title: Optimum treatment strategies for polyallergic patients - analysis of a large observational trial.
abstract: OBJECTIVE
  To document the effectiveness and safety of sublingual allergen immunotherapy (SLIT) with a five-grass pollen tablet (Oralair ) and compare different treatment options in a broad, non-selected population of patients in a real-world clinical setting.
  
  
  METHODS
  This was a 2 year, open, prospective, multicenter, single-arm, non-interventional study. Patients with a history of clinically relevant allergic symptoms caused by grass pollen, confirmed by skin prick testing, received treatment with the five-grass pollen tablet. Concomitant treatment with symptomatic medication and/or additional SLIT or subcutaneous immunotherapy (SCIT) was permitted. Twelve-month data are presented here. Effectiveness was assessed comparing a combined rhinoconjunctivitis (RC) score derived from the severity of rhinitis and conjunctivitis symptoms under treatment with retrospective data of the previous year.
  
  
  RESULTS
  A total of 1408 patients participated in the study, of whom 434 were children/adolescents and 962 polyallergic. Compared with the grass pollen season preceding five-grass pollen tablet treatment, a statistically significant reduction of 49.9% was achieved in RC score for the total population (p < 0.001), and an improvement in overall health was perceived by 90.9% of patients. The overall population of polyallergic patients derived similar benefits from treatment with the five-grass pollen tablet as monoallergic patients. The percentage reduction in RC score was larger in polyallergic patients taking no additional therapy (60.2%) than in those taking concomitant symptomatic medication (38.1%) or allergen immunotherapy (AIT) (50.8%). Within the last of these groups, RC score improved by 47.6% among patients receiving additional SCIT, versus 54.8% with additional SLIT. Adverse drug reactions, reported in 15.3% of study participants, were mostly local in nature and mild or moderate in intensity.
  
  
  CONCLUSIONS
  After 1 year of treatment, polyallergic patients responded similarly to the five-grass pollen tablet as monoallergic patients. For polyallergic patients in whom additional treatment was needed, a second SLIT may be more beneficial than a SCIT or symptomatic co-medication.
authors.affiliation: a a Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), Faculty of Medicine, University of Cologne , Cologne , Germany.
authors.forename: Kija
authors.initials: K
authors.lastname: Shah-Hosseini
authors.affiliation: a a Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), Faculty of Medicine, University of Cologne , Cologne , Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Mioc
authors.affiliation: b b Stallergenes GmbH , Kamp-Lintfort , Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Hadler
authors.affiliation: b b Stallergenes GmbH , Kamp-Lintfort , Germany.
authors.forename: Efstrathios
authors.initials: E
authors.lastname: Karagiannis
authors.affiliation: a a Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), Faculty of Medicine, University of Cologne , Cologne , Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Mösges
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006109:Poaceae / Q000276:immunology; D011058:Pollen / Q000276:immunology; D011446:Prospective Studies; D012189:Retrospective Studies; D006255:Rhinitis, Allergic, Seasonal / Q000628:therapy*; D012621:Seasons; D063729:Sublingual Immunotherapy / Q000009:adverse effects / Q000379:methods*; D013607:Tablets / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000485:Allergens; D013607:Tablets
keywords: Allergen immunotherapy; Allergic rhinitis; Polyallergy; Polysensitization; Subcutaneous immunotherapy; Sublingual immunotherapy