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Sublingual birch pollen immunotherapy yielded sustained improvements to allergic rhinoconjunctivitis
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The administration of a sublingual solution of birch-pollen 4 months before and during the pollen period led to a significant and sustained reduction in symptoms associated with allergic rhinoconjunctivitis in a recent study.
“The sustained clinical efficacy over 2 years, favorable safety profile, and ability to administer birch pollen sublingual immunotherapy at home, make this treatment an alternative to subcutaneous immunotherapy for patients with birch pollen-associated [allergic rhinoconjunctivitis],” Margitta Worm, MD, PhD, of the Allergy-Centre-Charité in Berlin, and colleagues wrote.
At baseline, the average patient had a history of birch-associated allergic rhinitis for about 14 years, more than 68% were polysensitized, 20% had asthma, and about 54% had oral allergy syndrome (OAS), according to researchers.
Margitta Worm
In their study, adults (aged 18 to 65 years) with a birch pollen allergy were randomly assigned to a sublingual solution of birch-pollen standardized extract (Staloral, Stallergenes) at 300 IR/mL (n=284) or placebo (n=290), daily starting 4 months before and continuing through the pollen season for two pollen seasons. Of those, 496 completed the study.
The least square (LS) mean Average Adjusted Symptom Score (AAdSS) appeared significantly lower in the 300IR group compared with the placebo group (LS mean difference, –2.04; 95% CI, –2.69 to –1.4) during the second pollen period, with a relative reduction of 30.6%.
The researchers reported that data were consistent across patients with (−33.6%) and without (−28.4%) OAS. They also observed a significant reduction LS mean AAdSS over the first pollen season.
There were no reports of anaphylaxis; the most common adverse events included application site reactions, such as oral pruritus, throat irritation, and mouth edema.
Disclosure: See the study for a full list of relevant financial disclosures.
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Linda Cox, MD, FAAAAI
Worm and colleagues looked at the efficacy four months before season then continuing through season; stopping and repeating the second year. It’s a little different concept from the year-round treatment regimen.
This is a fairly standard practice in Europe, to treat before season and continue through the season and then stop. The concerns about something like that might be safety or if patients will have more side effects. However, that has not been proven to be problematic.
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