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JACI Highlights - July 2009Does sublingual immunotherapy work with multiallergen mixes?It is generally accepted—in the United States, at least—that effective subcutaneous injection immunotherapy can be accomplished with mixes of multiple, non–cross-reacting allergen extracts. To date, no study of sublingual immunotherapy (SLIT) with more than two differing allergen extracts has been reported. In the July 2009 issue of The Journal of Allergy and Clinical Immunology, Amar and coworkers address this question. Fifty-three subjects with grass pollen-induced allergic rhinitis received 10 months of SLIT consisting of monotherapy with timothy (30 mcg Phl p 5 daily), the same dose of timothy plus nine nonrelated pollen extracts, or placebo. A very poor pollen season obscured the clinical response. However, those receiving timothy monotherapy showed significant differences from placebo for titrated skin prick tests and nasal challenge, specific IgG4 antibodies, and timothy-stimulated release of IFN-y from peripheral blood mononuclear cells, all indicating a relevant positive response. Those receiving the same dose of timothy combined with nine other extracts differed from placebo only for titrated skin prick tests and then less than those on monotherapy. Although lacking statistical power to directly compare the two active groups, this study suggests caution in administering multiallergen SLIT until further studies have been conducted. “Response to Sublingual Immunotherapy with Grass Pollen Extract: Monotherapy versus Combination in a Multiallergen Extract” by Amar et al. (JACI July 2009 Volume 124 No. 1) |
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