Pollen-induced Allergic Rhinitis Research Articles

Detection of specific IgE antibodies in the sera of patients allergic to birch pollen using recombinant allergens Bet v 1, Bet v 2, Bet v 4: evaluation of different IgE reactivity profiles.

Birch pollen is a significant cause of immediate hypersensitivity among susceptible subjects in temperate climates, affecting 5-54% of the population in western Europe. We examined the specific serum IgE antibodies towards recombinant allergens Bet v 1, Bet v 2 and Bet v 4 in birch-sensitive patients from the province of Cuneo, north-west Italy. Sera were obtained from 372 patients with symptomatic birch pollen-induced allergic rhinitis and/or asthma. A subgroup of these patients suffered from oral allergy syndrome after eating apple. Their sera were evaluated for specific IgE against natural birch pollen and apple extract, as well as Bet v 1, Bet v 2 and Bet v 4 using Pharmacia CAP system (Pharmacia, Uppsala, Sweden). Of 372 patients 215 (57.80%) had serum-specific IgE towards Bet v 1. A total of 166 sera (44.62%) contained serum-specific IgE to Bet v 2, while Bet v 4 IgE reactivity was documented in 35 subjects (9.41%). Moreover, 146 (39.25%) patients were monosensitized to Bet v 1; 96 (25.81%) patients were monosensitized to Bet v 2; only four sera (1.08%) contained specific IgE towards Bet v 4. Thirty-nine sera (11.02%) did not contain specific IgE to these individual birch pollen allergens. Of course, all 372 sera (100%) had specific IgE against natural birch pollen extract, of which 162 (43.55%) contained specific IgE to apple extract (75.35% of Bet v 1 positive sera). In this study we observed that three birch pollen recombinant allergens alone, could sufficiently identify 90% of birch pollen-sensitive patients. Therefore, for a more precise IgE profile of patients allergic to birch, further purified birch pollen allergens (i.e. Bet v 6, Bet v 7, Bet v 8) will be required.

Increased expression of surface activation markers on neutrophils following migration into the nasal lumen.

The sequence of events following the recruitment of a free-flowing neutrophil in the peripheral circulation, via adhesion, migration and release of mediators, to a neutrophil on the surface of the nasal epithelium is a co-ordinated process. Little is known about the state of neutrophil activation following this course of events. To investigate the expression of surface activation markers on neutrophils, reflecting activation during their recruitment to the nose, and to see whether the inflammatory process during allergic rhinitis influences this process. Nine healthy controls and 12 patients with grass pollen-induced intermittent allergic rhinitis were investigated during the peak of the pollen season. The expression of CD11b, CD66b and CD63 on the neutrophil cell surface, as a reflection of activation, was analysed using flow cytometry. Neutrophils were derived from peripheral blood and nasal lavage fluid. In addition, eosinophil cationic protein (ECP) and myeloperoxidase (MPO) as well as L-, P- and E-selectins in the nasal lavage fluid were analysed using RIA and ELISA, respectively. A marked increase in the expression of all three CD markers on the neutrophil cell surface was noticed following migration from the bloodstream to the surface of the nasal mucosa. At the peak of the grass pollen season, the MPO levels increased, reflecting an increase in the total number of nasal fluid neutrophils. In parallel, the expression of CD11b was further augmented. The expression of the CDb11b was reduced on neutrophils remaining in the circulation. In addition, the level of L-selectin was reduced on neutrophils derived from the blood during allergic inflammation. Neutrophils might become activated during their transfer from the blood to the surface of the nasal mucosa, but these changes may also be due to depletion of activated neutrophils in the blood via activated endothelial/epithelial adhesion and chemoattractant measures. The increased expression of surface activation markers during allergic rhinitis suggests roles for neutrophils in the inflammatory process.

