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Intradermal grass pollen immunotherapy increases TH2 and IgE responses and worsens respiratory allergic symptoms.

Authors
  • Slovick, Anna1
  • Douiri, Abdel2
  • Muir, Rachel3
  • Guerra, Andrea4
  • Tsioulos, Konstantinos4
  • Hay, Evie4
  • Lam, Emily P S4
  • Kelly, Joanna5
  • Peacock, Janet L2
  • Ying, Sun4
  • Shamji, Mohamed H6
  • Cousins, David J7
  • Durham, Stephen R6
  • Till, Stephen J8
  • 1 Division of Asthma, Allergy and Lung Biology, King's College London, School of Medicine, Guy's Hospital, London, United Kingdom; MRC-Asthma UK Centre for Allergic Mechanisms of Asthma, London, United Kingdom. , (United Kingdom)
  • 2 Division of Health and Social Care Research, King's College London, 4th floor Addison House, Guy's Campus, London, United Kingdom. , (United Kingdom)
  • 3 Clinical Research Facility, NIHR Biomedical Research Centre, Guy's Hospital, London, United Kingdom. , (United Kingdom)
  • 4 Division of Asthma, Allergy and Lung Biology, King's College London, School of Medicine, Guy's Hospital, London, United Kingdom. , (United Kingdom)
  • 5 King's Clinical Trials Unit, King's College London, Institute of Psychiatry, London, United Kingdom. , (United Kingdom)
  • 6 Allergy and Clinical Immunology, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, United Kingdom. , (United Kingdom)
  • 7 Division of Asthma, Allergy and Lung Biology, King's College London, School of Medicine, Guy's Hospital, London, United Kingdom; Department of Infection, Immunity and Inflammation, NIHR Leicester Respiratory Biomedical Research Unit, Leicester Institute for Lung Health, University of Leicester, Leicester, United Kingdom; MRC-Asthma UK Centre for Allergic Mechanisms of Asthma, London, United Kingdom. , (United Kingdom)
  • 8 Division of Asthma, Allergy and Lung Biology, King's College London, School of Medicine, Guy's Hospital, London, United Kingdom; MRC-Asthma UK Centre for Allergic Mechanisms of Asthma, London, United Kingdom. Electronic address: [email protected] , (United Kingdom)
Type
Published Article
Journal
The Journal of allergy and clinical immunology
Publication Date
Jun 01, 2017
Volume
139
Issue
6
Identifiers
DOI: 10.1016/j.jaci.2016.09.024
PMID: 27773851
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Repeated low-dose grass pollen intradermal allergen injection suppresses allergen-induced cutaneous late-phase responses comparably with conventional subcutaneous and sublingual immunotherapy. We sought to evaluate the efficacy and safety of grass pollen intradermal immunotherapy in the treatment of allergic rhinitis. 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. 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). Intradermal allergen immunotherapy suppressed skin late-phase responses but was not clinically effective and resulted in worsening of respiratory allergic symptoms. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

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