Allergic Rhinitis: Three Years of Immunotherapy Gives Longer Lasting Symptom Control Interview with:
Stephen R. Durham, MD

Imperial College, London, and Royal Brompton and Harefield Hospitals
NHS Foundation Trust
London, United Kingdom What is the background for this study? What are the main findings?

Response: Allergic rhinitis affects 1 in 4 the UK population and may compromise sleep and work/school performance and be associated with bronchial asthma. When nasal steroids and antihistamines do not work or cause side effects, allergen immunotherapy is an alternative. Immunotherapy using high doses of grass pollen allergen as monthly injections or daily tablets under the tongue are highly effective. Treatment for 3 years not only gives sustained improvement on treatment but also long-term benefits and disease remission for at least 2-3 years after stopping treatment.

This single centre study at Imperial College London and Royal Brompton Hospital London included 106 adults with severe Hayfever followed up for 3 years, 2 years on treatment and 1 year after stopping treatment. In this double-blind trial, 3 randomised groups took sublingual immunotherapy, subcutaneous immunotherapy and placebo treatment. 92 completed the trial. Results showed that 2 years treatment with both modalities did not result in persistent benefit at year 3, although the researchers found that both treatments were effective compared to placebo during years 1 and 2. What should readers take away from this report?

Response: Two years of treatment with either Sublingual tablet immunotherapy and subcutaneous immunotherapy are effective but insufficient for long-term clinical tolerance, as has previously shown following 3 years treatment. Doctors should therefore follow current guidelines that recommend a duration of at least 3 years Immunotherapy. What recommendations do you have for future research as a result of this study?

Response: Exploration of underlying mechanisms in this trial are will provide important insights relevant for developing more effective allergen immunotherapy in the future. Is there anything else you would like to add:

Response: This work was funded by the Immune Tolerance Network, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA. The allergen immunotherapy vaccines used (Sublingual tablets (Grazax) and subcutaneous immunotherapy (Phleum Pratense Alutard SQ) were provided free of charge by the manufacturer, ALK Denmark who had no other involvement in the clinical trial).
The principle investigator Dr Durham has received from manufacturers of allergy vaccines consultancy fees unrelated to the current work.

Scadding GW, Calderon MA, Shamji MH, Eifan AO, Penagos M, Dumitru F, Sever ML, Bahnson HT, Lawson K, Harris KM, Plough AG, Panza JL, Qin T, Lim N, Tchao NK, Togias A, Durham SR, for the Immune Tolerance Network GRASS Study Team. Effect of 2 Years of Treatment With Sublingual Grass Pollen Immunotherapy on Nasal Response to Allergen Challenge at 3 Years Among Patients With Moderate to Severe Seasonal Allergic RhinitisThe GRASS Randomized Clinical Trial. JAMA. 2017;317(6):615-625. doi:10.1001/jama.2016.21040

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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