title: Responses to ragweed-pollen nasal challenge before and after immunotherapy.
abstract: To evaluate whether immunotherapy reduces mediator release after nasal challenge, we followed previously untreated patients with ragweed hay fever through 2 years (three seasons) of treatment. Eleven adult patients started immunotherapy after a season of symptom diaries and graded pretreatment challenges with 0.03, 0.3, 3.3, and 16.5 mg of ragweed pollen. Repeat challenges were performed when the treatment dosage reached 0.6, 12.4, and 24.8 micrograms of Amb a I (antigen E) equivalents per injection. After the 0.6 micrograms dose, there was little change, but after the larger doses, there was a significant reduction in histamine and tosylarginine methyl ester-esterase (TAME-esterase) release in two respects. More pollen was required before any mediator appeared, and the amount of mediator released at each stage of the challenge was reduced. There was no significant difference between the responses at the 12.4 and 24.8 micrograms treatment doses. Sneezing after challenge was not apparently changed after immunotherapy; however, patients' seasonal symptom-medication scores were reduced after treatment. These data set the optimal individual treatment dose of ragweed extract for immunotherapy at greater than 0.6 micrograms, but probably not more than 12.4 micrograms in terms of Amb a I equivalents.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md. 21239.
authors.forename: P S
authors.initials: PS
authors.lastname: Creticos
authors.forename: D G
authors.initials: DG
authors.lastname: Marsh
authors.forename: D
authors.initials: D
authors.lastname: Proud
authors.forename: A
authors.initials: A
authors.lastname: Kagey-Sobotka
authors.forename: N F
authors.initials: NF
authors.lastname: Adkinson
authors.forename: L
authors.initials: L
authors.lastname: Friedhoff
authors.forename: R M
authors.initials: RM
authors.lastname: Naclerio
authors.forename: L M
authors.initials: LM
authors.lastname: Lichtenstein
authors.forename: P S
authors.initials: PS
authors.lastname: Norman
mesh_terms: D000293:Adolescent; D000328:Adult; D004306:Dose-Response Relationship, Immunologic; D004311:Double-Blind Method; D006632:Histamine / Q000032:analysis; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008875:Middle Aged; D009297:Nasal Mucosa / Q000378:metabolism; D009299:Nasal Provocation Tests / Q000379:methods; D010447:Peptide Hydrolases / Q000032:analysis; D011058:Pollen / Q000276:immunology*; D011446:Prospective Studies; D011897:Random Allocation; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000628:therapy; D012882:Skin Tests
chemical_list: D006632:Histamine; D010447:Peptide Hydrolases; C023073:tosylarginine methyl ester hydrolase