Oak-related allergic rhinoconjunctivitis treated with the tree sublingual immunotherapy tablet
Published online: May 1, 2021
Oak is an important allergen in the United States, with approximately a third of patients with allergic rhinoconjunctivitis in the northeastern, eastern, and central regions demonstrating oak sensitivity. Peak oak pollen counts are associated with increases in over-the-counter allergy medication sales and asthma-related emergency department visits. The major allergen in oak pollen demonstrates immunoglobulin E (IgE) cross-reactivity to the birch major allergen Bet v 1. Because of this cross-reactivity, allergy to oak pollen may theoretically be treated by immunotherapy with birch allergen extract. A tree sublingual immunotherapy (SLIT)-tablet containing standardized birch pollen extract is approved in Europe and Canada.
In a Phase 3, randomized, multinational, double-blind trial, adolescents and adults (12-65 years) with moderate-to-severe birch pollen-induced allergic rhinoconjunctivitis received the tree SLIT-tablet or placebo daily before and during the alder/hazel/birch tree pollen season in Europe. A post hoc analysis of this trial evaluated outcomes during the oak pollen season, excluding data from any days that overlapped with the birch pollen season, and was reported by Nolte et al. in The Journal of Allergy and Clinical Immunology: In Practice.
Of the 634 participants, 86% were sensitized to oak pollen. For the primary endpoint of the average rhinoconjunctivitis total combined symptom and medication score, the tree SLIT-tablet provided a significant improvement of 25% relative to placebo. The daily symptom score was improved by 22% and the daily medication score was improved by 32% relative to placebo. The tree SLIT-tablet also induced oak-specific antibody responses. These data indicate that the tree SLIT-tablet may be used to treat oak-related allergic rhinoconjunctivitis symptoms and reduce the need for symptom-relieving pharmacotherapy.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.