title: Allergen specific immunotherapy attenuates early and late phase reactions in lower airways of birch pollen asthmatic patients: a double blind placebo-controlled study.
abstract: BACKGROUND
  Few placebo-controlled studies have examined the effect of allergen specific immunotherapy (SIT) on early and late phase asthmatic reactions. In this placebo-controlled study we have investigated the effect of 1 year of SIT with standardized birch pollen extract on early and late phase asthmatic reactions in adult asthmatic patients.
  
  
  METHODS
  Nineteen patients with a history of birch-pollen-induced seasonal symptoms from upper and lower airways, positive skin prick test and in vitro specific immunoglobulin E to birch pollen extract were included. Allergen and methacholine bronchial challenges were performed and blood samples obtained for analyses of total eosinophil count and eosinophil cationic protein (ECP) in serum, before and after 1 year of immunotherapy treatment.
  
  
  RESULTS
  All patients developed early and 16 of 19 both early and late phase asthmatic reactions. A significant increase in allergen dose was required to evoke early asthmatic reaction in the immunotherapy group (P < 0.01) after 1 year of treatment. The difference between the groups was significant (P < 0.01). Also the size of late asthmatic reaction was significantly reduced in the SIT group compared with placebo treated patients (P < 0.01). Twenty-four hours after allergen challenge methacholine sensitivity, number of total eosinophils and ECP increased significantly in the placebo (P < 0.02, P < 0.05 and P < 0.05 respectively), but not in the SIT group.
  
  
  CONCLUSIONS
  Allergen SIT with standardized birch pollen extract decreased early and late asthmatic responses following bronchial challenge in pollen allergic patients, thus confirming anti-inflammatory effect of the treatment.
authors.affiliation: Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: M B
authors.initials: MB
authors.lastname: Arvidsson
authors.forename: O
authors.initials: O
authors.lastname: Löwhagen
authors.forename: S
authors.initials: S
authors.lastname: Rak
mesh_terms: D000328:Adult; D001249:Asthma / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy*; D029662:Betula / Q000276:immunology*; D001985:Bronchial Provocation Tests; D003888:Desensitization, Immunologic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D006969:Hypersensitivity, Immediate / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D010328:Patch Tests; D011058:Pollen / Q000276:immunology*; D011336:Probability; D012016:Reference Values; D012130:Respiratory Hypersensitivity / Q000276:immunology; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome