Disease-modification of allergic rhinoconjunctivitis by sublingual grass immunotherapy
Published Online: January 30 , 2012
Specific immunotherapy is highly effective for treatment of seasonal allergic rhinitis, particularly where symptomatic medications have proved ineffective or their use is limited by side effects. A major advantage of subcutaneous immunotherapy is the induction of long-term clinical and immunologic tolerance for years after discontinuation. Now it has been demonstrated, using a rapidly-dissolving grass allergy immunotherapy tablet (Grazax®), that long-term tolerance similarly can be achieved by the sublingual route.
In the article by Durham et al in The Journal of Allergy and Clinical Immunology (JACI), results of the first completed 5-year double-blind, placebo-controlled trial, with three years of sublingual immunotherapy treatment and two years of immunotherapy-free follow-up, is presented. 51 sites from eight European countries participated in the trial, involving 634 participants with grass pollen induced allergic rhinoconjunctivitis with or without asthma. Treatment was either the grass allergy immunotherapy tablet or a matching placebo tablet. Free access to supplementary symptomatic medications was provided to all participants as needed throughout the trial.
The data demonstrated sustained and disease modifying efficacy, with a significant difference between the active and the placebo group in the combined rhinoconjunctivitis symptom and medication score for at least two years following three years’ treatment. This was supported by the individual nasal and eye symptom scores, as well as by improved quality of life, less days with severe symptoms and long-lasting changes in the immunological response to treatment in the active group. Treatment was well-tolerated. The most common adverse events were mild to moderate local application site reactions that in most cases presented at treatment initiation and resolved within two weeks.
The authors conclude that treatment with the grass allergy immunotherapy tablet for three years introduces sustained disease-modifying effects that last at least two years after completion of treatment. Grass allergy tablet immunotherapy represents an important treatment option for patients with grass pollen allergy inadequately controlled by symptomatic medications.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.