title: Epicutaneous allergen administration as a novel method of allergen-specific immunotherapy.
abstract: BACKGROUND
  Subcutaneous allergen-specific immunotherapy is an effective treatment of IgE-mediated allergies, but it requires repeated allergen injections with a risk of systemic allergic reactions. Transcutaneous immunotherapy may improve patient compliance and safety.
  
  
  OBJECTIVE
  To assess the safety and efficacy of epicutaneous allergen immunotherapy.
  
  
  METHODS
  This monocentric, placebo-controlled, double-blind trial was conducted from March 2006 to December 2007 at the University Hospital Zurich. Thirty-seven adult patients with positive skin prick and nasal provocation tests to grass pollen were randomized to receive patches containing either allergen (n = 21) or placebo (n = 16). Treatment took place before and during the pollen season 2006, and follow-up visits took place before (n = 26) and after the pollen season 2007 (n = 30). The primary outcome measures were nasal provocation tests.
  
  
  RESULTS
  Allergen-treated patients showed significantly decreased scores in nasal provocation tests in the first (P < .001) and second year (P = .003) after treatment. In contrast, placebo-treated patients had decreased scores in the first treatment year, 2006 (P = .03), but the effect diminished in the second year (P = .53). Although improvement of nasal provocation test scores was not significantly better in the verum versus placebo group, the overall treatment success was rated significantly higher by the allergen-treated group than by the placebo group (2006, P = .02; 2007, P = .005). No severe adverse events were observed. Occurrence of eczema after allergen patch applications proved stimulation of specific T-cell responses, but was noted as an adverse effect of the treatment.
  
  
  CONCLUSIONS
  Epicutaneous allergen immunotherapy is a promising strategy to treat allergies and merits further investigation.
authors.affiliation: Unit for Experimental Immunotherapy, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Senti
authors.forename: Nicole
authors.initials: N
authors.lastname: Graf
authors.forename: Susanne
authors.initials: S
authors.lastname: Haug
authors.forename: Nadine
authors.initials: N
authors.lastname: Rüedi
authors.forename: Seraina
authors.initials: S
authors.lastname: von Moos
authors.forename: Theodor
authors.initials: T
authors.lastname: Sonderegger
authors.forename: Pål
authors.initials: P
authors.lastname: Johansen
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kündig
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D004485:Eczema / Q000209:etiology; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009299:Nasal Provocation Tests; D031784:Phleum / Q000276:immunology*; D010919:Placebos; D011058:Pollen / Q000276:immunology*; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000485:Allergens; D010919:Placebos