Factors Predicting Efficacy of Allergen Injection Immunotherapy for Grass Pollen Hayfever

Factors Predicting Efficacy of Allergen Injection Immunotherapy for Grass Pollen Hayfever: A Pilot Study. (Up-dosing Study)

The purpose of this study is to determine at which point in the dosing regime grass pollen immunotherapy causes a significant reduction in the late skin response to allergen challenge. A once weekly cluster regimen of 2 injections per visit was employed during the up-dosing phase, followed by monthly maintenance injections of 100,000 SQ units. Symptom scores and need of rescue medication were recorded by patients during the study period. The size of early and late cutaneous response to allergen challenge was recorded and measured by a physician.

Study Overview

• Status: Completed
• Conditions: Rhinitis, Allergic, Seasonal
• Intervention / Treatment: Biological: Active injections of alum-adsorbed grass pollen vaccine (Alutard SQ).; Procedure: Venepuncture: 100ml blood sample taken on 12 separate visits; Other: Placebo Injection

Detailed Description

This was a single centre, randomised, double-blind placebo controlled trial of grass pollen injection immunotherapy (Alutard SQ, ALK Abello, Denmark) in adults with severe summer hayfever unresponsive to antihistamines and topical steroids. The main aim was to determine at which point in the dosing regime grass pollen immunotherapy causes a significant reduction in the late skin response to allergen challenge. A once weekly cluster regimen of 2 injections per visit was employed during the up-dosing phase, followed by monthly maintenance injections of 100,000 SQ units. Twelve patients received active treatment (mean age 31, 7 male) whilst 6 were given placebo (mean age 37, 2 male). The 24 hour skin response (size of swelling, (mm)) to intradermal allergen challenge (0.1, 1, 10 BU) was determined on alternate weeks during the 8 week up-dosing phase and then monthly up to 6 months and 3 monthly up to 11-13 months following initiation of treatment.

• Study Type: Interventional
• Enrollment (Actual): 18
• Phase: Phase 3

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, SW3 6LY
    • Royal Brompton Hospital, NHLI Imperial College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Male and female 18-65 years of age
• Written informed consent obtained before entering the trial
• A clinical history of grass pollen induced allergic rhinoconjunctivitis of two years or more requiring treatment during the grass pollen season
• A clinical history of severe rhinoconjunctivitis symptoms (interfering with usual daily activities or sleep), which remain troublesome despite treatment with anti-allergic drugs during the grass pollen season
• Positive Skin Prick Test (SPT) response (wheal diameter ≥ 3 mm) to Phleum pratense
• Positive specific IgE against Phleum pratense (≥ IgE Class 2)
• Physical examination with no clinically relevant findings
• If pre-menopausal female of childbearing potential, the subject must test negative on standard urine pregnancy test and must be willing to practice appropriate contraceptive methods for the duration of the trial
• Willingness to comply with this protocol

Exclusion Criteria:

• FEV1 < 70% of predicted value
• A clinical history of symptomatic seasonal allergic rhinitis and/or asthma due to tree pollen or weed pollen adjacent to the start of - and potentially overlapping - the grass pollen season
• A clinical history of significant symptomatic perennial allergic rhinitis and/or asthma caused by an allergen to which the subject is regularly exposed
• A clinical history of significant recurrent acute sinusitis (defined as 2 episodes per year for the last two years all of which required antibiotic treatment) or chronic sinusitis
• At randomisation, current symptoms of, or treatment for, upper respiratory tract infection, acute sinusitis, acute otitis media or other relevant infectious process (serous otitis media is not an exclusion criterion)
• History of emergency visit or admission for asthma in the previous 12 months
• Use of an investigational drug within 30 days prior to screening
• Previous treatment by immunotherapy with grass pollen allergen or any other allergen within the previous 5 years
• History of anaphylaxis, including anaphylactic food allergy, bee venom anaphylaxis, exercise anaphylaxis or drug induced anaphylaxis
• History of angioedema

• Any of the following underlying conditions known or suspected to be present:

