Intradermal Grass Pollen Allergen Immunotherapy for Seasonal Allergy: A Randomized Controlled Trial.

BACKGROUND: Repeated low dose grass pollen intradermal allergen injection suppresses allergen-induced cutaneous late phase responses, comparable with conventional subcutaneous and sublingual immunotherapy. OBJECTIVE: To evaluate the efficacy and safety of grass pollen intradermal immunotherapy in the treatment of allergic rhinitis. METHODS: We randomly assigned 93 adults with grass pollen allergic rhinitis to receive 7 pre-seasonal intradermal allergen injections (containing 7 nanograms of Phl p 5 major allergen) or histamine control. The primary endpoint was daily combined symptom-medication scores during the 2013 pollen season (area under curve). Analysis was by intention-to-treat. Skin biopsies were collected following intradermal allergen challenges and late phase responses measured four and seven, ten or thirteen months post-treatment. RESULTS: There was no significant difference in primary endpoint between treatment arms (active n=46, control n=47, median difference, 14; 95% CI -172.5-215.1; P=.80). Among secondary endpoints, nasal symptoms were worse in the intradermal treatment group, measured by daily scores (median difference, 35; 95% CI 4.0-67.5; P=.03) and visual-analog scales (median difference, 53; 95% CI -11.6-125·2; P=.05). In a per protocol analysis, intradermal immunotherapy was further associated with worse asthma symptoms and fewer symptom free days. Intradermal immunotherapy increased serum Phl p-specific IgE (P=.001) compared to the control arm. T cells cultured from biopsies of intradermal immunotherapy subjects showed higher expression of Th2 surface marker CRTH2 (P=.04) and lower Th1 marker CXCR (P=.01), respectively. Late phase responses remained inhibited seven months after treatment (P=.03). CONCLUSION: Intradermal allergen immunotherapy suppressed skin late responses but was not clinically effective and resulted in worsening of respiratory allergic symptoms

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease