Seasonal Allergic Rhinoconjunctivitis Research Articles

A cost-effectiveness analysis of immunotherapy with SQ allergen extract for patients with seasonal allergic rhinoconjunctivitis in selected European countries

ABSTRACTBackground: Seasonal allergic rhinoconjunctivitis can, for some people, reduce quality of life and the ability to cope with everyday tasks.Scope: In this paper we investigate the cost-effective­ness of immunization therapy with Alutard SQ (ASQ) and compare the cost-effectiveness in countries where the therapy has been in use in order to assess the impact of national therapeutic practices on the results of health economic assessments. Data are obtained from a clinical trial carried out in 2001–2002. To evaluate the cost-effectiveness of immunization we have added data on resource use in Austria, Denmark, Finland, Germany, the Netherlands, and Sweden.Findings: The computations result in cost-effectiveness ratios for allergen immunization between €10 000 and €20 000 per QALY even without provision for indirect costs, and achieving dominance in most countries where indirect costs have also been taken into account. The country comparisons show that the direct cost of administrating the up-dosing and maintenance differs considerably between countries, and that the cost of medical staff is substantial, constituting in most cases more than half of the direct costs of the immunization therapy.Conclusion: The study shows that immunotherapy with SQ allergen extract is cost-effective in a wide range of national environments, and that cost-effectiveness differences by country are largely a result of different practices in the up-dosing phase.

Erfolgreiche spezifische Immuntherapie (SIT) bei Rhinoconjunctivitis allergica und persistierendem atopischem Handekzem

Specific immunotherapy (SIT) is the only causal treatment for an IgE-mediated allergy such as allergic rhinoconjunctivitis. In patients with concomitant atopic eczema (AE) and allergic rhinoconjunctivitis, it is still applied restrainedly. A 44-year-old man working in a sheltered workshop had been suffering from AE since childhood, and seasonal allergic rhinoconjunctivitis experiencing frequent bouts of eczema also during adulthood, which after several years of working were increasingly dominating as severe hand eczema. Various therapies such as medical rehabilitation, various topical therapies and implementation of protective measures on the job reduced the severity of hand eczema, but complete absence of eczema, however, could not be achieved. At the same time, seasonal rhinoconjunctival symptoms severely exacerbated, particularly pronounced during spring as well as during the summer months. By application of a short-time SIT (grasses-rye) with the adjuvant monophosphoryl lipid A (Pollinex Quattro), almost complete absence of symptoms of seasonal rhinoconjunctivitis could be achieved during the following summer. Interestingly, the patient had a 1-time eczema response at the injection site after the first application which disappeared after 14 days. During the following months, a distinct improvement of the hand eczema occurred and, to date, the patient is free of eczema lesions except ofxerosis cutis primarily of the hands, occurring mainly during winter. Until now, the patient has remained in his job without any sick leave. In the meantime, SIT with the same adjuvant preparation was also applied against the pollen of trees (birch, hazel, alder). This case report demonstrates that SIT containing the adjuvant monophosphoryl lipid A is well-tolerated and is able to positively affect the course of eczema in AE patients including severe form of atopic hand eczema.

Efficacy of combination treatment with Omalizumab and specific immunotherapy (Depigoid®) in adult and adolescent patients with seasonal allergic asthma and comorbid seasonal allergic rhinoconjunctivitis

Efficacy of combination treatment with Omalizumab and specific immunotherapy (Depigoid®) in adult and adolescent patients with seasonal allergic asthma and comorbid seasonal allergic rhinoconjunctivitis

Do skin prick and conjunctival provocation tests predict symptom severity in seasonal allergic rhinoconjunctivitis?

