- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03682965
Texan Allergy & Sinus Center Mountain Cedar Intra-Lymphatic Immunotherapy Study (TX-SMILE)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
TX-SMILE is an investigator-initiated, multi-center, randomized, double-blind, parallel-group, placebo-controlled study to evaluate the efficacy, safety, and tolerability of an alternative injection site and associated adjustments to dosing and treatment regimen for allergen immunotherapy with a commercially-available, FDA-approved allergenic extract for the immunotherapy treatment of allergic rhinitis and conjunctivitis due to pollen from the conifer Mountain Cedar (Juniperus ashei).
The purpose of this study is to evaluate the effect of a three-dose treatment series of ultrasonography-guided, intra-lymphatic immunotherapy injections over a two-month period prior to the start of the 2018-2019 Mountain Cedar allergy season in central Texas. Patients will be evaluated for safety and tolerability during the treatment period and for efficacy during the 2018-2019 Texas Mountain Cedar pollen season.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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Texas
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Austin, Texas, United States, 78758
- Texan Allergy & Sinus Center
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Grapevine, Texas, United States, 76051
- Texan Allergy & Sinus Center
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San Antonio, Texas, United States, 78232
- Texan Allergy & Sinus Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Both male and female adult patients with a history of Season Allergic Rhinitis (SAR) with bothersome symptoms due to Mountain Cedar pollinosis confirmed using the Modified Quantitate Test (MQT; defined as a wheal greater than or equal to 3 millimeters larger than the diluent control)
- Patients must be willing to provide written, informed consent
- Patients must be willing and able to comply with study procedures
- Women of childbearing potential must agree to use an acceptable form of contraception during the trial
Exclusion Criteria:
- Patients less than 18 years of age
- Clinically-significant chronic sinusitis, as determined by the investigator
- History of anaphylaxis during Mountain Cedar skin prick testing
- Participation in another clinical trial or use of an experimental medication within 30 days of enrollment
Medically significant co-morbidities that, in the opinion of the investigator, place the subject at increased risk during the study, including but not limited to:
- Autoimmune diseases, other than allergic rhinitis (AR), stable allergic asthma, eczema and food sensitivities
- Pulmonary or respiratory diseases other than stable asthma
- Cancer other than basal cell carcinoma
- Coronary artery disease or hypertension treated with beta-blockers
- Clinically significant impairment of renal or hepatic function
- Use of concomitant medications that, in the opinion of the investigator, may reduce the effectiveness of rescue treatments for anaphylaxis (e.g. beta-blockers) or alter the immune response to allergen immunotherapy (e.g., immunosuppressants, systemic corticosteroids)
- Previously completed immunotherapy for Mountain Cedar pollinosis, that in the opinion of the investigator would interfere with the assessment or treatment of the patient
- Inability to access suitable lymph nodes for intralympahtic injections
- Plans to leave the area for a significant period of the upcoming Mountain Cedar pollen season
- Pregnant or lactating females
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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EXPERIMENTAL: Intra-lymphatic allergenic extract
A series of three injections of 0.1 mL (about 2 drops) of the allergenic extract of Mountain Cedar Pollen given every four weeks into a superficial inguinal lymph node through guidance via ultrasonography using a 1-mL hypodermic syringe with a 25-gauge or smaller needle.
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Mountain Cedar pollen allergenic extract is an FDA-approved, commercially available product for diagnosis and hypo-sensitization treatment of allergies.
The labeled use is deep subcutaneous or percutaneous injection.
Hyposensitization treatment is typically a series of 30 - 70 injections over 3 - 5 years into the upper aspect of the arm.
This investigation is a proof-of-concept study to evaluate an alternative hyposensitization regimen of 3 injections directly into an inguinal lymph node.
Other Names:
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PLACEBO_COMPARATOR: Intra-lymphatic placebo
Diluent as placebo control (sterile saline solution containing 0.4% phenol as a preservative and matched concentration of glycerin) given as a series of three injections of 0.1 mL (about 2 drops) every four weeks into a superficial inguinal lymph node through guidance via ultrasonography using a 1-mL hypodermic syringe with a 25-gauge or smaller needle.
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The control group will receive a regimen of 3 injections of diluent (placebo) directly into an inguinal lymph node on the same schedule as the active treatment group.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average Daily Total Combined Score (TCS)
Time Frame: Up to 4 months
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The TCS is the preferred endpoint for rhinoconjunctivitis as recommended by the European Academy of Allergy and Clinical Immunology.
Scoring of the TCS is from 0 to 38 on each day that it is assessed.
