title: Efficacy of grass pollen sublingual immunotherapy for three consecutive seasons and after cessation of treatment: the ECRIT study.
abstract: BACKGROUND
  Data supporting a carry-over effect with sublingual immunotherapy (SLIT) are scarce. This randomized, double-blind, placebo-controlled study evaluated the efficacy, carry-over effect and safety of grass pollen SLIT using co-seasonal treatment.
  
  
  METHODS
  Patients (7.9-64.7 years) with grass pollen allergy received ultra-rush titration with increasing doses (30, 90, 150 and 300 IR) of a 5-grass pollen mixture every 20 min at the start of the pollen seasons, followed by 300 IR daily until the end of the pollen seasons. A baseline season (no SLIT) was followed by three consecutive treatment seasons and one follow-up season. Symptoms, medication and adverse events were documented and specific immunoglobulin (Ig)E and IgG(4) measured.
  
  
  RESULTS
  Data were analysed for 183 of the 213 randomized patients. Mean treatment duration varied between seasons (81.8-92.7 days). Combined scores (symptoms and medication) improved progressively across treatment seasons (up to 44.7% improvement for SLIT compared with baseline) and fluctuated between -11.3% and -14.8% for placebo (P < 0.05). Similar changes were observed for symptom scores, with a successive decrease of 39.7% (SLIT) and fluctuations between +13.6% and -1.51% for placebo (P < 0.05). Combined score (P = 0.0508) and symptom score improvements (P = 0.0144) with SLIT continued during follow up. Increases in specific IgG(4) observed in the first season were sustained for SLIT vs placebo throughout treatment (P = 0.0001). Titration and daily SLIT were well tolerated. No serious systemic or anaphylactic reactions were reported.
  
  
  CONCLUSIONS
  Seasonal SLIT with ultra-rush titration is well tolerated and effective from the first treatment season onwards. These data indicate a carry-over effect of seasonal SLIT.
authors.affiliation: Department of Dermatology & Allergology, University Hospital of the Rheinisch Westfälische Technische Hochschule Aachen, Kamp-Lintfort, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Ott
authors.forename: J
authors.initials: J
authors.lastname: Sieber
authors.forename: R
authors.initials: R
authors.lastname: Brehler
authors.forename: R
authors.initials: R
authors.lastname: Fölster-Holst
authors.forename: A
authors.initials: A
authors.lastname: Kapp
authors.forename: L
authors.initials: L
authors.lastname: Klimek
authors.forename: O
authors.initials: O
authors.lastname: Pfaar
authors.forename: H
authors.initials: H
authors.lastname: Merk
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003888:Desensitization, Immunologic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D011058:Pollen / Q000276:immunology*; D006255:Rhinitis, Allergic, Seasonal / Q000628:therapy*; D012621:Seasons; D055815:Young Adult
chemical_list: D000485:Allergens; D007074:Immunoglobulin G; D007073:Immunoglobulin E