In the investigation of seasonal allergic rhinoconjunctivitis (SAR), quantitative skin and conjunctival allergen challenge tests are used to measure individual allergen sensitivity. These tests are reproducible and relate well to prevalence but their relationship to symptom severity is less well established. We wished to determine if quantitative skin prick tests (QSPT) and conjunctival provocation tests (CPTs) using a single grass pollen allergen extract are reproducible and predict symptom severity in SAR. We retrospectively analysed data from 91 participants in a previously published randomized placebo controlled study of low dosage allergen immunotherapy who were randomized to receive placebo treatment. We examined the relationship between pre-seasonal QSPT, CPT and SAR symptoms. We found a high level of reproducibility when repeated measures were compared for both the QSPT (P < 0.001) and the CPT (P < 0.001) and moderate correlation (0.49) between the standard skin prick test (SPT) and the QSPT (P < 0.001). We found weak negative correlation (-0.27) between the QSPT and the CPT (P < 0.001). We found no correlation between seasonal symptom, use of rescue medication or quality of life (QOL) scores and pre-seasonal QSPT or CPT. Conclusion In the assessment of seasonal rhinoconjunctivitis, quantitative skin and conjunctival allergen challenge tests are strongly reproducible, although there is no correlation between these tests and seasonal symptom, use of rescue medication or QOL scores.

Patterns of Allergic Reactivity and Disease in Olympic Athletes

Because the Sydney Olympic Games were being held in the spring, we wished to examine the prevalence of allergic disorders in the Australian Olympic and Paralympic athletes and to examine patterns of allergic reactivity and medication use for the treatment of allergic symptoms. A survey case series of Australian Olympic and Paralympic athletes. Screening was conducted on team processing days. Prospective members of the Australian Olympic and Paralympic teams. A questionnaire seeking information on the presence of allergic disorders, symptoms, family history, and medication use was administered. Skin-prick tests (SPT) for sensitivity to common aeroallergens was performed. Athletes were classified as atopic or non-atopic, and patterns of reactivity were examined according to sporting category. Of the athletes, 56% had a positive SPT to at least 1 allergen, with 34% reacting to at least 1 seasonal allergen. There was no significant association between skin test reactivity and sporting category. Of the athletes, 37% had allergic rhinoconjunctivitis (AR/C), whereas 24% had seasonal allergic rhinoconjunctivitis (SAR/C). Approximately one-third of all those with AR/C had a history of asthma, whereas approximately one-fifth had a history of atopic dermatitis. Swimmers were most likely to have asthma, AR/C, and positive skin tests to any allergen. Very few athletes with self-reported AR/C took any medication to relieve their symptoms. Allergic disorders are common among athletes from all sports. The known impact of AR/C on quality of life necessitates that it be screened for and managed appropriately.

Specific immunotherapy with standardized quality allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis

Specific immunotherapy with standardized quality allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis

Efficacy and safety of sublingual immunotherapy with grass allergen tablets for seasonal allergic rhinoconjunctivitis

Allergen immunotherapy (desensitization) by injection is effective for seasonal allergic rhinitis and has been shown to induce long-term disease remission. The sublingual route also has potential, although definitive evidence from large randomized controlled trials has been lacking. The aim was to confirm the efficacy of a rapidly dissolving grass allergen tablet (GRAZAX, ALK-Abelló, Hørsholm, Denmark) compared with placebo in patients with seasonal rhinoconjunctivitis. A longitudinal, double-blind, placebo-controlled, parallel-group study that included 51 centers from 8 countries. Subjects were randomized (1:1) to receive a grass allergen tablet or placebo once daily. A total of 634 subjects with a history of grass pollen-induced rhinoconjunctivitis for at least 2 years and confirmation of IgE sensitivity (positive skin prick test and serum-specific IgE) were included in the study. Subjects commenced treatment at least 16 weeks before the grass pollen season, and treatment was continued throughout the entire season. The primary efficacy analysis showed a reduction of 30% in rhinoconjunctivitis symptom score (P < .0001) and a reduction of 38% in rhinoconjunctivitis medication score (P < .0001) compared with placebo. Side effects mainly comprised mild itching and swelling in the mouth that was in general well tolerated and led to treatment withdrawal in less than 4% of participants. There were no serious local side effects and no severe systemic adverse events. Sublingual immunotherapy with grass allergen tablets was effective in grass pollen-induced rhinoconjunctivitis. The tablet was well tolerated with minor local side effects. The grass allergen tablet represents a safe alternative to injection immunotherapy suitable for home use.

