title: Accelerated up-dosing of subcutaneous immunotherapy with a registered allergoid grass pollen preparation.
abstract: BACKGROUND
  Climatic changes causing early pollen flight and new allergens prolonging the pollen season render up-dosing of allergen-specific subcutaneous immunotherapy (SCIT) outside the pollen season considerably more difficult. In addition, for patients with multiple pollen allergies, patients coming near the beginning of pollen season, and patients who wish to up-dose faster, an accelerated induction regimen would be helpful.
  
  
  METHODS
  In an open, randomized, parallel group, multicenter safety trial, an accelerated up-dosing regimen (0.1-0.3-0.5 ml in weekly intervals) was compared to conventional up-dosing (0.05-0.1-0.2-0.3-0.4-0.5 ml in weekly intervals) with an allergoid grass pollen SCIT preparation. After up-dosing, the maintenance dose was given in monthly intervals.
  
  
  RESULTS
  A total of 146 adult patients with rhinitis or rhinoconjunctivitis with or without mild asthma (FEV1 >70%) due to grass pollen were randomized to either the conventional registered up-dosing or an accelerated regimen. In both groups (accelerated regimen, n = 69; conventional regimen, n = 75), a high proportion of patients (92.75 and 92.0%, respectively) successfully reached the maintenance dose without safety concerns. Furthermore, significant increases in specific IgG and IgG4 after 4 months of treatment were observed in both groups.
  
  
  CONCLUSIONS
  The accelerated SCIT regimen was found to be as safe as the conventional regimen and might be used to up-dose patients within 2 weeks. Moreover, the immunological effects of both up-dosing regimens were comparable.
authors.affiliation: Center for Rhinology and Allergology Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Düsseldorf, Germany. oliver.pfaar@allergiezentrum.org
authors.forename: Oliver
authors.initials: O
authors.lastname: Pfaar
authors.forename: Esther
authors.initials: E
authors.lastname: van Twuijver
authors.forename: Heike
authors.initials: H
authors.lastname: Hecker
authors.forename: Johan Diderik
authors.initials: JD
authors.lastname: Boot
authors.forename: Ronald
authors.initials: R
authors.lastname: van Ree
authors.forename: Ludger
authors.initials: L
authors.lastname: Klimek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology; D000080384:Allergoids; D052179:Antigens, Plant / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D001249:Asthma / Q000628:therapy*; D003233:Conjunctivitis, Allergic / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D010936:Plant Extracts / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000628:therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology / Q000628:therapy; D055815:Young Adult
chemical_list: D000485:Allergens; D000080384:Allergoids; D052179:Antigens, Plant; D007074:Immunoglobulin G; D010936:Plant Extracts; C451253:grass pollen extract, alum-adsorbed