Clinical efficacy of sublingual-swallow immunotherapy: a double-blind, placebo-controlled trial of a standardized five-grass-pollen extract in rhinitis.
Sublingual-swallow immunotherapy (SLIT) using high doses of standardized allergen extracts has been found to be effective in reducing allergic symptoms and medication needs. A double-blind, placebo-controlled study was carried out in a large number of patients to determine whether medication needs can be reduced by SLIT. Some 136 patients with grass-pollen rhinitis with or without mild asthma were studied. Patients received either placebo or SLIT with a standardized grass-pollen extract administered daily with increasing doses up to 300 IR (index of reactivity) from January to the end of July 1994. During the grass-pollen season, patients were instructed to use medications as required and to visit their doctors in case of asthma. Symptom-medications scores were assessed during the pollen season, and serum-specific IgG4 was measured before and at the end of SLIT. In the SLIT group, drug consumption dropped significantly throughout the pollen season (P < 0.02). Moreover, at the peak of the pollen season, betamethasone consumption was significantly reduced in the SLIT group (P < 0.02). Only one patient in the SLIT group had an asthma attack compared to eight patients in the placebo group (P < 0.02). IgG4 levels increased significantly in the SLIT group (P < 0.001) but without correlation with symptoms. Side-effects were comparable in both groups. This study indicates that SLIT in grass-pollen rhinitis is well tolerated, improves overall clinical symptoms, and reduces drug consumption and the need for oral corticosteroids.
Clavel
R
R
Groupement d'Allergologie et d'Immunologie Clinique du Rhône Moyen, Lyon, France.
Bousquet
J
J
André
C
C
D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D002648:Child; D003679:Deglutition; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis; D007167:Immunotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010936:Plant Extracts / Q000009:adverse effects / Q000627:therapeutic use*; D006109:Poaceae / Q000737:chemistry*; D011058:Pollen / Q000737:chemistry*; D006255:Rhinitis, Allergic, Seasonal / Q000097:blood / Q000628:therapy*
D007136:Immunoglobulins; D010936:Plant Extracts