A Prospective, Randomized, Double-blind, Placebo-Controlled Multi-centre Study on the Efficacy and Safety of Sublingual Immunotherapy (SLIT) in Children With Seasonal Allergic Rhinoconjunctivitis to Grass Pollen

Purpose of the Study. Subcutaneous immunotherapy (SCIT) for seasonal allergic rhinitis is a well-established, effective, and potentially curative therapy. This study evaluated an alternate route for immunotherapy: the oral mucosa and gastrointestinal tract. Study Population. Ninety-seven children, aged 3 to 14 years, with seasonal allergic rhinitis and proven sensitivity to grass pollen were studied. Methods. Sensitivity to grass pollen was confirmed by positive skin-prick test, grass pollen–specific immunoglobulin E, and conjunctival provocation test. Patients were enrolled in a prospective, double-blind trial comparing sublingual immunotherapy (SLIT) to placebo. The treatment duration was 32 months. The primary outcome measure was the change in a multiple-symptom/medication score (which measured eye, nasal, and lung symptoms and rescue-medication use) after treatment. Data collected included patient-reported symptom scores and medication use, total and antigen-specific immunoglobulin E, skin-prick test, conjunctival provocation test, nasal provocation test, spirometry, exhaled nitric-oxide concentration, atopic dermatitis score, and eosinophilic cationic protein in nasal lavage fluid. Results. The multiple-symptom/medication score was significantly reduced by SLIT to 77.3% of the placebo group (P = .049). This overall score was affected mainly by a large reduction in rescue-medication usage among those in the treatment group (67% of placebo; P = .0025). There was no significant difference in any individual-symptom score. Conclusion. SLIT had a positive effect on rescue-medication usage but no significant effect on symptoms alone. Reviewer Comments. SLIT represents an alternative therapy with multiple potential advantages to SCIT, including the elimination of injections and improved safety profile. Several studies in adults and children have found improvement in symptom scores as well as reductions in medication use to the point where this is now being used in clinical practice in place of SCIT in many European countries. Additional studies, including investigation of optimal dosing and the potential to use multiple allergens, are needed to further define the future role of SLIT in the United States.

Sublingual immunotherapy with once-daily grass allergen tablets: A randomized controlled trial in seasonal allergic rhinoconjunctivitis

Specific immunotherapy is the only treatment modality that has the potential to alter the natural course of allergic diseases. Sublingual immunotherapy has been developed to facilitate access to this form of treatment and to minimize serious adverse events. To investigate the efficacy and safety of sublingual grass allergen tablets in seasonal allergic rhinoconjunctivitis. A multinational, multicenter, randomized, placebo-controlled trial conducted during 2002 and 2003. Fifty-five centers in 8 countries included 855 participants age 18 to 65 years who gave a history of grass pollen-induced allergic rhinoconjunctivitis and had a positive skin prick test and elevated serum allergen-specific IgE to Phleum pratense. Participants were randomized to 2500, 25,000, or 75,000 SQ-T grass allergen tablets (GRAZAX; ALK-Abelló, Hørsholm, Denmark) or placebo for sublingual administration once daily. Mean duration of treatment was 18 weeks. Average rhinoconjunctivitis scores during the season showed moderate reductions of symptoms (16%) and medication use (28%) for the grass allergen tablet 75,000 SQ-T (P = .0710; P = .0470) compared with placebo. Significantly better rhinoconjunctivitis quality of life scores (P = .006) and an increased number of well days (P = .041) were also observed. Efficacy was increased in the subgroup of patients who completed the recommended preseasonal treatment of at least 8 weeks before the grass pollen season (symptoms, 21%, P = .0020; and medication use, 29%, P = .0120). No safety concerns were observed. This study confirms dose-dependent efficacy of the grass allergen tablet. Although further studies are required, the greater tolerability of the tablet may permit immunotherapy to be available to a much broader group of patients with impaired quality of life caused by grass pollen allergy. For patients with grass pollen allergy, sublingual immunotherapy is well tolerated and can reduce symptoms and improve quality of life.

Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis

Specific immunotherapy is widely used to treat allergic rhinitis, but few large-scale clinical trials have been performed. We sought to assess the efficacy and safety of specific immunotherapy with 2 doses of Alutard grass pollen in patients with moderately severe seasonal allergic rhinitis inadequately controlled with standard drug therapy. We performed a double-blind, randomized, placebo-controlled study of 410 subjects (203 randomized to 100,000 standardized quality units [SQ-U] maintenance, 104 to 10,000 SQ-U, and 103 to placebo). Three hundred forty-seven (85%) completed treatment. Groups were well matched for demographics and symptoms. Across the whole pollen season, mean symptom and medication scores were 29% and 32% lower, respectively, in the 100,000-SQ-U group compared with those in the placebo group (both P < .001). Over the peak pollen season, mean symptom and medication scores were 32% and 41% lower, respectively, than those in the placebo group. The 10,000-SQ-U group had 22% less symptoms than the placebo group over the whole season (P < .01), but medication scores reduced by only 16% (P = .16). Quality-of-life measures confirmed the superiority of both doses to placebo. Local and delayed side effects were common but generally mild. Clinically significant early and delayed systemic side effects were confined to the 100,000-SQ-U group, but no life-threatening reactions occurred. One season of immunotherapy with Alutard grass pollen reduced symptoms and medication use and improved the quality of life of subjects with moderately severe hay fever. The 100,000-SQ-U regimen was more effective, but the 10,000-SQ-U regimen caused fewer side effects.

Impairment in quality of life is directly related to the level of allergen exposure and allergic airway inflammation

Allergic disease has been shown to impair health-related quality of life (HRQL). The relationship between HRQL and either allergen exposure or allergic inflammation has not been previously assessed. To assess the relationship between HRQL and both grass pollen exposure and airway inflammation using the Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ). This is a novel questionnaire previously developed to assess the multi-system aspects of allergic disease. Eighty-four subjects, aged 6-17 years, with seasonal allergic rhinoconjunctivitis, asthma and/or cutaneous manifestations were assessed before and during the grass pollen season. They were assessed with the PADQLQ, a visual analogue scale (VAS) to assess quality of life, symptom diary and exhaled nitric oxide (FENO). HRQL, as measured by the PADQLQ, significantly correlated with the average pollen count in the previous week (regression coefficient 0.038, 95% confidence interval (CI) 0.027-0.049, P<0.001). The PADQLQ score was also found to be significantly associated with airway inflammation as measured by FENO (regression coefficient 0.410, 95% CI 0.175-0.646, P=0.001). Additionally, PADQLQ showed a high degree of correlation with symptom scores and quality of life as measured by a VAS, good within-subject reliability and a small minimal important difference (0.20, 95% CI -0.09 to 0.49 on a seven-point scale). HRQL is related to both allergen load and allergic inflammation and the PADQLQ has excellent cross-sectional and longitudinal validity with respect to quality of life and symptoms.

Recurrent IgM nephropathy associated with seasonal allergic rhinitis

AllergyVolume 60, Issue 10 p. 1332-1332 Recurrent IgM nephropathy associated with seasonal allergic rhinitis M. Al-Ahmad, M. Al-Ahmad Division of Allergy and Clinical Immunology St. Michael's Hospital 30 Bond St. Toronto Ontario Canada M5B 1W8 Tel: +1-416-8851566 E-mail: [email protected]Search for more papers by this authorS. Betschel, S. Betschel Division of Allergy and Clinical Immunology St. Michael's Hospital 30 Bond St. Toronto Ontario Canada M5B 1W8 Tel: +1-416-8851566 E-mail: [email protected]Search for more papers by this authorP. Vadas, P. Vadas Division of Allergy and Clinical Immunology St. Michael's Hospital 30 Bond St. Toronto Ontario Canada M5B 1W8 Tel: +1-416-8851566 E-mail: [email protected]Search for more papers by this author M. Al-Ahmad, M. Al-Ahmad Division of Allergy and Clinical Immunology St. Michael's Hospital 30 Bond St. Toronto Ontario Canada M5B 1W8 Tel: +1-416-8851566 E-mail: [email protected]Search for more papers by this authorS. Betschel, S. Betschel Division of Allergy and Clinical Immunology St. Michael's Hospital 30 Bond St. Toronto Ontario Canada M5B 1W8 Tel: +1-416-8851566 E-mail: [email protected]Search for more papers by this authorP. Vadas, P. Vadas Division of Allergy and Clinical Immunology St. Michael's Hospital 30 Bond St. Toronto Ontario Canada M5B 1W8 Tel: +1-416-8851566 E-mail: [email protected]Search for more papers by this author First published: 31 August 2005 https://doi.org/10.1111/j.1398-9995.2005.00889.xCitations: 1 A case of recurrent IgM nephropathy associated with seasonal allergic rhinoconjunctivitis in an adult. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume60, Issue10October 2005Pages 1332-1332 RelatedInformation

Nasal Rinsing with Hypertonic Solution: An Adjunctive Treatment for Pediatric Seasonal Allergic Rhinoconjunctivitis

Background: Recent but limited evidence suggests that nasal lavage with hypertonic saline may be useful as an adjunctive treatment modality in the management of pediatric allergic rhinitis. The aim of this study was to clarify whether nasal irrigation with hypertonic solution should be routinely recommended to children with seasonal grass pollen rhinoconjunctivitis. Methods: Fourty-four children with seasonal grass pollen rhinoconjunctivitis were recruited. Twenty-two patients were random ized to receive three-times daily nasal rinsing with hypertonic saline during the pollen season, which lasted 7 weeks. Twenty-two patients were allocated to receive no nasal irrigation and were used as controls. Twenty patients per group completed the study. A mean daily rhinoconjunctivitis score based on the presence of nasal discharge and obstruction as well as ocular symptoms as reddening and itching were calculated for each week of the pollen season. Patients were allowed to use oral antihistamines when required and the mean number of drugs taken per week was also calculated. Results: The mean weekly rhinoconjunctivitis score in the active group was reduced during the whole pollen period. This difference was statistically significant in week 6 and 7 of therapy. A markedly reduced intake of oral antihistamines was also observed in patients allocated to nasal rinsing, being statistically significant in 5 of the 7 weeks. No adverse effect was reported in the active group. Conclusions: This study supports the use of nasal rinsing with hypertonic saline in the pediatric patient with seasonal allergic rhinoconjunctivitis. This treatment proved to be tolerable, inexpensive and effective.

Lack of Detectable Alterations in Immune Responses during Sublingual Immunotherapy in Children with Seasonal Allergic Rhinoconjunctivitis to Grass Pollen

Background: Recent work indicates that subcutaneous specific immunotherapy induces specific T-cell anergy, a shift in the TH1/TH2 ratio, and antibody production in favor of IgG4. There are few data on sublingual immunotherapy (SLIT), especially in children. Methods: We assessed the proliferation of peripheral blood mononuclear cells (³H-thymidine incorporation) and secretion of interleukin (IL)-4, interferon (IFN)γ and IL-5 (ELISA) after in vitro stimulation with allergen or phytohemagglutinin (PHA) in 29 children with allergic rhinoconjunctivitis receiving SLIT with grass pollen before, and after 1 and 2 years of treatment in a multicenter placebo-controlled study on the efficacy of the treatment. Further, non-specific intracellular production of IL-4, IL-13, IFNγ, IL-2, IL-10 and IL-5 (FACS) and serum total and specific IgE and IgG4 (ELISA) were analyzed. Results: Proliferation and IL-4 and IL-5 secretion after stimulation with allergen or PHA did not differ between the groups. In addition, we observed no effect of SLIT on intracellular cytokine production. IFNγ secretion after allergen coculture was comparable between the groups. Following PHA stimulation, IFNγ secretion was significantly higher in the SLIT group after 1 year, and a trend was observable already before and after 2 years of treatment, probably due to the inhomogeneity in the groups despite randomization (for age and asthma). No significant changes were observed for sIgE/sIgG4 ratios over time either in or between the groups. Conclusion: During 2 years of SLIT in children with a positive effect on rescue medication use, we observed no significant effects on in vitro T-cell immune responses or immunoglobulins. So far, pediatric studies demonstrating stable effects of SLIT on such reactions are missing, probably due to limited effects of SLIT on systemic immunologic reactions.

A prospective, randomized, double‐blind, placebo‐controlled multi‐centre study on the efficacy and safety of sublingual immunotherapy (SLIT) in children with seasonal allergic rhinoconjunctivitis to grass pollen

Especially in childhood, sublingual immunotherapy (SLIT) could offer advantages over subcutaneous therapy. However, limited data on its efficacy is available. In four German centres 97 children (age 3-14 years) with allergic rhinoconjunctivitis to grass pollen were enrolled in a prospective, double-blind trial comparing SLIT (Pangramin SLIT; ALK-SCHERAX, 0.5 microg major allergens, three times per week, 32 months) with placebo. Primary endpoint was a multiple symptom-medication score for changes in seasonal diary entries between the first and third year of the study (SLIT n=39; placebo n=38). The multiple symptom-medication score was significantly reduced by SLIT to 77.3% of the placebo group (P=0.0498). The subsequent analysis of the single endpoints did not reveal significant differences for symptom scores in favour of SLIT (85.1% of placebo group; P=0.22). However, the medication score improved significantly (67.1% of placebo group; P=0.0025). Furthermore, secondary endpoints assessing in vivo immune responses did not differ significantly between the groups. However, retrospective analysis showed some inhomogeneity for clinical and in vitro parameters at the beginning of the study. Allergic side effects with possible relation to the study drug were reported in both groups (SLIT 49%, placebo 27%, P=0.026). Our study indicates that SLIT had a positive effect on the reduction of a multiple symptom-medication score, mainly by significantly reducing rescue medication use, but had no significant effect on symptoms alone in children with rhinoconjunctivitis to grass pollen compared with a placebo.

Effect of anti‐immunoglobulin E on nasal inflammation in patients with seasonal allergic rhinoconjunctivitis

Effect of anti‐immunoglobulin E on nasal inflammation in patients with seasonal allergic rhinoconjunctivitis

Clinical efficacy of olopatadine hydrochloride ophthalmic solution 0.2% compared with placebo in patients with allergic conjunctivitis or rhinoconjunctivitis: a randomized, double-masked environmental study

BackgroundPrevious studies have suggested that olopatadine hydrochloride ophthalmic solution 0.2% administered once daily is effective for up to 24 hours after instillation and is well tolerated in adults and children aged ≥3 years. ObjectiveThe goal of this study was to evaluate the efficacy and safety profile of olopatadine 0.2% compared with placebo in patients with seasonal allergic conjunctivitis or rhinoconjunctivitis. MethodsThis was a 10-week, randomized, placebo-controlled, double-masked environmental study conducted during the spring allergy season (April–August) of 2003. Patients assessed their ocular signs and symptoms in terms of frequency (whole-unit scale from 0 to 5) and severity (half-unit scale from 0 to 4), and grass pollen counts were obtained daily for each investigative site. Responder analyses were conducted by pollen level (frequency based) and pollen period (severity based) to evaluate the clinical significance of differences in ocular itching and redness between treatment groups. ResultsTwo hundred sixty patients (137 females, 123 males) were enrolled in the study, including 28 children aged between 11 and 17 years; the overall population was 74% white, 11% black, 4% Hispanic, and 11% other. The frequency-based responder analyses of ocular itching and redness showed that when grass pollen counts were high (>20 gr/m3 air), a respective 21% and 14% of patients in the olopatadine 0.2% group assessed the frequency of ocular itching and redness as >2, compared with 47% and 31% of patients in the placebo group (P < 0.001 for ocular itching; P < 0.003 for redness). The results of the severity-based responder analyses by peak pollen period were consistent with those of the frequency-based analyses. Compared with placebo, olopatadine 0.2% was associated with significant reductions in calculated mean scores for ocular itching and redness by pollen level and by pollen period. No patient was discontinued from the study because of a treatment-related adverse event, and no patient experienced a treatment-related serious adverse event. ConclusionIn the patients studied, olopatadine 0.2% appeared to be effective and well tolerated when administered once daily for the treatment of the ocular signs and symptoms of allergic conjunctivitis or rhinoconjunctivitis.

Alutard SQ grass demonstrates clinical efficacy in subjects with seasonal allergic rhinoconjunctivitis in a large-scale double-blind placebo controlled study of specific allergy vaccination (the AVANZ study)

