Summer Hay Fever Research Articles

Grass pollen immunotherapy inhibits allergen-induced infiltration of CD4+ T lymphocytes and eosinophils in the nasal mucosa and increases the number of cells expressing messenger RNA for interferon-γ

BACKGROUND: Grass pollen injection immunotherapy is effective in patients with summer hay fever, although efficacy must be balanced against possible side effects. The mechanism of immunotherapy is unknown but may be related to its ability to inhibit allergen-induced late responses, which are known to be characterized by infiltration of T lymphocytes, eosinophils, and cells with messenger RNA for so-called TH2-type cytokines (IL-4 and IL-5). OBJECTIVE: This study was designed to observe the effect of grass pollen immunotherapy on late nasal responses and associated cellular infiltration and cytokine mRNA expression. METHODS: We performed local nasal provocation with grass pollen (and a control challenge) in 28 patients after a 12-month double-blind, placebo-controlled trial of immunotherapy. Nasal biopsy specimens were obtained at 24 hours and processed for immunohistology and in situ hybridization studies. RESULTS: Grass pollen immunotherapy inhibited allergen-induced immediate (0 to 60 minutes) increases in sneezing (p < 0.02) and nasal blocking (p < 0.01) and late (0 to 24 hours) nasal symptoms (p < 0.05). Immunotherapy also inhibited the associated infiltration of the nasal mucosa by CD4+ T lymphocytes and total (major basic protein–containing) and “activated” (cationic protein–secreting) eosinophils (all p = 0.03). There was a significant (p = 0.04) increase in cells expressing mRNA for interferon-γ at 24 hours after allergen challenge, which correlated inversely with patients’ seasonal symptoms (r = -0.65, p < 0.05) and medication requirements (r = -0.75, p < 0.02) during the pollen season. CONCLUSION: The results suggest that successful grass pollen immunotherapy for summer hay fever may act by inhibiting allergen-induced T lymphocyte and eosinophil recruitment and eosinophil activation in the target organ, possibly through a mechanism involving protective local increases in TH1-type cells. (J ALLERGY CLIN IMMUNOL 1996;97:1356-65.)

Aeroallergens of plant origin: Molecular basis and aerobiological significance

This review presents an update on the sources and molecular basis of aeroallergens of plants, derived from pollen, seeds, leaf and stem detritus and their protein molecules. These aeroallergens are a natural component of the atmosphere, either because of their natural function or human activity. Pollen is a source of allergens within the 10–200 μm size range, and while most allergenic pollen types account for only 20–30% of total annual pollen catch, during their flowering season, they are usually the dominant type. Tree pollen commences the season in winter, with birch pollen counts in Scandinavia being the highest daily pollen counts yet reported and a major allergen, a 14-kDa protein, which is similar to pathogenesis-related proteins. Grass pollen follows in spring, and is unique as its two immunodominant allergens, a 35-kDa glycoprotein and 28–32-kDa protein, are in different cellular sites: the cytosol and surface of pollen grains; and in intracellular starch granules. The allergens at the pollen surface are not inhalable and can interact only with the eyes, nasal and oral cavities. Starch granules are released to the atmospheric aerosol when grains rupture in rainwater. These are a major source of allergen-containing micronic particles, which are important because they are inhalable. At the same time, allergen molecules are present in the aerosol, and these can bind to soot particles, and so be respired deep into the airways. The major Japanese cedar pollen allergen has been detected both within the pollen and in orbicules; particles less than 1 μm that line the anther cavity and can be released into the air when dehiscence occurs. Ragweed is the major cause of late summer hayfever in eastern North America, where its pollen accounts for up to 41% of the annual pollen catch. It is a major source of aeroallergens in both respirable and non-respirable size ranges. As a result of human activity, dusts derived from seeds and cereal grains during transport, storage and milling provide a source of micronic particles, containing potent allergens that can trigger allergic disease.

Injection immunotherapy. British Society for Allergy and Clinical Immunology Working Party.

A working party of the British Society for Allergy and Clinical Immunology has reviewed the role of specific allergen immunotherapy in the treatment of allergic disease and produced a position statement summarising the available evidence for efficacy and safety. The working party recommends specific allergen immunotherapy for treating summer hay fever uncontrolled by conventional medication and for wasp and bee venom hypersensitivity. It is not recommended for asthma or for allergic rhinitis due to other allergens. For the recommended indications the risk:benefit ratio is acceptable provided patients are carefully selected; in particular, patients with asthma should be excluded as they are especially vulnerable to adverse reactions. Injections should be given only by doctors experiences in this form of treatment in a clinic where full resuscitative facilities are immediately available. Provided patients remain symptom free a 60 minute observation period after injection is sufficient to detect all serious adverse reactions.

Allergy. Conventional and alternative concepts. A report of the Royal College of Physicians Committee on Clinical Immunology and Allergy.

Allergy is an exaggerated response of the immune system to external substances. It plays a role in a wide range of diseases. In some, such as summer hayfever, the symptoms are due entirely to allergy. In other conditions, particularly asthma, eczema and urticaria, allergy plays a part in some patients but not all. In these situations, allergy may have either a major role or provide just one of many triggers. In an individual patient's illness, the importance of allergy may change with time. The most common allergens (substances causing allergy) are grass and tree pollens, the house dust mite, products from pets and other animals, agents encountered in industry, wasp and bee venom, drugs, and certain foods. Food allergy presents a particularly difficult problem. Some individuals who react to food suffer from food allergy in its strict sense but in others there is no evidence of an alteration in the immune system. Here the term 'food intolerance' is preferable. Conventional doctors treat allergy by allergen avoidance--where this is possible--and drugs that relieve symptoms. In a few selected cases, in which other methods have failed, immunotherapy (desensitisation or hyposensitisation) is recommended. Although patients who consult practitioners of alternative allergy may do so by preference, it is often also because they are dissatisfied with the conventional approach to diagnosis and treatment, or because they have conditions which conventional doctors do not accept as having an allergic basis. There is a very wide range of alternative approaches to allergy, including the methods used by clinical ecologists and other treatments such as acupuncture and homoeopathy. Hypnosis may have a small role to play in helping the asthmatic and similar effects have been suggested for acupuncture. Furthermore, it is likely that there are still many active ingredients in medicinal plants used by herbalists but these need to be clearly identified and purified before their usefulness can be evaluated properly. Apart from these situations, we have yet to be convinced by substantial evidence that any of the other alternative methods of diagnosing or treating allergic disease are of proven value. There have, however, been many false and misleading claims and serious harm may be caused by misdiagnosis or delays in appropriate treatment. The public should be warned against costly methods of diagnosis and treatment which have not been validated.(ABSTRACT TRUNCATED AT 400 WORDS)

Immunotherapy with Alutard SQ reduced symptoms and need for medication in severe summer hay fever

Source Citation Varney VA, Gaga M, Frew AJ, et al. Usefulness of immunotherapy in patients with severe summer hay fever uncontrolled by antiallergic drugs. BMJ. 1991;302:265-9.1998791

Immunotherapy and allergic inflammation

A double-blind placebo-controlled trial of allergen injection immunotherapy in adult patients with severe summer hayfever. We used a partially purified biologically standardised grass pollen depot preparation (Alutard SQ, ALK Denmark Ltd.). Immunotherapy was extremely effective in reducing symptoms and medication requirements. Clinical improvement was accompanied by a decrease in both a target organ (conjunctival) and skin sensitivity. The injections were well-tolerated with minimal side effects. The results suggest that 30 minutes rather than 2 hours is an acceptable post-injection observation period. Successful immunotherapy was accompanied by suppression of the late cutaneous response to allergen. Specific immunostaining of skin biopsies revealed inhibition of the characteristic CD4+ T cell and EG2+ activated eosinophil cellular infiltrate during the late response. There was a significant relationship between CD4+ T cell and eosinophil counts after immunotherapy, i.e. the lower the number of infiltrating CD4+ cells, the lower the eosinophil counts. An unexpected finding was a prominent CD25+ (interleukin-2 receptor positive) cellular infiltrate which was only observed following Alutard SQ. Further studies involving double immunostaining methods should identify the phenotype of these activated, IL-2R+ cells. Based on murine studies Mosmann and colleagues have classified T cell responses into two types according to their profile of lymphokine production [11]. TH1 cells produce predominantly the IL-4 family of cytokines (IL-3, IL-4, IL-5) whereas TH2 cells produce predominantly interleukin-2 and interferon gamma. Insofar as the Mosmann classification may possibly be relevant to human T cell responses, the above findings would support a switch from a "TH2-" to a "TH1-" lymphocyte response following immunotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Hyposensitisation for summer hayfever

Hyposensitisation for summer hayfever

Usefulness of immunotherapy in patients with severe summer hay fever uncontrolled by antiallergic drugs.

