Document Detail


Grass pollen sublingual immunotherapy for seasonal rhinoconjunctivitis: a randomized controlled trial.
MedLine Citation:
PMID:  11972594     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Previous studies suggest that sublingual immunotherapy (SLIT) represents a safer alternative to injection immunotherapy but equivalent efficacy is yet to be confirmed. OBJECTIVE: To evaluate the efficacy and safety of SLIT in grass pollen-induced seasonal rhinoconjunctivitis. METHODS: A randomized, placebo-controlled trial in 56 adults over 18 months. Outcome measures included diary scores of seasonal symptoms and medication use, overall assessments, conjunctival and intradermal provocation tests and serum antibody measurements. To investigate possible mechanisms, sublingual biopsies were taken for measurement of local T cells, antigen-presenting cells and IL-12 mRNA expression. RESULTS: There were no significant differences between the immunotherapy (IT) and placebo groups for diary symptom scores (P = 0.48) or rescue medication (P = 0.19). The patients' overall assessment of hayfever severity compared with previous years showed a highly significant improvement in favour of the IT group (P < 0.02). After treatment the late skin response was smaller (P = 0.003) and the ratio of serum allergen-specific IgG4/IgE was higher (P = 0.05) in the IT group. Both of these variables correlated with the clinical response to SLIT. There were no differences between groups in either the sublingual epithelium or lamina propria for numbers of CD3+ cells (epithelium: P = 0.9, lamina propria: P = 0.2), CD1a+ cells (P = 0.3, P = 0.25), CD68+ cells (P = 0.9, P = 1.0) or IL-12 mRNA+ cells (P = 0.6, P = 0.4). Local side-effects were minor and there were no serious treatment-related adverse events. CONCLUSION: Grass pollen sublingual immunotherapy was well tolerated. Although there was no significant change in diary scores, the improvement in overall assessments, which correlated with inhibition of the late skin response and increases in serum IgG4 : IgE ratio, indicates the need for larger, dose-ranging studies.
Authors:
M Torres Lima; D Wilson; L Pitkin; A Roberts; K Nouri-Aria; M Jacobson; S Walker; S Durham
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology     Volume:  32     ISSN:  0954-7894     ISO Abbreviation:  Clin. Exp. Allergy     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-04-25     Completed Date:  2002-09-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8906443     Medline TA:  Clin Exp Allergy     Country:  England    
Other Details:
Languages:  eng     Pagination:  507-14     Citation Subset:  IM    
Affiliation:
Upper Respiratory Medicine, Faculty of Medicine, Imperial College of Science, Technology and Medicine at the National Heart & Lung Institute, and Royal Brompton and Harefield Hospital NHS Trust, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Administration, Sublingual
Adult
Allergens / therapeutic use*
Antigens, CD1 / analysis,  immunology
Antigens, CD3 / analysis,  immunology
Conjunctivitis, Allergic / diagnosis,  immunology,  therapy*
Double-Blind Method
Female
Humans
Immunoglobulin E / blood
Immunoglobulin G / blood
Immunohistochemistry
Interleukin-12 / biosynthesis,  genetics
Male
Middle Aged
Mouth Mucosa / cytology,  metabolism
Poaceae / immunology*
Pollen / immunology*
RNA, Messenger / biosynthesis
Rhinitis, Allergic, Seasonal / diagnosis,  immunology,  therapy*
Chemical
Reg. No./Substance:
0/Allergens; 0/Antigens, CD1; 0/Antigens, CD3; 0/CD1a antigen; 0/Immunoglobulin G; 0/RNA, Messenger; 187348-17-0/Interleukin-12; 37341-29-0/Immunoglobulin E

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