Treatment of Hay Fever

Abstract

12 patients suffering from grass pollen hay fever were treated for 14 weeks pre- and co-seasonally by intranasal self-administration of an aqueous solution of a glutaraldehyde-treated timothy grass pollen allergen. These patients had a statistically significant decrease in nasal symptom scores during the grass pollen peak period and in nasal challenge end-point titre after the season compared to placebo-treated patients. No significant effect was seen on the eye symptoms. 1 patient withdrew from the trial as a consequence of too strong local nasal reactions during treatment. Most other patients treated with active material reported mild local reactions during the first minutes after administration of the nasal spray. In the actively treated group a significant increase in serum and nasal secretion of grass pollen specific IgE, IgG and IgA antibodies was obtained during the treatment. In contrast, in the placebo group a significant increase in IgE antibody levels in serum and secretion occurred during the pollen season. The reduction in symptoms and increase in antibody production together with the simplicity of the procedure makes this approach to immunotherapy attractive.

Detection of IgE‐binding activity in serum after intranasal treatment of normal rabbits with P. judaica extract

“…Detection of IgE-reactive components in the systemic circulation when an allergenic extract is given intranasally introduces a new element of discussion about the possible mechanisms by which this form of treatment, recently proposed as an alternative to the parenteral route, produces clinical efficacy in rhinitic patients (15,19,21,30,33). Various hypotheses have been put forward: a common finding in allergic patients after local therapy is a rise in the threshold value as determined by specific provocation tests at the target organ, while the induction of local immunological protection (IgA and IgG blocking antibodies) is suggestive, but results are still contradictory (12,15). Recent studies in mice and rats showed that repeated inhalation of aerosols containing egg albumin or ragweed antigens induced a transient IgE response which switched oii spontaneously despite continuous exposure (10,13,26).…”

Local immunotherapy: pharmacokinetics and efficacy

“…So far, 21 studies are available for LNIT, and 14 of them were properly performed (43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56), Of these, 13 report a significant improvement of rhinitic symptoms. Furthermore, a reduction of the nasal reactivity and local immunologic response was found in some studies, while systemic immunologic changes were usually absent or equivocal: this may suggest that LNIT exerts its actions only on the target organ.…”

Clinical efficacy and safety of local nasal immunotherapy

“…As, for traditional subcutaneous immunotherapy, the mechanism of LNIT is still unclear, some immunological modifications were observed during the treatment. An increase of specific secretory IgA and IgG was reported by several authors (9,10,14,21,22), but without any clinical and immunological correlation (9,10,21). A systemic immunological action could be hypothesized by the increase of serum specific IgE, reported after the treatment with intranasal aqueous extract (9,21) and by the relevant allergenic activity observed in animal models after intranasal treatment with allergen in powder form (36).…”