Kinins are involved in the development of allergic nasal hyperresponsiveness in guinea pigs

We evaluated roles of kinins in allergen-induced nasal blockage and sneezing, and development of nasal hyperresponsiveness to leukotriene D 4 in a Japanese cedar pollen-induced allergic rhinitis model of guinea pigs. Sensitised guinea pigs were repeatedly challenged by pollen inhalation once every week. Neither a bradykinin B 1 receptor antagonist, des-Arg 9-[Leu 8]bradykinin nor a bradykinin B 2 receptor antagonist, icatibant suppressed allergen-induced sneezing and nasal blockage. However, development of nasal hyperresponsiveness to leukotriene D 4 was significantly suppressed by them. The amount of bradykinin in nasal cavity lavage fluid was immediately increased after the challenge. In non-sensitised animals, hyperresponsiveness to leukotriene D 4 was developed by a bradykinin B 2 receptor agonist, bradykinin, but not by a bradykinin B 1 receptor agonist, des-Arg 10-kallidin, while in the sensitised-challenged animal, both agonists developed hyperresponsiveness. In conclusion, the nasal hyperresponsiveness appeared to be induced by kinins produced in response to the antigen challenge through activation of not only bradykinin B 2 but also B 1 receptors.

The editors' choice

The editors' choice

DNA microarrays to study gene expression in allergic airways.

Allergic rhinitis results from interactions between a large number of cells and mediators in different compartments of the body. DNA microarrays allow simultaneous measurement of expression of thousands of genes in the same tissue sample. To study gene expression in nasal mucosal biopsies from patients with allergic rhinitis using DNA micro-arrays. Nasal biopsies were obtained from 14 patients with symptomatic birch pollen-induced allergic rhinitis and five healthy controls. RNA was extracted from the biopsies and pooled into one patient pool and one control pool. These were analysed in duplicate with DNA micro-arrays containing more than 12 000 known genes. Approximately half of the genes were expressed in the patient and control samples. Guided by the current literature we chose 32 genes of possible relevance to allergic airway inflammation and investigated their relative expression. Among these, transcripts encoding immunoglobulins and their receptors were most abundant. The expression of cytokines and growth factors was low, whereas their corresponding receptors and cell surface markers displayed higher expression levels. IgA had the highest expression of all 12 626 genes. RT-PCR showed that IgA1 was the predominant subclass. This was confirmed by the protein level in nasal fluids. Allergen-specific IgA was significantly higher in patients than in controls and correlated significantly with eosinophil granulae proteins. DNA micro-array analysis can be used to identify genes of possible relevance to allergic airway inflammation. In this study, the expression profile in the nasal mucosa was quantitatively dominated by immunoglobulins, particularly IgA. Protein analyses in nasal fluids indicated a role for allergen-specific IgA in eosinophil degranulation.

免疫療法による花粉症の発症予防とその機序 スギ花粉感作成立個体に対する予防的免疫療法

This study was designed to investigate whether prophylactic immunotherapy for individuals sensitized to Japanese cedar pollen could prevent an outbreak of pollen-induced allergic rhinitis. A total of 13 non-atopic volunteers and 67 patients sensitized to Dermatophagoides farinae (D. farinae) and Japanese cedar pollen were enrolled in the study. Before enrollment in the study, all of the 67 patients had perennial nasal symptoms due to D. farinae, but no seasonal aggravation of nasal symptoms. 32 patients were treated with immunotherapy using standardized D. farinae extracts alone (control group), and the remaining 35 patients were treated with immunotherapy using the same D. farinae extracts and Japanese cedar pollen extracts (immunotherapy group). The following results were derived from the study:1. Prophylactic immunotherapy significantly decreased incidences of the outbreak of seasonal allergic rhinitis due to pollen.2. IL-4 synthesis during the pollen season by peripheral blood T cells stimulated with the cedar pollen allergen were enhanced in the control group, whereas IL-4 synthesis during the season was not enhanced in the immunotherapy group. In particular, IL-4 synthesis during the season did not differ between the non-atopic volunteers and the patients who were treated with prophylactic immunotherapy for more than 3 years.In conclusion, prophylactic immunotherapy could prevent the outbreak of seasonal allergic rhinitis in those who had been sensitized to the pollen. Therefore, it is likely that prophylactic immunotherapy is a new method of decreasing the incidence of seasonal allergic rhinitis in Japan.

Anti-immunoglobulin E (omalizumab) therapy in seasonal allergic rhinitis.

Anti-immunoglobulin E (anti-IgE) (omalizumab), a humanized monoclonal anti-IgE antibody that binds to circulating IgE, has been studied in several large double-blind, randomized, placebo-controlled clinical trials to determine its pharmacokinetic characteristics, efficacy, and safety in ragweed- or birch pollen-induced seasonal allergic rhinitis (SAR). The consequences of readministering omalizulab after a lapse of time have also been studied. These studies have confirmed that serum-free IgE declines in a dose-related manner with such treatment and that omalizumab-induced declines in IgE correlate with symptom improvement. Whether omalizumab is administered intravenously or subcutaneously, its pharmacokinetics do not differ. A Phase II dose-ranging study demonstrated that the optimum efficacious dose of omalizumab for the treatment of seasonal allergic rhinitis is 300 mg administered subcutaneously. The dosing frequency, in terms of whether the antibody is administered every 3 or 4 wk, is based on the patient's baseline IgE level. With adequate dosing, nasal and ocular symptoms are significantly reduced, and quality of life is significantly improved. Omalizumab is safe and well tolerated and can be safely readministered in subsequent pollen seasons.

Comparison of Cedar Pollen-Induced Allergic Rhinitis in Passively and Actively Sensitized Guinea Pigs

We have developed an allergic rhinitis model in guinea pigs using Japanese cedar pollen as antigen. In the present study, we examined whether provocation by pollen induces similar magnitudes of rhinitis symptoms in passively and actively sensitized guinea pigs. One group of animals was actively sensitized by intranasal application of pollen extract, and another was passively sensitized by intraperitoneal injection with anti-pollen serum. Actively and passively sensitized groups were then challenged by repeated and a single pollen inhalation, respectively. In both groups, sneeze was induced immediately after the challenge. The actively sensitized animals developed not only early but also late nasal blockage, whereas the passively sensitized animals showed only early nasal blockage. In both groups, an Hi antagonist, mepyramine, inhibited the occurrence of sneezing but did not inhibit nasal blockage. Nasal hyperresponsiveness to intranasal instillation of leukotriene D4 was obvious only in the actively sensitized animals. We thus conclude that although early nasal blockage is induced by a single antigen-antibody reaction, repetitive anaphylactic reaction is required for occurrence of late nasal blockage and hyperresponsiveness to stimuli. Furthermore, his-tamine plays a central role in induction of sneezing but not in nasal blockage, irrespective of whether animals are actively or passively sensitized.

Development of pollen-induced allergic rhinitis with early and late phase nasal blockage in guinea pigs.

Development of nasal blockage and sneezing during repeated inhalation challenges with Japanese cedar pollens was evaluated in guinea pigs. Male Hartley guinea pigs. Guinea pigs were sensitized by intranasal instillation of cedar pollen extracts + Al(OH)3 2 times a day for 7 days. The animal was then forced to inhale the pollens for challenge, which was restrictively trapped in the upper airways, once a week. Change of specific airway resistance (sRaw), sneezing frequency, and titers of anaphylactic antibodies in the serum were measured after each of the 30 challenges. At the first challenge, no obvious increase in sRaw was observed. However, the second and third challenges to the animals caused modest biphasic elevations of sRaw, with peaks at the first and the fourth to sixth hour. At the fourth to tenth challenges, marked elevations of sRaw were observed. However, with repetition of the inhalation challenge, the early and the late responses became almost indistinguishable because of partial overlapping as the responses expanded. All guinea pigs sneezed immediately after each pollen inhalation challenge. Apparent increases of both circulating gamma1 and IgE antibodies were seen after the seventh challenge. These results indicate that the experimental allergic rhinitis established in the present study can be a valuable model for analyzing the pathogenesis of the disease and developing new therapeutic drugs.

