Nasal immunotherapy in weed-induced allergic rhinitis.
BACKGROUND
Nasal immunotherapy with single allergen extracts, following premedication with cromolyn, has been reported to be effective in treating seasonal and perennial allergic rhinitis.


METHODS
We conducted a double-blind, placebo-controlled study to assess the efficacy, tolerability, and mechanism of action of nasal immunotherapy for allergic rhinitis caused by weed pollens from three unrelated families. Twenty-seven weed-allergic patients underwent baseline nasal provocation and titrated skin test with a mixed weed extract containing ragweed, sage, and Chenopod extracts. Patients were randomized to receive either mixed weed extract or placebo. Nasal immunotherapy was self-administered daily to alternate nostrils preceded by 5.2 mg intranasal cromolyn. Beginning with 1:2500 wt/vol the concentration was increased to 1:10 wt/vol over an average period of 36 days. The maintenance dose (1:10 wt/vol) was administered daily for 12 to 16 weeks through the weed pollen season. Patients recorded nasal and eye symptoms and the use of rescue medications throughout the study. A nasal lavage for cytokine levels and nasal scraping with Rhinoprobe for nasal cytology were performed at the peak of the weed season. Nasal provocation and titrated skin tests with mixed weed extract were repeated after the weed season. Nasal lavage and scraping were also performed before and 24 hours after the final nasal provocation.


RESULTS
During the peak weeks of the weed season the group receiving mixed weed extract by nasal instillation, compared with those treated with placebo, had significantly lower total nasal symptom scores, total eye symptom scores, and symptom medication scores. There were no significant differences in the nasal cytology or cytokines levels between the two groups, except for elevated IL-10 in the nasal lavage in the treated group at the peak of the season. Nasal symptoms and medication use were higher preseasonally in the active treatment group.


CONCLUSIONS
Nasal immunotherapy with aqueous mixed weed extract administered with cromolyn sodium pretreatment for 17 to 21 weeks was effective in reducing both nasal and ocular symptoms of weed pollen-induced allergic rhinitis. There were increased nasal symptoms in the treated group preseasonally.
Gaglani
B
B
Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado, USA.
Borish
L
L
Bartelson
B L
BL
Buchmeier
A
A
Keller
L
L
Nelson
H S
HS
D000281:Administration, Intranasal; D000328:Adult; D004311:Double-Blind Method; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007167:Immunotherapy / Q000592:standards; D007371:Interferon-gamma / Q000032:analysis; D016753:Interleukin-10 / Q000032:analysis; D015847:Interleukin-4 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000737:chemistry / Q000276:immunology*; D009299:Nasal Provocation Tests; D010936:Plant Extracts / Q000009:adverse effects; D012221:Rhinitis, Allergic, Perennial / Q000209:etiology / Q000628:therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000209:etiology / Q000628:therapy*; D012882:Skin Tests; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D010936:Plant Extracts; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015847:Interleukin-4; D007371:Interferon-gamma