A comparative study of the effectiveness of the Rinkel method and the current standard method of immunotherapy for ragweed pollen hay fever

Abstract

In a double-blind study, we compared the effects of the Rinkel and the current standard methods of immunotherapy with ragweed pollen extract and those of placebo on symptoms of ragweed hay fever and immunologic parameters in 43 patients highly sensitive to ragweed. Each had a skin-test end point by Rinkel serial titration at 1:312,500 w/v or greater dilution, a 2+ skin test to ragweed AgE 0.01 μg/ml, and in vitro histamine release by ragweed pollen extract. None had had immunotherapy for at least 7 yr. Patients were matched on the basis of leukocyte histamine release to ragweed pollen extract and assigned to treatment groups. Fourteen received ragweed pollen extract by the Rinkel method, 14 received placebo, and 15 received ragweed pollen extract by the current standard method weekly between February and October, 1979. Rinkel method doses were derived from skin-test end points and were advanced to 0.5 ml of the end-point dilution; current standard method doses were advanced to the highest tolerated dose. The median maintenance dose for Rinkel method patients was 0.5 ml of 1:1,562,500 w/v (0.001 μg AgE), and for current standard method patients was 0.3 ml of 1:100 w/v (11 μg AgE). An additional unmatched group of nine similar patients received Rinkel method immunotherapy in both 1978 and 1979. Under the conditions of this study, the current standard method of immunotherapy produced a significant decrease in ragweed hay fever symptom-medication scores, increase in antiragweed IgG levels, and decrease in seasonal rise in antiragweed IgE levels in comparison with the effects of either Rinkel method or placebo. The effect of the Rinkel method on these variates was not significantly different from the effects of placebo.