Rationale Valuation of the clinical efficacy and safety of Specific Allergy Vaccination (SAV) with Alutard SQ Grass in the doses 100,000 SQ-U and 10,000 SQ-U. Methods Subjects aged 18 to 60 years with grass pollen-induced allergic rhinoconjunctivitis not adequately controlled by symptomatic treatment were included. In all, 203 subjects were randomized to 100,000 SQ-U, 104 to 10,000 SQ-U and 103 to placebo. Up-dosing was performed over 8 weeks. Maintenance treatment was given every 6 weeks +/− 2. Subjects completed a daily diary card on symptoms and use of allergy medication. Allergic symptoms were assessed weekly by Visual Analogue Scale (VAS) and Quality of Life (QoL) was measured. Subjects were given free symptomatic medication during the study. Results In the 100,000 SQ-U group reductions were obtained in symptom and medication score and VAS compared to placebo (p<0.001). The 10,000 SQ-U group obtained reduction in symptom score (p<0.013). Reduction in symptom/medication score over placebo was 41/48% in the 100,000 SQ-U group compared to 24/21% in the 10,000 SQ-U group (peak season). QoL was statistically significant better in subjects who received active treatment compared to placebo. Allergic reactions to injections were reported in all groups and most frequently in the 100,000 SQ-U group. Most systemic reactions were non-specific or mild (WHO position paper). Non-life threatening systemic reactions all responded to symptomatic allergy treatment and adrenaline was used on only one occasion. No anaphylactic reactions were reported. Conclusions SAV with Alutard SQ Grass 100,000 SQ-U is clinically effective, superior to 10,000 SQ-U and well tolerated.

Anti‐inflammatory and anti‐allergic effect of rosmarinic acid (RA); inhibition of seasonal allergic rhinoconjunctivitis (SAR) and its mechanism

The present study was undertaken to determine whether oral supplementation with rosmarinic acid (RA) is an effective intervention for patients with SAR. In addition, the anti-inflammatory mechanism of RA also estimated in the ear edema models. Patients were treated daily with RA (200 mg or 50 mg) or placebo for 21 days. Patients recorded symptoms daily and profiles of infiltrating cells and concentration of cytokines were measured in nasal lavage fluid. Compared to placebo, supplementation with RA resulted in a significant decrease in responder rates for each symptom. RA also significantly decreased the numbers of neutrophils and eosinophils in nasal lavage fluid. Topical application RA showed anti-inflammatory activity 5-hours after 12-tetradecanoylphorbol 13-acetate (TPA) treatment with marked inhibition of neutrophil infiltration. Up regulation of ICAM-1, VCAM-1 cyclooxygenase-2 (COX-2), KC and MIP-2 by TPA were markedly reduced by pre-treatment with extract of perilla (PE) or RA. Reactive oxygen radical production detected as thiobarbituric acid reactive substance (TBARS), lipid peroxide (LPO) and 8-hydroxy-2'deoxyguanosine (8OH-dG), by double treatment of TPA was reduced by pretreatment with PE or RA. RA is an effective intervention for SAR that is mediated by inhibition of PMNL infiltration. This effect of RA is due to two independent mechanisms: inhibition of the inflammatory response and scavenging of ROS.

Myeloperoxidase Release After Allergen‐Specific Conjunctival Challenge

Background: Allergen‐specific conjunctival challenge is a fruitful and complete tool in evaluating pathophysiological phenomena of allergic inflammation. After challenge, a significant neutrophil infiltrate occurred in allergic subjects. The primary (azurophilic) granules of neutrophils contain a variety of enzymes that might potentiate inflammation, such as myeloperoxidase (MPO). It is not known whether allergen‐specific conjunctival challenge (ASCC) is able to elicit MPO release. We also investigated the possible role of immunotherapy (IT) in the release of MPO. Method: The groups studied included Dactylis glomerata‐sensitive adult atopic patients suffering from seasonal allergic rhinoconjunctivitis, and healthy adult nonatopic volunteer controls. One group of allergic patients received no specific hyposensitization (not‐IT allergic group). A second group of allergic patients had been immunotherapy‐treated with Dactylis glomerata extract for the preceding three years and continued to receive a maintenance dose within the highest potency of the extract (IT‐allergic group). ASCC with Dactylis glomerata was performed outside the pollen season in all subjects. Myeloperoxidase was assayed by MPO‐enzyme immunoassay method. Results: Thirty minutes after challenge, myeloperoxidase levels in the non‐immunotherapy allergic patients were significantly higher compared than in the healthy group (p < 0.001). The levels of myeloperoxidase released in the immunotherapy allergic group were significantly lower than those in the nonimmunotherapy allergic group (p < 0.001) and higher than those in non‐allergic subjects (p < 0.001). Conclusion: These results indicate that after ASCC there is a release of MPO. Our study suggests that immunotherapy actively modifies the release of MPO after ASCC.