Suppression of Seasonal Increase in Serum Interleukin-5 is linked to the Clinical Efficacy of Immunotherapy for Seasonal Allergic Rhinitis

Although immunotherapy is recognized as a highly effective form of treatment for allergic rhinitis, especially pollen-induced seasonal allergic rhinitis, the mechanisms have not been fully established. In the present study, we investigated whether immunotherapy could affect the seasonal increase in interleukin-5 (IL-5) in the serum of patients with seasonal allergic rhinitis and whether the effect on IL-5 in serum is related to the clinical efficacy of immunotherapy. Venous blood was collected twice from each patient with seasonal allergic rhinitis due to Japanese cedar pollens, before and during the cedar pollen season in 1997, to determine the cedar pollen-specific IgE and IL-5 in serum. Both specific IgE and IL-5 in serum were significantly increased during the pollen season, not only in the poor responders to antihistamines but also in the good responders. Neither the rate of seasonal increase in specific IgE nor the rate of seasonal increase in IL-5 differed significantly between the good responders and the poor responders to antihistamines. Both specific IgE and IL-5 were significantly increased during the pollen season in the poor responders to immunotherapy, whereas neither specific IgE nor IL-5 was increased during the pollen season in the good responders to immunotherapy. The rate of seasonal increase in specific IgE as well as IL-5 was significantly smaller in the good responders than in the poor responders to immunotherapy. The rates of seasonal increase in specific IgE and in IL-5 were inversely correlated with the length of time on immunotherapy. However, the rate of seasonal increase in specific IgE was not significantly correlated with the rate of seasonal increase in IL-5. In conclusion, the suppression of the seasonal increase in IL-5 in serum is a working mechanism of immunotherapy related to the clinical efficacy of the treatment.

Clinical Evaluation of Lumiward Immunoassay System for Detection of Specific IgE Associated with Allergic Rhinitis

The detection of specific IgE is a critical prerequisite for both the definitive diagnosis and the therapeutic strategy of allergic rhinitis and other allergic disorders. The aim of the present study was thus to evaluate the clinical significance of the solid phase capture system (CAP) and the lumiward immunoassay system (LMD) in the diagnosis of allergic rhinitis due to Dermatophagoides farinae ( D. farinae ) and Japanese cedar ( Cryptomeria japonica ) pollens. The specificity of both the CAP and the LMD in the detection of D. farinae -specific IgE and Japanese cedar pollen-specific IgE was 100%. The sensitivity to detect D. farinae -specific IgE was 95.76% in the skin test, 86.53% in the CAP and 88.53% in the LMD, respectively. The combination of the nasal provocation test and the CAP substituted for the skin test resulted in correct diagnoses for 98.25% of the patients, and the combination of the nasal provocation test and the LMD substituted for the skin test resulted in correct diagnoses for 98.00% of the patients. Therefore, the diagnostic significance of the LMD for perennial allergic rhinitis is likely to be equal to that of the CAP. The sensitivity to detect Japanese cedar pollen-specific IgE was 94.50% in the skin test, 84.47% in the CAP, and 96.76% in the LMD, respectively. The sensitivity of the CAP in the detection of Japanese cedar pollen-specific IgE was inferior to that of the skin test, but the sensitivity of the LMD in the detection of pollen-specific IgE was somewhat superior to that of the skin test. In addition, the combination of the nasal provocation test and the CAP substituted for the skin test resulted in correct diagnoses for 98.38% of the patients, whereas the combination of the nasal provocation test and the LMD substituted for the skin test resulted in correct diagnoses for 100% of the patients. Therefore, the diagnostic significance of the LMD for seasonal allergic rhinitis due to Japanese cedar pollens is probably larger than that of the CAP. In conclusion, the LMD may be a better “gold standard” for the detection of Japanese cedar pollen-specific IgE than the skin test, and the combination of the nasal provocation test and the LMD is a better diagnostic tool for the detection of Japanese cedar pollen-induced seasonal allergic rhinitis than the combination of the nasal provocation test and the skin test or the CAP.

