Sublingual grass allergen tablet immunotherapy provides sustained clinical benefit with progressive immunologic changes over 2 years

Background: This is an interim analysis of a randomized, double-blind, placebo-controlled phase III trial with 3 years of daily treatment with grass tablet immunotherapy (GRAZAX; ALK-Abello A/S, Horsholm, Denmark) or placebo, followed by 2 years of follow-up to assess the persistent efficacy. Objective: We sought to evaluate the efficacy and safety of specific immunotherapy with grass allergen tablets compared with placebo after treatment covering 2 consecutive grass pollen seasons. Methods: The interim analyses included 351 adult participants with moderate-to-severe allergic rhinoconjunctivitis caused by grass pollen. Participants were treated with active (n = 189) or placebo (n = 162) tablets for an average of 22 months. All participants were allowed to use symptomatic rescue medication. Results: The primary efficacy analysis showed highly significant mean reductions of 36% in rhinoconjunctivitis symptom score (P Conclusion: Grass allergen tablet immunotherapy showed progressive immunologic changes and highly significant efficacy over 2 years of continued treatment

The association of sensitization to inhalant allergens with allergy symptoms: the influence of bronchial hyperresponsiveness and blood eosinophil count

Background We investigated whether the association of allergy symptoms with sensitization to inhalant allergens depends on bronchial hyperresponsiveness, blood eosinophil count, or the degree and nature of sensitization. Methods Data on asthma and rhino-conjunctivitis symptoms were obtained from 1904 subjects from a random sample of the Dutch population, aged 20-70 years by the ECRHS questionnaire. Total IgE and specific IgE to four inhalant allergens were measured using CAP System. Bronchial hyperresponsiveness (BHR) was defined as PD20 less than or equal to 2 mg methacholine and 'high eosinophil count' as an eosinophil count in the highest quartile. Results Forty-three percent of the subjects with specific IgE to inhalant allergens was asymptomatic. These subjects had a lower degree of sensitization than symptomatic sensitized subjects and had 'normal' prevalences of BHR and 'high eosinophil count'. Logistic regression showed that the presence of BHR increased the risk of having symptoms for subjects who were sensitized to indoor allergens. Low levels of specific IgE to indoor allergens were only associated with symptoms when BHR was present. Sensitization to outdoor allergens was associated with symptoms at all levels of specific IgE, independently of BHR or eosinophils. Conclusion Our epidemiological data suggest that whether low levels of specific IgE to indoor allergens lead to allergic symptoms is probably determined by the concurrent existence of inflammation of the airways