Epicutaneous allergen administration as a novel method of allergen-specific immunotherapy.
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.
Senti
Gabriela
G
Unit for Experimental Immunotherapy, University Hospital of Zurich, Zurich, Switzerland.
Graf
Nicole
N
Haug
Susanne
S
Rüedi
Nadine
N
von Moos
Seraina
S
Sonderegger
Theodor
T
Johansen
Pål
P
Kündig
Thomas M
TM
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
D000485:Allergens; D010919:Placebos