Grass pollen sublingual immunotherapy for seasonal rhinoconjunctivitis: a randomized controlled trial

被引:142
作者
Lima, MT
Wilson, D
Pitkin, L
Roberts, A
Nouri-Aria, K
Jacobson, M
Walker, S
Durham, S
机构
[1] Natl Heart & Lung Inst, Imperial Coll Sci Technol & Med, Fac Med, Upper Resp Med, London SW3 6LY, England
[2] Royal Brompton & Harefield Hosp NHS Trust, London, England
关键词
antibodies; cytokines; hayfever; inummohistochemistry; immunotherapy; rhinoconjunctivitis; sublingual;
D O I
10.1046/j.0954-7894.2002.01327.x
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background Previous studies suggest that sublingual immunotherapy (SLIT) represents a safer alternative to injection immunotherapy but equivalent efficacy is yet to be confirmed. Objective To evaluate the efficacy and safety of SLIT in grass pollen-induced seasonal rhinoconjunctivitis. Methods A randomized, placebo-controlled trial in 56 adults over 18 months. Outcome measures included diary scores of seasonal symptoms and medication use, overall assessments, conjunctival and intradermal provocation tests and serum antibody measurements. To investigate possible mechanisms, sublingual biopsies were taken for measurement of local T cells, antigen-presenting cells and IL-12 mRNA expression. Results There were no significant differences between the mimunotherapy (IT) and placebo groups for diary symptom scores (P = 0.48) or rescue medication (P = 0.19). The patients' overall assessment of hayfever severity compared with previous years showed a highly significant improvement in favour of the IT group (P < 0.02). After treatment the late skin response was smaller (P = 0.003) and the ratio of serum allergen-specific IgG4/IgE was higher (P = 0.05) in the IT group. Both of these variables correlated with the clinical response to SLIT. There were no differences between groups in either the sublingual epithelium or lamina propria for numbers of CD3(+) cells (epithelium: P = 0.9. lamina propria: P = 0.2), CD1a(+) cells (P = 0.3, P = 0.25), CD68(+) cells (P = 0.9 P = 1.0) or IL-12 mRNA(+) cells (P = 0.6, P = 0.4). Local side-effects were minor and there were no serious treatment-related adverse events. Conclusion Grass pollen sublingual immunotherapy was well tolerated. Although there was no significant change in diary scores, the improvement in overall assessments, which correlated with inhibition of the late skin response and increases in serum IgG4: IgE ratio, indicates the need for larger, dose-ranging studies.
引用
收藏
页码:507 / 514
页数:8
相关论文
共 35 条
[1]   Role of interleukin 10 in specific immunotherapy [J].
Akdis, CA ;
Blesken, T ;
Akdis, M ;
Wüthrich, B ;
Blaser, K .
JOURNAL OF CLINICAL INVESTIGATION, 1998, 102 (01) :98-106
[2]   Safety of sublingual-swallow immunotherapy in children and adults [J].
André, C ;
Vatrinet, C ;
Galvain, S ;
Carat, F ;
Sicard, H .
INTERNATIONAL ARCHIVES OF ALLERGY AND IMMUNOLOGY, 2000, 121 (03) :229-234
[3]   Dendritic cells and the control of immunity [J].
Banchereau, J ;
Steinman, RM .
NATURE, 1998, 392 (6673) :245-252
[4]   Sublingual-swallow immunotherapy (SLIT) in patients with asthma due to house-dust mites:: a double-blind, placebo-controlled study [J].
Bousquet, J ;
Scheinmann, P ;
Guinnepain, MT ;
Perrin-Fayolle, M ;
Sauvaget, J ;
Tonnel, AB ;
Pauli, G ;
Caillaud, D ;
Dubost, R ;
Leynadier, F ;
Vervloet, D ;
Herman, D ;
Galvain, S ;
André, C .
ALLERGY, 1999, 54 (03) :249-260
[5]  
Bousquet J., 1998, Allergy (Copenhagen), V53, P1
[6]   Clinical efficacy of sublingual-swallow immunotherapy: a double-blind, placebo-controlled trial of a standardized five-grass-pollen extract in rhinitis [J].
Clavel, R ;
Bousquet, J ;
Andre, C .
ALLERGY, 1998, 53 (05) :493-498
[7]   REGIONAL VARIATION IN LANGERHANS CELL DISTRIBUTION AND DENSITY IN NORMAL HUMAN ORAL-MUCOSA DETERMINED USING MONOCLONAL-ANTIBODIES AGAINST CD1, HLADR, HLADQ AND HLADP [J].
CRUCHLEY, AT ;
WILLIAMS, DM ;
FARTHING, PM ;
LESCH, CA ;
SQUIER, CA .
JOURNAL OF ORAL PATHOLOGY & MEDICINE, 1989, 18 (09) :510-516
[8]   A double-blind, placebo-controlled study of immunotherapy with grass-pollen extract Alutard SQ during a 3-year period with initial rush immunotherapy [J].
Dolz, I ;
MartinezCocera, C ;
Bartolome, JM ;
Cimarra, M .
ALLERGY, 1996, 51 (07) :489-500
[9]   Immunologic changes associated with allergen immunotherapy [J].
Durham, SR ;
Till, SJ .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 1998, 102 (02) :157-164
[10]   Long-term clinical efficacy of grass-pollen immunotherapy [J].
Durham, SR ;
Walker, SM ;
Varga, EM ;
Jacobson, MR ;
O'Brien, F ;
Noble, W ;
Till, SJ ;
Hamid, QA ;
Nouri-Aria, KT .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (07) :468-475