  • Cystic fibrosis
  • Malignancy
  • Insulin-dependent diabetes
  • Malabsorption or malnutrition
  • Renal or hepatic insufficiency
  • Chronic infection
  • Drug dependency or alcoholism
  • Ischemic heart disease or angina requiring current daily medication or with any evidence of disease making implementation of the protocol or interpretation of the protocol results difficult or jeopardising the safety of the subject (e.g. clinically significant cardiovascular, serious immunopathologic, immunodeficiency whether acquired or not, hepatic, neurologic, psychiatric, endocrine, or other major systemic disease)
• Immunosuppressive treatment
• History of hypersensitivity to the excipients of the trial medications
• History of allergy, hypersensitivity or intolerance to trial medications or rescue medications
• A mental condition rendering the subject unable to understand the nature, scope and possible consequences of the trial, and/or evidence of an uncooperative attitude
• Unlikely to be able to complete the trial, for any reason, or likely to travel for extended periods of time during the grass pollen season

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Immunotherpy Arm; 12 patients received active injections of an alum-adsorbed grass pollen vaccine	Biological: Active injections of alum-adsorbed grass pollen vaccine (Alutard SQ).; Active injections of alum-adsorbed grass pollen vaccine (Alutard SQ).; Procedure: Venepuncture: 100ml blood sample taken on 12 separate visits; Venepuncture: 100ml blood sample taken on 12 separate visits
Placebo Comparator: Placebo Arm; 6 patients received placebo injections	Procedure: Venepuncture: 100ml blood sample taken on 12 separate visits; Venepuncture: 100ml blood sample taken on 12 separate visits; Other: Placebo Injection; Placebo Injection

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Symptom and medication score recorded by subjects	Overall assessment of symptoms was recorded on a numeric scale (-3 to +3) by each patient at the end of the study	Assessment scores obtained after 12 months of treatment
Adverse events (conjunctival symptoms)	Conjunctival symptoms elicitation with P-pratense allergen (reduced response detection)	10 minutes post-conjunctival allergen provocation after 12 months of treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intradermal allergen challenge	All patients underwent re-peated venesection and intradermal allergen challenge for testing of early and late skin responses: allergen-induced cytokine production over 10 months (reduced response change to P pratense-specific antigens). Intradermal allergen challenge for testing of early and late skin responses at biweekly intervals during updosing and at monthly intervals during the maintenance phase.	Biweekly during up-dosing and then monthly upto 6 months, and up to 12 months following initiation of treatment.

Collaborators and Investigators

• Sponsor: Imperial College London
• Collaborators: ALK-Abelló A/S
• Investigators: Principal Investigator: Stephen R Durham, Professor, Royal Brompton Hospital, Imperial College, National Heart & Lung Institute

Publications and helpful links

General Publications

• Francis JN, James LK, Paraskevopoulos G, Wong C, Calderon MA, Durham SR, Till SJ. Grass pollen immunotherapy: IL-10 induction and suppression of late responses precedes IgG4 inhibitory antibody activity. J Allergy Clin Immunol. 2008 May;121(5):1120-1125.e2. doi: 10.1016/j.jaci.2008.01.072. Epub 2008 Apr 18.

Study record dates

Study Major Dates

• Study Start: October 1, 2002
• Primary Completion (Actual): January 1, 2008
• Study Completion (Actual): October 1, 2008

Study Registration Dates

• First Submitted: August 25, 2005
• First Submitted That Met QC Criteria: August 25, 2005
• First Posted (Estimated): August 26, 2005

Study Record Updates

• Last Update Posted (Actual): May 16, 2024
• Last Update Submitted That Met QC Criteria: May 15, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: Hayfever; Sublingual Immunotherapy; Grass pollen immunotherapy; Late cutaneous response; Intradermal allergen challenge; Seasonal Allergic Rhinoconjunctivitis
• Additional Relevant MeSH Terms: Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Immune System Diseases; Hypersensitivity, Immediate; Otorhinolaryngologic Diseases; Respiratory Hypersensitivity; Hypersensitivity; Nose Diseases; Rhinitis; Rhinitis, Allergic; Rhinitis, Allergic, Seasonal
• Other Study ID Numbers: DHRG-UpDosing

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No