Short-term immunotherapy: A prospective, randomized, double-blind, placebo-controlled multicenter study of molecular standardized grass and rye allergens in patients with grass pollen-induced allergic rhinitis

Background: Short-term immunotherapy (STI) can be beneficial for patients who are noncompliant with long-term specific immunotherapy. Objective: The efficacy and tolerance of STI with seven preseasonal injections of molecular standardized allergens from grass and rye pollen has been investigated in a double-blind, placebo-controlled multicenter study with 87 patients at 12 German University hospitals. Methods: Symptoms of the eyes, nose, and bronchi and use of symptomatic drugs were documented daily in diaries by patients with allergic rhinitis to grass and/or rye pollen and without bronchial asthma. Patients were monitored by skin prick test titration and measurement of levels of specific IgE and IgG4. Results: The median nasal score for the 10 weeks with the strongest symptoms during the grass pollen season was significantly lower ( p = 0.014) with 35.0 for STI ( n = 41) versus 69.0 for placebo ( n = 40); the overall symptom score was 54.0 for STI versus 97.5 for placebo ( p = 0.020). Only STI-treated patients exposed to less than 40 pollen grains per cubic meter per week showed a significantly lower nasal symptom score of 39.0 versus 75.0 for placebo ( p = 0.006); these patients also had fewer nasal symptoms and less use of topical nasal drugs ( p < 0.001). The threshold dose in skin prick tests was significantly higher, being 9.06 histamine equivalent for skin prick test (HEP) for STI-treated patients who received the maximum dose ( n = 22) versus 4.33 HEP for placebo ( p = 0.005). Specific IgE levels were significantly higher, being 55.9 SU/ml for STI versus 39.2 SU/ml for placebo after seven injections ( p = 0.006) and level of specific IgG4 was 5.36% for STI versus 1.28% for placebo ( p < 0.001). No severe systemic reactions were observed. Conclusion: STI with seven preseasonal injections with molecular standardized allergens is effective and well tolerated. J Allergy Clin Immunol 1997;100:23-9.

Allergen challenge-induced entry of α 2-macroglobulin and tryptase into human nasal and bronchial airways

Background: Microvascular-epithelial exudation of bulk plasma may characterize inflammatory airway diseases. This study compares the acute allergen challenge–induced mast cell and exudative responses in nasal and bronchial airways. The focus is on α 2-macroglobulin as an index of luminal entry of plasma exudates. Methods: Separate nasal and bronchial allergen challenges were carried out outside the pollen season in eight patients with pollen-induced seasonal allergic rhinitis. The levels of different-sized plasma proteins (albumin molecular weight, 66,000 d and α 2-macroglobulin molecular weight, 725,000 d) and tryptase were determined in pre- and postchallenge nasal lavage and bronchoalveolar lavage (BAL) fluids. Diluent and increasing doses of allergen were sprayed into the right nasal cavity, and each challenge was followed by a nasal lavage (volume, 15 ml) with a “nasal pool” device (recovery, >80%). Endobronchial allergen challenge (individual doses) and BAL (volume, 2 × 25 ml) were performed in a lobe bronchus through a fiberoptic bronchoscope (recovery, 30%). Saline challenge and BAL were carried out in the contralateral lung as control. Results: The levels of albumin, α 2-macroglobulin, and tryptase increased dose-dependently in postchallenge nasal lavage fluids ( p < 0.05) and correlated to nasal symptoms. In particular, albumin and α 2-macroglobulin correlated ( r = 0.98, p < 0.001). Both α 2-macroglobulin and tryptase, but not albumin, were increased in BAL fluids from the allergen-challenged side ( p < 0.05). Conclusion: Local allergen challenge causes luminal entry of tryptase and α 2-macroglobulin in the nose and bronchi of patients with allergy. We suggest that mast cell and plasma exudation responses may be similar in human nasal and bronchial airways and that albumin levels (in BAL fluids) may not well reflect the exudation process in bronchial airways. (J A LLERGY C LIN I MMUNOL 1995;96:239-46.)