The TCS is the sum of the symptom scores for "runny nose", "stuff nose", "sneezing", "itchy nose", "gritty/itchy eyes", and "watery eyes" rated from no symptoms = 0 to severe symptoms = 3 plus the score for use of rescue medications for allergy symptoms 6 points for oral antihistamine, 6 points for eye drops, and 8 points for a nasal corticosteroid.
Thus, a lower score represents fewer symptoms and associated need for allergy medication, while a higher score reflects more severe symptoms and the use of medication to treat symptoms.
The TCS will be measured during the 2018-2019 Mountain Cedar pollen se
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Up to 4 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Peak Pollen Season Days With a Lower Group Average Total Combined Score
Time Frame: Assessed up to 4 months, number of actual peak pollen season days was 27
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Evaluated during the 2018-2019 Texas Mountain Cedar allergy season.
The number of days with a lower group average Total Combined Score, comparatively, in each Arm/Group are reported.
Scoring of the TCS is from 0 to 38 on each day that it is assessed.The TCS is the sum of the symptom scores for "runny nose", "stuff nose", "sneezing", "itchy nose", "gritty/itchy eyes", and "watery eyes" rated from no symptoms = 0 to severe symptoms = 3 plus the score for use of rescue medications for allergy symptoms 6 points for oral antihistamine, 6 points for eye drops, and 8 points for a nasal corticosteroid.
Thus, a lower score represents fewer symptoms and associated need for allergy medication, while a higher score reflects more severe symptoms and the use of medication to treat symptoms.
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Assessed up to 4 months, number of actual peak pollen season days was 27
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Patient Reported Pain or Discomfort Following Intra-lymphatic Injections
Time Frame: Immediately after the ILIT procedure
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Patient reported pain will be measured immediately after ILIT procedure using the Numeric Rating Scale 11 (NRS-11 rating scale).
The NRS-11 asks patients to rate their pain on a scale from 0 (no pain or discomfort) to 11 (worst possible pain).
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Immediately after the ILIT procedure
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Patient-reported Treatment Satisfaction at the End of Study
Time Frame: Up to 4 months
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Percentage of patients reporting satisfaction with their treatment
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Up to 4 months
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Percentage Change in Allergen-specific Serum IgE
Time Frame: Assessed prior to the first injection and to 4-8 weeks after the end of the 2018-2019 pollen season
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Percentage change in allergen-specific serum IgE from baseline to the end-of-study visit between active ILIT and placebo.
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Assessed prior to the first injection and to 4-8 weeks after the end of the 2018-2019 pollen season
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Total Safety Score (TSS) for Active and Placebo Treatment Groups
Time Frame: 8 weeks
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The total safety score is a is based on World Allergy Organization grading for allergic reactions.
Following allergen or placebo exposure via intra-lymphatic injection, patients are monitored for local and systemic allergic reactions for up to 60 minutes post-procedure.
At each exposure, a score is rated on a scale from none = 0, local reactions only = 1, mild systemic reactions (WAO Grade 1/2) = 2, moderate systemic reaction (WAO Grade 3) = 3, and severe systemic reaction (WAO grade 4) = 4.
The total safety score for each group is the sum of the individual scores of each patient across all three treatments (exposures).
Thus, the subject may have a score from 0 to 12 with 0 reflecting no allergic reaction to the allergen and 12 reflecting severe allergic reactions, and the TSS for a group is the sum for all patients in the group.
The TSS is used to elicit and grade adverse events of interest rather than for statistical analysis.
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8 weeks
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Number of Subjects Who: Experienced Anaphylaxis, Were Treated With Epinephrine, or Experienced Any Other Treatment-emergent SAE Within 60 Minutes of Any of Three Planned ILIT Procedures
Time Frame: 8 weeks
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To evaluate the safety of ILIT for Mountain Cedar pollinosis relative to placebo control based on the proportion of subjects receiving allergenic extract versus the proportion of subjects receiving placebo that:
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8 weeks
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Total Number of Rescue Inhaler Uses by Patients With Asthma
Time Frame: Up to 4 month
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Relative use of rescue inhalers by patients with comorbid asthma between active and placebo groups during the 2018-2019 Mountain Cedar pollen season.
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Up to 4 month
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Christopher Thompson, MD, Texan Allergy & Sinus Center
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Infections
- Respiratory Tract Infections
- Respiratory Tract Diseases
- Immune System Diseases
- Hypersensitivity, Immediate
- Eye Diseases
- Otorhinolaryngologic Diseases
- Respiratory Hypersensitivity
- Hypersensitivity
- Nose Diseases
- Conjunctival Diseases
- Rhinitis
- Rhinitis, Allergic
- Conjunctivitis
- Conjunctivitis, Allergic
Other Study ID Numbers
- TASC-ILIT-MC-2018
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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