title: Immunotherapy with depigmented-polymerized mixed tree pollen extract: a clinical trial and responder analysis.
abstract: BACKGROUND
  Rhinoconjunctivitis because of tree pollen sensitization is common in Northern Europe. Specific subcutaneous immunotherapy (SCIT) is the only disease-modifying treatment, but unmodified allergen extracts carry a risk of allergic side-effects. Our objective was to examine efficacy and safety of a depigmented-polymerized mixed tree pollen extract.
  
  
  METHODS
  A double-blind, placebo-controlled trial of 184 tree pollen allergic adults was performed. SCIT consisted of four increasing doses at 7-day intervals, then maintenance injections every 6 weeks for 18 months. Primary outcome was combined symptom and medication score during the 2008 season. Secondary outcomes included analysis at different levels of pollen exposure and a responder analysis. Adverse events were classified using the EAACI scale. Birch pollen-specific IgE and IgG(4) were measured before and after treatment.
  
  
  RESULTS
  The combined symptom and medication score of actively treated patients was significantly lower than those on placebo (P < 0.04). Increased efficacy was seen at high pollen exposure (median score 2.1 for active [IQR 0.7-3.4] vs 4.2 [IQR 2.4-5.3] for placebo for days with 500 or more pollen grains per m(3) , a 50% reduction, P < 0.01). A modified responder analysis revealed 64% responders in the active and 32% in the placebo group (P < 0.01). There were 17 systemic reactions. All were mild (grade 1 or 2) and required no treatment. Serum birch-specific IgG(4) increased in the SCIT group (P < .01).
  
  
  CONCLUSIONS
  SCIT with depigmented- polymerized tree pollen extract was clinically effective and well tolerated. Responder analysis suggested that one-third of patients treated with immunotherapy may not respond.
authors.affiliation: Center for Rhinology and Allergology Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany. oliver.pfaar@allergiezentrum.org
authors.forename: O
authors.initials: O
authors.lastname: Pfaar
authors.forename: D S
authors.initials: DS
authors.lastname: Robinson
authors.forename: A
authors.initials: A
authors.lastname: Sager
authors.forename: R
authors.initials: R
authors.lastname: Emuzyte
mesh_terms: D000328:Adult; D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects; D019540:Area Under Curve; D003888:Desensitization, Immunologic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D010936:Plant Extracts / Q000008:administration & dosage / Q000009:adverse effects; D011058:Pollen / Q000276:immunology; D012372:ROC Curve; D006255:Rhinitis, Allergic, Seasonal / Q000517:prevention & control*; D014197:Trees / Q000276:immunology
chemical_list: D000485:Allergens; D010936:Plant Extracts