To evaluate the efficacy and safety of immunotherapy (hyposensitisation) in patients with severe summer hay fever. A randomised, double blind, placebo controlled study of a biologically standardised depot grass pollen extract. Allergy clinic, Royal Brompton and National Heart Hospital, London. 40 adults (mean age 35 years) with a history of severe grass pollen allergy uncontrolled by standard antiallergic drugs. Patients with perennial asthma were specifically excluded. Patients were randomised to receive either an active preparation (Alutard SQ, a grass pollen (Phleum pratense) extract) or placebo at a rate of two subcutaneous injections a week in increasing doses until a maintenance dose was reached. This maintenance dose was given once a month. Clinical efficacy was evaluated by symptom and drug diary cards, visual analogue scores during the grass pollen season, and a postseasonal assessment by the patients and a doctor. Conjunctival and skin sensitivity to local allergen provocation was measured before and after eight months of treatment. There was a highly significant decrease (median Alutard SQ v median placebo (95% confidence interval for difference between medians] in total symptom scores (p=0.001) in the Alutard SQ treated group (360 v 928 (238 to 825]. Significant differences were also found in total drug use (p=0.002, 129 v 627 (178 to 574]. Visual analogue symptom scores were also reduced in the active group (p=0.02, 2.2 v 5.5 (-4.8 to -0.5]. The postseasonal assessment, by either the doctor or the patients, showed a large improvement (p less than 0.001) in favour of Alutard SQ. Provocation tests showed a greater than 10-fold reduction for the active group in immediate conjunctival allergen sensitivity (p=0.001), a 40% decrease in early phase response (p=0.02), and a 57% decrease in the late phase (p=0.001) cutaneous response after intradermal allergen. A total of 523 active injections were given. There was one systemic reaction at 10 minutes after injection, which was rapidly reversed with intramuscular adrenaline. There was one mild delayed urticarial reaction at 2 1/2 hours. Immunotherapy is effective in patients with severe summer hay fever, but immediate anaphylactic reactions limit its use to specialised centres. Patient selection is extremely important, and chronic perennial asthma should be specifically excluded. As serious reactions occur within minutes a two hour wait for all patients after each injection seems unnecessary.

Pollen immunotherapy should be considered for severe summer hay fever in refractory patients

Pollen immunotherapy should be considered for severe summer hay fever in refractory patients

A single dose desensitization for summer hay fever

A new type of desensitising vaccine, enzyme potentiated was subjected to a double-blind randomised study during the hay fever season. The vaccine is a convenient single injection given in March and the results show good protection throughout the grass pollen season.

Immunochemical Demonstration of Red Oak Pollen Aeroallergens outside the Oak Pollination Season

Abstract Airborne red oak (Quercus rubra) allergens were collected with volumetric air samplers during 1983–1985 and quantitated immunochemically using red oak pollen proteins adsorbed to plastic microtiter plates and pooled IgE-containing sera from seven oak-sensitive persons. Peak levels of allergen occurred in late April to early May and coincided with peak oak pollen counts from Rotoslide collections. However, additional peaks of oak allergenic activity were measured during July through early October, at times when oak pollen was not airborne. Most of the allergen was in particles smaller than 5 microns even during the pollination period. These peaks coincided with changes in wind from the usual northwest direction to a southernly direction. Among 19 other tree, grass, weed, mold, or insect allergens tested, only birch, and, to a lesser extent, willow, cross-reacted with red oak. We postulate that bits of decaying leaves, male catkins during the summer and early fall and other plant particles become airborne during changes in wind direction and velocity. Because other allergens, such as ragweed, Alternaria, grass and insects, are also abundant in late summer and fall, it will be very difficult to determine the degree to which this oak allergen contributes to late summer hay fever and asthma.

Forecasting the start and severity of the hay fever season.

SummarySince the season of summer hay fever may last only 4 weeks and rainfall may produce days with virtually no airborne pollen, the timing of clinical trials is important. To facilitate this a method of forecasting the first possible 100% symptom day, and the severity of the season in terms of light, moderate or severe, is presented. The forecast is based on temperature in April and May, and formulae tested by reference to records of grass pollen concentrations over Central London during 1961–70.

Cellular and humoral effects of hyposensitization in patients with summer hay fever.

Cellular and humoral effects of hyposensitization in patients with summer hay fever.