Azelastine in Pollen-Induced Allergic Rhinitis

The manifestation of rhinitic symptoms in 9 patients with grass pollen-induced rhinitis was studied during long term allergen exposure at physiological concentrations in the ‘Vienna Challenge Chamber’. Patients were pretreated with a single dose of azelastine (either 2.2mg orally or 0.28mg intranasally) or placebo. Nasal resistance was estimated by active anterior rhinomanometry every 15 minutes. Analysis of changes in nasal airways resistance demonstrated significant protection against allergen-induced nasal obstruction (p < 0.01) for azelastine administered by either route. The onset of action of treatment in relation to nasal obstruction was significantly more rapid for the nasal spray (135 minutes) than for the tablet (205 minutes) [p < 0.01] formulation. Similarly, the onset of effect derived from subjective assessment of symptom severity was markedly more rapid (60 minutes) after intranasal azelastine than after administration of the oral form (120 minutes). Tolerability of azelastine was good, with no side effects reported with either oral or intranasal therapy.

花粉症に対するロキシスロマイシンの効果

The clinical effectiveness of roxithromycin (RXM), a new semisynthetic macrolide, in the treatment of allergic rhinitis was evaluated. Thirty-one patients who were treated in our outpatient clinic for Japanese cedar pollen-induced allergic rhinitis were selected for this clinical trial. They were treated with 150 mg/day of RXM in addition to the same medication they had received in the 1992 pollen season. RXM was administered from the 1993 pre-season until the end of May, 1993. The clinical efficacy of RXM was evaluated by a comparison of the nasal symptoms in 1992 season with those seen in 1993.1. The respective improvement rates for sneezing attacks, nasal hypersecretion, and nasal congestion were 53.3%, 50%, and 50%.2. Improvement and slight improvement rates according to Okuda' a criteria for general improvement were 45.2% and 58.1%, respectively.3. Improvement and slight improvement rates judged from questionnaires about general improvement were 45.2% and 58.1%, respectively.4. RXM administration superimposed on specific immunotherapy contributed significantly to clinical relief of nasal symptoms during the pollen season (improvement: 58.8%; slight improvement: 76.5%).5. RXM administration superimposed on nonspecific anti-allergic treatment had little effect on nasal symptoms during the season (improvement: 28.6%; slight improvement: 35.7%).6. Side effects were noted in 2 patients; slight upper abdominal discomfort.Our clinical study suggests that RXM is effective in the treatment of Japanese cedar pollen-induced allergic rhinitis. An additional suggestion is that RXM may enhance the mechanism by which specific immunotherapy alleviates nasal symptoms.

Cetirizine for seasonal allergic rhinitis in children aged 2‐6 years

A total of 107 children of both sexes between 2 and 6 years of age with pollen-induced seasonal allergic rhinitis (SAR) were entered in a multicentre study of double-blind parallel group design in which the effects of 5 mg cetirizine, given as drops from a solution containing 10 mg/ml once daily each evening for two weeks, were compared with those of identical placebo. Sneezing, rhinorrhea, nasal obstruction and nasal and ocular pruritus were the symptoms evaluated by means of symptom scores by investigators and, on daily record cards, by parents. Investigators also made a global evaluation at the end of treatment. Cetirizine was more active than placebo for each symptom evaluated both by parents and investigators. There were significant by more (p = 0.002) days during which symptoms were absent or mild, in the cetirizine than in the placebo group. When the maximum symptom scores rated by investigators at each visit were compared, the difference in favour of cetirizine at the end of treatment was statistically significant (p = 0.04). Global evaluation by investigators of changes in symptoms at the end of the study showed an improvement in both groups which was significantly greater with cetirizine, providing excellent or good improvement in 34/54 patients compared with 25/53 patients on placebo (p = 0.039). Tolerance was good. Three patients on cetirizine and none on placebo experienced mild somnolence.

