title: Induction of Bronchial Tolerance After 1 Cycle of Monophosphoryl-A-Adjuvanted Specific Immunotherapy in Children With Grass Pollen Allergies.
abstract: OBJECTIVE
  Subcutaneous allergen-specific immunotherapy (SCIT) is a well-established and clinically effective method to treat allergic diseases, such as rhinitis and asthma. It remains unclear how soon after initiation of an ultra-short course of grass pollen immunotherapy adjuvanted with monophosphoryl lipid A (MPL)-specific bronchial tolerance can be induced.
  
  
  METHODS
  In a prospective study of 69 children double-sensitized to birch and grass pollens (51 males, average age 11.1 years), development of bronchial tolerance after 1 cycle of SCIT for grass was evaluated. In all the patients, the bronchial allergen provocation test (BAP) was performed before and after treatment. According to the results of the first BAP, the patients were divided into 2 groups: those showing a negative BAP with a decrease in FEV1 of <20% (seasonal allergic rhinitis [SAR] group, n=47); and those showing a positive BAP with a decrease in FEV1 of ≥20% (SAR with allergic asthma [SAR and Asthma] group, n=22). All the patients received MPL-adjuvanted, ultra-short course immunotherapy for birch, but only those with a positive BAP to grass received MPL-SCIT for grass.
  
  
  RESULTS
  After the pollen season, the BAP in the SAR group remained unchanged, while it was improved in the SAR and Asthma group (decrease in FEV1 of 28.8% vs 12.5%, P<0.01). The IgG4 levels increased after SCIT (median before SCIT 0.34 to 11.4 after SCIT), whereas the total and specific IgE levels remained unchanged.
  
  
  CONCLUSIONS
  After 1 cycle of MPL-SCIT, specific bronchial tolerance may be significantly induced, whereas in patients without SCIT, bronchial hyperactivity may remain unchanged.
authors.affiliation: Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany. Martin.Rosewich@kgu.de.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0002-6971-3485
authors.initials: M
authors.lastname: Rosewich
authors.affiliation: Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Girod
authors.affiliation: Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zielen
authors.affiliation: Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Schubert
authors.affiliation: Children's Hospital, Department of Allergy, Pneumology and Cystic Fibrosis, Goethe-University, Frankfurt/Main, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schulze
keywords: Allergic asthma; bronchial allergen challenge; desensitization, immunologic; pollen allergy; tolerance