HIGH AND LOW DOSAGE POLLEN EXTRACT TREATMENT IN SUMMER HAY FEVER AND ASTHMA

AllergyVolume 9, Issue 3 p. 183-187 HIGH AND LOW DOSAGE POLLEN EXTRACT TREATMENT IN SUMMER HAY FEVER AND ASTHMA A. W. FRANKLAND, A. W. FRANKLAND LondonSearch for more papers by this author A. W. FRANKLAND, A. W. FRANKLAND LondonSearch for more papers by this author First published: November 1955 https://doi.org/10.1111/j.1398-9995.1955.tb03687.xCitations: 14AboutPDF 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 onFacebookTwitterLinked InRedditWechat Citing Literature Volume9, Issue3November 1955Pages 183-187 RelatedInformation

PROPHYLAXIS OF SUMMER HAY-FEVER AND ASTHMA: A CONTROLLED TRIAL COMPARING CRUDE GRASS-POLLEN EXTRACTS WITH THE ISOLATED MAIN PROTEIN COMPONENT

PROPHYLAXIS OF SUMMER HAY-FEVER AND ASTHMA: A CONTROLLED TRIAL COMPARING CRUDE GRASS-POLLEN EXTRACTS WITH THE ISOLATED MAIN PROTEIN COMPONENT

Summer hay-fever and asthma treated with antihistaminic drugs.

Summer hay-fever and asthma treated with antihistaminic drugs.

Mixed grass pollen vs. pure timothy extract in uncontrolled summer hay fever patients

1. 1. Of fifty summer hay fever patients who were doing poorly on pure timothy extract, thirty-six reported better results when treated with a mixture of the grasses. 2. 2. Thirty-two cases of this group who were not highly sensitive and who had reached their maintenance dose were changed from timothy to a mixture of the grasses. Thirteen developed constitutional symptoms when given the same quantity of the mixed grass pollen extract. 3. 3. Nine patients in our series gave more marked skin reactions to some of the individual grasses than to timothy when tested with the same unit strength. 4. 4. There is evidence, therefore, that the grass mixture contains specific antigenic factors which are absent in the pure timothy extract. 5. 5. Patients not doing well on pure timothy pollen extract should, therefore, receive a mixture of the common grasses, or an extract of mixed grasses should be routinely used.

Summer hay fever of unknown origin in the southeast

Summer hay fever of unknown origin in the southeast

The May fly as an exciting cause of seasonal allergic coryza and asthma

1. 1. The May fly and its pellicle are described. Allergic symptoms are believed to be caused by the inhalation of minute particles of the pellicle. 2. 2. Of 589 patients with seasonal hay fever and asthma studied during the years 1930 to 1937, 19 gave repeated positive skin reactions. Of these, 7 cases, or little over 1 per cent, could be really proved hypersensitive. The other 11 skin-positive cases were considered nonspecific reactors. 3. 3. The work of Figley is confirmed. This introduces another allergen which should be considered, especially by allergists who treat patients residing near the Great Lakes and other fresh water bodies. May fly hypersensitiveness should be remembered when patients with summer hay fever and asthma do not receive satisfactory results from the usual pollen treatments. In this respect, the May fly may take its place along the caddis fly as an excitant of allergic symptoms. It is not believed, however, that the former is as common an allergen as the latter. 4. 4. Three of the positive cases were treated with encouraging effect. However, the data pertaining to treatment with May fly extracts are too meager to warrant any conclusion at this time.

Further studies on the influences of regional differences in intracutaneous testing: Schmidt, W.: Klin. Wchnschr. 14: 738, 1935

1.1. The May fly and its pellicle are described. Allergic symptoms are believed to be caused by the inhalation of minute particles of the pellicle.2.2. Of 589 patients with seasonal hay fever and asthma studied during the years 1930 to 1937, 19 gave repeated positive skin reactions. Of these, 7 cases, or little over 1 per cent, could be really proved hypersensitive. The other 11 skin-positive cases were considered nonspecific reactors.3.3. The work of Figley is confirmed. This introduces another allergen which should be considered, especially by allergists who treat patients residing near the Great Lakes and other fresh water bodies. May fly hypersensitiveness should be remembered when patients with summer hay fever and asthma do not receive satisfactory results from the usual pollen treatments. In this respect, the May fly may take its place along the caddis fly as an excitant of allergic symptoms. It is not believed, however, that the former is as common an allergen as the latter.4.4. Three of the positive cases were treated with encouraging effect. However, the data pertaining to treatment with May fly extracts are too meager to warrant any conclusion at this time.