Intradermal grass pollen immunotherapy increases T(H)2 and IgE responses and worsens respiratory allergic symptoms
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Published version
Author(s)
Type
Journal Article
Abstract
Background Repeated low-dose grass pollen intradermal allergen injection suppresses allergen-induced cutaneous late-phase responses comparably with conventional subcutaneous and sublingual immunotherapy. Objective We sought 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–induced allergic rhinitis to receive 7 preseasonal intradermal allergen injections (containing 7 ng of Phl p 5 major allergen) or a histamine control. The primary end point was daily combined symptom-medication scores during the 2013 pollen season (area under the curve). Analysis was by intention to treat. Skin biopsy specimens were collected after intradermal allergen challenges, and late-phase responses were measured 4 and 7, 10, or 13 months after treatment. Results There was no significant difference in the primary end point between treatment arms (active, n = 46; control, n = 47; median difference, 14; 95% CI, −172.5 to 215.1; P = .80). Among secondary end points, nasal symptoms were worse in the intradermal treatment group, as measured based on daily (median difference, 35; 95% CI, 4.0-67.5; P = .03) and visual analog scale (median difference, 53; 95% CI, −11.6 to 125.2; P = .05) scores. In a per-protocol analysis intradermal immunotherapy was further associated with worse asthma symptoms and fewer symptom-free days. Intradermal immunotherapy increased serum Phleum pratense–specific IgE levels (P = .001) compared with those in the control arm. T cells cultured from biopsy specimens of subjects undergoing intradermal immunotherapy had higher expression of the TH2 surface marker CRTH2 (P = .04) and lower expression of the TH1 marker CXCR3 (P = .01), respectively. Late-phase responses remained inhibited 7 months after treatment (P = .03). Conclusion Intradermal allergen immunotherapy suppressed skin late-phase responses but was not clinically effective and resulted in worsening of respiratory allergic symptoms.
Date Issued
2016-10-20
Online Publication Date
2016-10-20
2017-12-07T14:15:19Z
Date Acceptance
2016-09-19
ISSN
0091-6749
Publisher
Elsevier
Start Page
1830
End Page
1839.e13
Journal / Book Title
Journal of Allergy and Clinical Immunology
Volume
139
Issue
6
Copyright Statement
© 2016 The Authors. Published by Elsevier Inc. on behalf of the American Academy of
Allergy, Asthma & Immunology. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).
Allergy, Asthma & Immunology. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).
Sponsor
Medical Research Council (MRC)
Medical Research Council (MRC)
Grant Number
G1000758
G1000758
Subjects
Science & Technology
Life Sciences & Biomedicine
Allergy
Immunology
Allergy immunotherapy
allergic rhinitis
grass pollen
Phleum pratense
immunotherapy
intradermal
low dose
MESSENGER-RNA EXPRESSION
ATOPIC-DERMATITIS
SKIN PREPARATION
HAY-FEVER
RHINITIS
RHINOCONJUNCTIVITIS
SENSITIZATION
INFILTRATION
INJECTIONS
EFFICACY
Adult
Allergens
Desensitization, Immunologic
Double-Blind Method
Female
Humans
Immunoglobulin E
Injections, Intradermal
Male
Middle Aged
Phleum
Pollen
Rhinitis, Allergic, Seasonal
Skin
Th2 Cells
Treatment Outcome
Young Adult
1107 Immunology
Publication Status
Published