Grass pollen immunotherapy: Symptomatic improvement correlates with reductions in eosinophils and IL-5 mRNA expression in the nasal mucosa during the pollen season

• Published in: Journal of allergy and clinical immunology 2001-06, Vol.107 (6), p.971-976
• Main Authors: Wilson, Duncan R., Nouri-Aria, Kayhan T., Walker, Samantha M., Pajno, Giovanni B., O’Brien, Fiona, Jacobson, Mikila R., Mackay, Ian S., Durham, Stephen R.
• Format: Article
• Language: English
• Subjects: Allergic rhinitis; Biological and medical sciences; Biopsy; Desensitization, Immunologic; Double-Blind Method; eosinophils; Eosinophils - cytology; Eosinophils - immunology; Humans; IL-5; Immunohistochemistry; Immunopathology; immunotherapy; Immunotherapy (general aspects); In Situ Hybridization; Interleukin-5 - metabolism; Medical sciences; Nasal Mucosa - metabolism; Poaceae - immunology; Pollen - immunology; Rhinitis, Allergic, Seasonal - therapy; RNA, Messenger - metabolism; T-Lymphocytes - immunology
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1067/mai.2001.115483

Background: Tissue eosinophilia and infiltration by TH2-type T cells are characteristic features of allergic rhinitis both after allergen challenge and during natural allergen exposure. Specific immunotherapy inhibits allergen-induced nasal eosinophilia. Objectives: We sought to assess, in the context of a randomized trial, the relationships between symptomatic improvement after immunotherapy and eosinophil numbers and IL-5 expression in the nasal mucosa during the pollen season. Methods: Nasal biopsy specimens were taken from 37 adults with severe summer hay fever at baseline (out of season) and at peak season after 2 years of treatment with a depot grass pollen extract or placebo. Biopsy specimens were processed for immunohistochemistry by using mAbs against eosinophils (EG2), T cells (CD3), and IL-2 receptor–positive cells (CD25), as well as for in situ hybridization by using a sulfur 35-labeled antisense riboprobe directed against IL-5. Results: Immunotherapy significantly reduced symptoms (49%, P = .01) and medication requirements (80%, P = .007) compared with placebo. There was a 400% increase (P = .004) in eosinophils during the pollen season in placebo-treated patients, which was inhibited in the immunotherapy group (20% increase, P = .04 between groups). Seasonal increases were also observed for CD25+ cells (P = .002), CD3+ cells (P = .02), and IL-5 mRNA–expressing cells (P = .03) in the placebo group but not in the immunotherapy group. A significant correlation was observed between eosinophils and IL-5 expression (r = 0.5, P < .05). Both eosinophils (r = 0.6, P < .02) and IL-5 (r = 0.6, P < .02) correlated with symptoms after immunotherapy. Conclusion: Improvement in symptoms after grass pollen immunotherapy may result, at least in part, from inhibition of IL-5–dependent tissue eosinophilia during the pollen season. (J Allergy Clin Immunol 2001;107:971-6.)