Grass pollen immunotherapy for seasonal rhinitis and asthma: A randomized,controlled trial

Background: Grass pollen Immunotherapy significantly reduces hay fever symp toms and medication requirements, Effects on seasonal asthma are less clear , and concerns over safety persist. Objective: The goal of this study was to assess the effects of grass pollen immunotherapy on symptoms, bronchial hyperresponsiveness, and quality of l ife in seasonal rhinitis and asthma, Methods: Forty-four patients with severe summer hay fever (of whom 36 repor ted seasonal chest symptoms and 28 had seasonal bronchial hyperresponsivene ss) participated in a randomized, double-blind, placebo-controlled, paralle l group study. After symptom monitoring for one summer, participants receiv ed injections of a depot grass pollen vaccine (n = 22) or matched placebo I njections (n = 22) in a rapid updosing fluster regimen fur 4 weeks, followe d by monthly injections for 2 years. Outcome measures included hay fever sy mptoms and medication use, health-related quality of life, and measurements of nonspecific bronchial responsiveness. Results: Significant reductions were observed in the immunotherapy group co mpared with the placebo group in hay fryer symptoms (49%, 15%; P =.01), med ication scores (80%, 18%; P =,007), and seasonal chest symptoms (90%, 11%; P <.05). Impairment of overall quality of life (mean score of 7 domains) du ring the pollen season was less in the immunotherapy group than In the plac ebo group (median difference [95% CI], 0.8 [0.18-1.5]; P =.02). During the pollen season there was no change in airway methacholine PC20 (provocation concentration producing a 20% fall in FEV1) in the immunotherapy-treated gr oup (P =.5), compared with an almost 3 doubling-dose decrease in the placeb o-treated group (P =.01, between-group difference), There were no significa nt local or systemic side effects during the study. Conclusion: Grass pollen immunotherapy improves quality of life in seasonal allergic rhinitis and reduces seasonal asthma symptoms and bronchial hyper responsiveness.