title: Canadian trial of sublingual swallow immunotherapy for ragweed rhinoconjunctivitis.
abstract: BACKGROUND
  Sublingual swallow immunotherapy has been increasingly recognized as a safe and efficacious alternative to parenteral specific immunotherapy.
  
  
  OBJECTIVE
  To determine the safety and efficacy of sublingual swallow immunotherapy ragweed allergen extract for rhinoconjunctivitis treatment starting just before and continuing through the ragweed pollen season.
  
  
  METHODS
  This randomized, double-blind, placebo-controlled study was performed in children and adults with a documented history of allergic rhinoconjunctivitis during ragweed season at 9 Canadian allergy centers. Active treatment was standardized extract of ragweed allergen administered as sublingual swallow drops at increasing doses starting shortly before the pollen season and maintenance doses continued daily during the season. Primary efficacy variables were symptom and medication scores, and secondary variables included global evaluation of efficacy and immunologic measurements.
  
  
  RESULTS
  Eighty-three patients were included in the safety analysis; 76 patients were included in the intent-to-treat analysis. Nine placebo recipients and 1 treatment recipient withdrew for lack of efficacy (P = .004). Nine patients in the treatment group withdrew because of adverse events, none serious (P = .003). Investigator evaluation of efficacy showed that significantly more patients improved and fewer deteriorated in the treatment group vs the placebo group (P = .047). Ragweed IgE and IgG4 levels increased significantly in treatment recipients vs placebo users (P < .001). Sneezing and nasal pruritus approached significant improvement in the treatment group vs the placebo group (P = .09 and .06, respectively). Quebec City experienced low pollen counts. Excluding Quebec City, significant improvement was seen for these 2 symptoms (P = .04).
  
  
  CONCLUSIONS
  Sublingual swallow immunotherapy seems to be safe and efficacious for ragweed rhinoconjunctivitis even when started immediately before the ragweed pollen season.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada. tbowen@pol.net
authors.forename: Tom
authors.initials: T
authors.lastname: Bowen
authors.forename: Joseph
authors.initials: J
authors.lastname: Greenbaum
authors.forename: Yves
authors.initials: Y
authors.lastname: Charbonneau
authors.forename: Jacques
authors.initials: J
authors.lastname: Hebert
authors.forename: Ronald
authors.initials: R
authors.lastname: Filderman
authors.forename: Gordon
authors.initials: G
authors.lastname: Sussman
authors.forename: Jaime
authors.initials: J
authors.lastname: Del Carpio
authors.forename: Milton
authors.initials: M
authors.lastname: Gold
authors.forename: Paul
authors.initials: P
authors.lastname: Keith
authors.forename: William
authors.initials: W
authors.lastname: Moote
authors.forename: Steve
authors.initials: S
authors.lastname: Cecchetto
authors.forename: Ollie
authors.initials: O
authors.lastname: Cecchetto
authors.forename: Daniel
authors.initials: D
authors.lastname: Sharp
authors.forename: Olivier
authors.initials: O
authors.lastname: Broutin
authors.forename: Claude
authors.initials: C
authors.lastname: André
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D031164:Ambrosia / Q000276:immunology*; D002648:Child; D003233:Conjunctivitis, Allergic / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006255:Rhinitis, Allergic, Seasonal / Q000628:therapy*