Grass pollen immunotherapy for seasonal rhinitis and asthma: A randomized, controlled trial

• Published in: Journal of allergy and clinical immunology 2001-01, Vol.107 (1), p.87-93
• Main Authors: Walker, Samantha M., Pajno, Giovanni B., Lima, Marcia Torres, Wilson, Duncan R., Durham, Stephen R.
• Format: Article
• Language: English
• Subjects: Adult; Asthma - therapy; Biological and medical sciences; Female; Humans; Immunopathology; Immunotherapy; Immunotherapy (general aspects); Male; Medical sciences; Middle Aged; Pollen - immunology; Quality of Life; Reproducibility of Results; Rhinitis, Allergic, Seasonal - therapy; Surveys and Questionnaires
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1067/mai.2001.112027

Background: Grass pollen immunotherapy significantly reduces hay fever symptoms and medication requirements. Effects on seasonal asthma are less clear, and concerns over safety persist. Objective: The goal of this study was to assess the effects of grass pollen immunotherapy on symptoms, bronchial hyperresponsiveness, and quality of life in seasonal rhinitis and asthma. Methods: Forty-four patients with severe summer hay fever (of whom 36 reported seasonal chest symptoms and 28 had seasonal bronchial hyperresponsiveness) participated in a randomized, double-blind, placebo-controlled, parallel group study. After symptom monitoring for one summer, participants received injections of a depot grass pollen vaccine (n = 22) or matched placebo injections (n = 22) in a rapid updosing cluster regimen for 4 weeks, followed by monthly injections for 2 years. Outcome measures included hay fever symptoms and medication use, health-related quality of life, and measurements of nonspecific bronchial responsiveness. Results: Significant reductions were observed in the immunotherapy group compared with the placebo group in hay fever symptoms (49%, 15%; P = .01), medication scores (80%, 18%; P = .007), and seasonal chest symptoms (90%, 11%; P < .05). Impairment of overall quality of life (mean score of 7 domains) during the pollen season was less in the immunotherapy group than in the placebo group (median difference [95% CI], 0.8 [0.18-1.5]; P = .02). During the pollen season there was no change in airway methacholine PC20 (provocation concentration producing a 20% fall in FEV1) in the immunotherapy-treated group (P = .5), compared with an almost 3 doubling-dose decrease in the placebo-treated group (P = .01, between-group difference). There were no significant local or systemic side effects during the study. Conclusion: Grass pollen immunotherapy improves quality of life in seasonal allergic rhinitis and reduces seasonal asthma symptoms and bronchial hyperresponsiveness. (J Allergy Clin Immunol 2001;107:87-93.)