title: A pre-seasonal birch/hazel sublingual immunotherapy can improve the outcome of grass pollen injective treatment in bisensitized individuals. A case-referent, two-year controlled study.
abstract: BACKGROUND
  The study tests the hypothesis of a reduction of priming due to tree allergy in patients sensitised to both birch/hazel and grass pollen undergoing an associated preseasonal Sublingual/Injective immunotherapy.
  
  
  METHODS
  36 out of 49 bisensitized candidates were pair-matched into 18 case-referent couples. During two years all patients were administered preseasonal grass-SIT and one patient in each couple received also birch/hazel-SLIT. Diary cards were fulfilled for three consecutive grass pollen seasons. Specific Nasal Provocation Test (NPT) for grass and aspecific bronchial challenge were done; sera were analyzed for specific IgE and IgG.
  
  
  RESULTS
  During the peak of the grass pollen season both groups showed a significant improvement in total symptom-score. Conjunctivitis and cough improved significantly more in patients with associated therapies. While antihistamine score decreased significantly in both groups, antiasthmatics did only in the SLIT-SIT group. The follow-up documented a significant increase in grass- and birch-specific IgG and a decrease in grass-specific IgE. Grass-NPT threshold was clearly higher in SLIT-SIT-group (p = 0.01) and only in this group PD20 methacholine improved significantly (p < 0.05).
  
  
  CONCLUSIONS
  Combined birch/hazel-SLIT and grass-SIT are safe and improve clinical outcomes of SIT alone in young bisensitized patients. Priming reduction is supported by specific NPT and bronchial hyperresponsiveness.
authors.affiliation: Istituti Ospitalieri, Center for Environmental Allergy, Cremona, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Cirla
authors.forename: P E
authors.initials: PE
authors.lastname: Cirla
authors.forename: S
authors.initials: S
authors.lastname: Parmiani
authors.forename: S
authors.initials: S
authors.lastname: Pecora
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000008:administration & dosage* / Q000627:therapeutic use; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000918:Antibody Specificity; D001249:Asthma / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D029662:Betula; D016535:Bronchial Hyperreactivity / Q000209:etiology / Q000276:immunology; D001985:Bronchial Provocation Tests; D003131:Combined Modality Therapy; D003233:Conjunctivitis, Allergic / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D031211:Corylus; D003371:Cough; D003888:Desensitization, Immunologic; D004334:Drug Administration Schedule; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007279:Injections, Subcutaneous; D007558:Italy; D008297:Male; D016210:Methacholine Chloride; D009299:Nasal Provocation Tests; D006109:Poaceae; D011058:Pollen / Q000009:adverse effects* / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D012621:Seasons; D016896:Treatment Outcome
chemical_list: D000485:Allergens; D018926:Anti-Allergic Agents; D018927:Anti-Asthmatic Agents; D007074:Immunoglobulin G; D016210:Methacholine Chloride; D007073:Immunoglobulin E