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Intralymphatic Immunotherapy and Vaccination in Mice
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Dosing and efficacy in specific immunotherapy.

P Demoly1, M A Calderon

  • 1University Hospital of Montpellier-INSERM U657, Montpellier, France. pascal.demoly@inserm.fr

Allergy
|June 15, 2011
PubMed
Summary
This summary is machine-generated.

Sublingual immunotherapy (SLIT) for allergic rhinitis requires specific allergen doses for efficacy. Daily doses of 15-25 μg of the major allergen Phl p 5 are needed for significant symptom improvement in grass pollen allergy.

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Area of Science:

  • Allergy and Immunology
  • Pharmacology
  • Clinical Trials

Background:

  • Allergen-specific immunotherapy, including subcutaneous (SCIT) and sublingual (SLIT) routes, is a global treatment for allergic rhinoconjunctivitis and asthma.
  • While SCIT and SLIT efficacy is established for respiratory allergies via double-blind, placebo-controlled, randomized clinical trials (DB PC RCTs), comprehensive dose-effect relationships are lacking for many allergen extracts.
  • A 1998 WHO report indicated SCIT's ineffectiveness at low doses and potential for systemic reactions at high doses.

Purpose of the Study:

  • To analyze dose-response data from recent phase II-III studies of SLIT grass pollen tablets in adults with allergic rhinitis.
  • To determine optimal allergen dosages for effective clinical improvement in allergic rhinitis treatment.
  • To inform the European Academy of Allergy and Clinical Immunology Immunotherapy Interest Group task force on allergen immunotherapy dosing.

Main Methods:

  • Analysis of data from large, well-designed DB PC RCTs involving SLIT grass pollen tablets.
  • Focus on studies providing proper dose-response data for the major allergen Phl p 5.
  • Evaluation of clinical improvement based on symptom scores.

Main Results:

  • Low daily doses of 5-7 μg of Phl p 5 were found to be ineffective for allergic rhinitis treatment.
  • Significant clinical improvement, measured by symptom scores, was observed with daily doses of 15-25 μg of Phl p 5.
  • Higher doses (33-40 μg of Phl p 5 per day) did not demonstrate superior efficacy compared to the 15-25 μg range.

Conclusions:

  • Effective clinical improvement in allergic rhinitis using SLIT grass pollen tablets requires daily doses of 15-25 μg of the major allergen Phl p 5.
  • Further research into optimizing the allergen/adjuvant ratio may enhance safety, efficacy, and reduce updosing times.
  • Each specific allergen immunotherapy product necessitates its own dedicated dose-response relationship study for optimal treatment strategies.