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Title: Intradermal Grass Pollen Allergen Immunotherapy for Seasonal Allergy: A Randomized Controlled Trial.
Authors: Slovick, A.
Douiri, A.
Muir, R.
Guerra, A.
Tsioulos, K.
Hay, E.
Lam, E. P.
Kelly, J.
Peacock, J. L.
Ying, S.
Shamji, M. H.
Cousins, David J.
Durham, S. R.
Till, S. J.
First Published: 20-Oct-2016
Publisher: Elsevier for American Academy of Allergy, Asthma and Immunology, Mosby
Citation: Journal of Allergy and Clinical Immunology, 2016
Abstract: BACKGROUND: Repeated low dose grass pollen intradermal allergen injection suppresses allergen-induced cutaneous late phase responses, comparable with conventional subcutaneous and sublingual immunotherapy. OBJECTIVE: To evaluate the efficacy and safety of grass pollen intradermal immunotherapy in the treatment of allergic rhinitis. METHODS: We randomly assigned 93 adults with grass pollen allergic rhinitis to receive 7 pre-seasonal intradermal allergen injections (containing 7 nanograms of Phl p 5 major allergen) or histamine control. The primary endpoint was daily combined symptom-medication scores during the 2013 pollen season (area under curve). Analysis was by intention-to-treat. Skin biopsies were collected following intradermal allergen challenges and late phase responses measured four and seven, ten or thirteen months post-treatment. RESULTS: There was no significant difference in primary endpoint between treatment arms (active n=46, control n=47, median difference, 14; 95% CI -172.5-215.1; P=.80). Among secondary endpoints, nasal symptoms were worse in the intradermal treatment group, measured by daily scores (median difference, 35; 95% CI 4.0-67.5; P=.03) and visual-analog scales (median difference, 53; 95% CI -11.6-125·2; P=.05). In a per protocol analysis, intradermal immunotherapy was further associated with worse asthma symptoms and fewer symptom free days. Intradermal immunotherapy increased serum Phl p-specific IgE (P=.001) compared to the control arm. T cells cultured from biopsies of intradermal immunotherapy subjects showed higher expression of Th2 surface marker CRTH2 (P=.04) and lower Th1 marker CXCR (P=.01), respectively. Late phase responses remained inhibited seven months after treatment (P=.03). CONCLUSION: Intradermal allergen immunotherapy suppressed skin late responses but was not clinically effective and resulted in worsening of respiratory allergic symptoms.
DOI Link: 10.1016/j.jaci.2016.09.024
ISSN: 0091-6749
eISSN: 1097-6825
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Creative Commons Attribution 4.0 International (CC BY 4.0)
Description: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Appears in Collections:Published Articles, Dept. of Infection, Immunity and Inflammation

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