Powder administration of pure budesonide for the treatment of seasonal allergic rhinitis

The objective of this study was to compare the efficacy and safety of a pure powder formulation of budesonide, delivered from a new multi-dose dispenser for nasal drug application, with the commercially available budesonide pressurized aerosol, and with placebo. Of 116 patients with grass pollen-induced allergic rhinitis, 112 finished the study, which comprised a 4-week treatment period, preceded by a 1-week run-in period. The patients were randomized to four parallel treatment groups: budesonide powder 400 micrograms daily; budesonide powder 800 micrograms daily; budesonide aerosol 400 micrograms daily; and placebo powder. Treatment was given once daily in the morning. The study was double-blind regarding comparison between budesonide powder and placebo. Assessment of efficacy, made by comparing mean scores of nasal symptoms and use of rescue medication, showed equal efficacy of all three budesonide groups compared with placebo. There were no differences between budesonide-and placebo-treated groups with regard to side effects. Budesonide treatment had no demonstrable effect on the HPA-axis assessed by measurement of 24-h urine cortisol. We conclude that budesonide, delivered as pure powder from a multi-dose dispenser, is effective and safe for the treatment of seasonal allergic rhinitis. This new formulation is a good alternative to the commercially available preparations, as it does not contain carrier gas, preservatives or lubricants.

Allergen injection therapy with glutaraldehyde-modified—ragweed pollen-tyrosine adsorbate: A double-blind trial

The effect of a preseasonal course of four injections of glutaraldehyde-modified—ragweed pollen-tyrosine adsorbate (MRTA), in a total dose of 7,000 Noon pollen units, was compared with a tyrosine base placebo in a double-blind trial in 43 matched patients with ragweed pollen-induced allergic rhinitis. During the pollen season, troublesome symptoms were treated with a standardized therapeutic regimen. The minimum medication requirement that adequately controlled symptoms was used as the main indicator of severity of the allergic rhinitis. Consequently, the symptom scores were similar in both treatment groups; however, the MRTA-treated group required approximately 50% less medication than the placebo group (p < 0.05). Subjective improvement was reported by 67% of the MRTA group and 38% of the placebo group (0.05 < p < 0.1). Serum concentrations of IgE and IgG antibodies to ragweed increased in response to MRTA (p < 0.02) but not in response to placebo. Side effects of MRTA included generalized urticaria in 2, mild asthma in 1, and large late swellings at the injection site which necessitated stopping the injections in 6 patients. MRTA was superior to placebo in reducing the severity of ragweed pollen-induced allergic rhinitis and was associated with a modest incidence of side effects.

Cromolyn sodium nasal solution in the prophylactic treatment of pollen-induced seasonal allergic rhinitis: A tri-city study of efficacy and safety

A large-scale multicenter investigation was undertaken in 3 cities with comparable pollen seasons and atmospheric pollen concentrations in order to obtain more definite information about the safety and efficacy of cromolyn sodium in the treatment of pollen-induced seasonal rhinitis. The 9-wk double-blind study was conducted in 104 patients in Pittsburgh, Pa., Cleveland, Ohio, and Louisville, Ky., during the 1975 ragweed season. It indicated that a nebulized 4% aqueous solution of cromolyn sodium is effective in reducing sneezing, rhinorrhea, nasal congestion, and ocular irritation in ragweed hay fever patients. The efficacy of the drug was notable despite the fact that patients used an average of 52 mg instead of the recommended 62.4 mg daily. Cromolyn sodium did not appear to have a significant effect on transseasonal antiragweed IgE (IgEAR) levels. Patients acceptance of the cromolyn nasal solution was good, and there were no significant adverse reactions. The side effects, which were distributed equally between the drug and placebo groups, were mild and of limited duration.