Year: 2017
Type: article
Abstract: Diseases and the GRASS study groupAllergen immunotherapy is effective in patients with allergic rhinitis including those with mild/moderate asthma who fail to respond to conventional anti-allergic medications.Both sublingual (SLIT) and subcutaneous (SCIT) immunotherapy are effective.Indirect comparisons have suggested that both may be more effective than anti-allergic drugs 1) .When IT is given continuously for 3 years both routes have been shown to induce disease modification, manifest as long-term remission of symptoms for at least 3 years following discontinuation.The GRASS trial 2) (Gauging Response in Allergic rhinitis to Sublingual and Subcutaneous immunotherapy) was designed to compare the two routes head-to-head and test whether 2 years (as opposed to 3 years) was sufficient for long-term tolerance.GRASS was a single-centre head-to-head, double-blind, double-dummy, placebo-controlled trial (n=106) with 2 years on treatment and one year follow up after discontinuation of treatment.Clinical results showed that both SCIT and SLIT were effective in inhibiting the nasal response to grass pollen allergen challenge (NAC) at 2 years whereas neither were effective during year 3, one year after discontinuation.Both treatments were well-tolerated and appeared equally effective on seasonal outcomes that included seasonal rhinitis quality of life, weekly symptom visual analogue scale, and patient global evaluations during years one and two.Whereas SCIT was more effective in suppressing NAC during year 1, there was the expected level of systemic side-effects whereas SLIT resulted in no systemic side effects and only mild transient local effects.There was a decrease in allergen-induced nasal Th2 cytokines, including IL-4, IL-5, and IL-13 protein in nasal fluid at 2-10 hours after NAC.This was accompanied by significant decreases in systemic allergen-specific Th2 cells as detected by Class 2 tetramer analysis 3) .There was a transient increase in grass pollen specific IgE observed after at one year after SLIT and a significant decrease in specific IgE observed at 2-3 years after SCIT.There was an increase in allergen specific IgG4 and inhibition of IgE-FAB after both SCIT and SLIT that persisted during years 1, 2 and 3.
DOI: 10.7248/jjrhi.56.275
Authors: 司会：岡本 美孝, 演者：Stephen R Durham
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2765331576