Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy
Abstract Background Clinical practice needs a common parameter that can provide an early, reliable estimation of the outcome of sublingual immunotherapy (SLIT) in an upcoming pollen season. We investigated whether the conjunctival provocation test (CPT) can predict the beneficial outcome of SLIT in...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-07-01
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| Series: | Clinical and Translational Allergy |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13601-018-0214-y |
| _version_ | 1818581746847842304 |
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| author | Janina Köther Alicia Mandl Silke Allekotte Anatoli Astvatsatourov Janin Chwieralski Jan-Patrick Liedtke Ursula Pieper-Fürst Esther Raskopf Kija Shah-Hosseini Ralph Mösges |
| author_facet | Janina Köther Alicia Mandl Silke Allekotte Anatoli Astvatsatourov Janin Chwieralski Jan-Patrick Liedtke Ursula Pieper-Fürst Esther Raskopf Kija Shah-Hosseini Ralph Mösges |
| author_sort | Janina Köther |
| collection | DOAJ |
| description | Abstract Background Clinical practice needs a common parameter that can provide an early, reliable estimation of the outcome of sublingual immunotherapy (SLIT) in an upcoming pollen season. We investigated whether the conjunctival provocation test (CPT) can predict the beneficial outcome of SLIT in patients with allergic rhinoconjunctivitis after 4 weeks of treatment. Methods We conducted two separate prospective, randomized, double-blind, placebo-controlled, multicenter trials. Adults 18–75 years of age received placebo or SLIT tablets containing tree or grass pollen allergoids and underwent CPTs. Participants receiving SLIT were divided into two groups (reactive, nonreactive) according to their CPT reactions after 4 weeks of treatment. These two groups were compared with regard to clinical outcome parameters (total combined score, rhinoconjunctivitis total symptom score, total rescue medication score, well days) assessed during the pollen season for the 14-day (tree) or 30-day (tree/grass) peaks and for the entire 60-day seasons. Participants’ global evaluations of therapy after completing treatment were also compared. Results The tree pollen trial randomized 188 participants; 182 participants were evaluable, 76 of whom received SLIT and were suitable for this post hoc analysis. The grass pollen trial included 90 participants; 82 participants were evaluable, 44 of whom underwent SLIT. Comparing SLIT participants who reacted to the CPT after 4 weeks (tree: 77.6%; grass: 79.5%) with those who ceased to show a reaction (tree: 22.4%; grass: 20.5%) (tree: P = 0.0001; grass: P = 0.003), the total combined score for the 14-day (P = 0.017) and 30-day peaks (P = 0.042) as well as the rhinoconjunctivitis total symptom score assessed for the 14-day peak (P = 0.024) were significantly lower in the nonreactive group of the tree pollen trial. In the grass pollen trial, the nonreactive group rated their SLIT treatment significantly better (P = 0.019). Conclusions Using clinically meaningful outcome parameters during the pollen season, both trials independently led to similar results when comparing participants’ reactions to the CPT 4 weeks after beginning SLIT. These results suggest that CPT allows an early estimation of allergic rhinoconjunctivitis symptoms before an upcoming season. Thus, the CPT can be used as a valuable parameter to predict the beneficial outcome of ongoing SLIT. Trial registration Both trials registered with the Medical Ethics Committee of the North Rhine Medical Council (EudraCT numbers 2012-004916-79 (grass pollen trial) and 2013-002129-43 (tree pollen trial)) and the German Federal Ministry of Health (Paul-Ehrlich-Institut). |
| first_indexed | 2024-12-16T07:38:24Z |
| format | Article |
| id | doaj.art-4cc8c0140d3042f9a78d710316aa854d |
| institution | Directory Open Access Journal |
| issn | 2045-7022 |
| language | English |
| last_indexed | 2024-12-16T07:38:24Z |
| publishDate | 2018-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Translational Allergy |
| spelling | doaj.art-4cc8c0140d3042f9a78d710316aa854d2022-12-21T22:39:08ZengWileyClinical and Translational Allergy2045-70222018-07-018111110.1186/s13601-018-0214-yEarly nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapyJanina Köther0Alicia Mandl1Silke Allekotte2Anatoli Astvatsatourov3Janin Chwieralski4Jan-Patrick Liedtke5Ursula Pieper-Fürst6Esther Raskopf7Kija Shah-Hosseini8Ralph Mösges9Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine, University of CologneAbstract Background Clinical practice needs a common parameter that can provide an early, reliable estimation of the outcome of sublingual immunotherapy (SLIT) in an upcoming pollen season. We investigated whether the conjunctival provocation test (CPT) can predict the beneficial outcome of SLIT in patients with allergic rhinoconjunctivitis after 4 weeks of treatment. Methods We conducted two separate prospective, randomized, double-blind, placebo-controlled, multicenter trials. Adults 18–75 years of age received placebo or SLIT tablets containing tree or grass pollen allergoids and underwent CPTs. Participants receiving SLIT were divided into two groups (reactive, nonreactive) according to their CPT reactions after 4 weeks of treatment. These two groups were compared with regard to clinical outcome parameters (total combined score, rhinoconjunctivitis total symptom score, total rescue medication score, well days) assessed during the pollen season for the 14-day (tree) or 30-day (tree/grass) peaks and for the entire 60-day seasons. Participants’ global evaluations of therapy after completing treatment were also compared. Results The tree pollen trial randomized 188 participants; 182 participants were evaluable, 76 of whom received SLIT and were suitable for this post hoc analysis. The grass pollen trial included 90 participants; 82 participants were evaluable, 44 of whom underwent SLIT. Comparing SLIT participants who reacted to the CPT after 4 weeks (tree: 77.6%; grass: 79.5%) with those who ceased to show a reaction (tree: 22.4%; grass: 20.5%) (tree: P = 0.0001; grass: P = 0.003), the total combined score for the 14-day (P = 0.017) and 30-day peaks (P = 0.042) as well as the rhinoconjunctivitis total symptom score assessed for the 14-day peak (P = 0.024) were significantly lower in the nonreactive group of the tree pollen trial. In the grass pollen trial, the nonreactive group rated their SLIT treatment significantly better (P = 0.019). Conclusions Using clinically meaningful outcome parameters during the pollen season, both trials independently led to similar results when comparing participants’ reactions to the CPT 4 weeks after beginning SLIT. These results suggest that CPT allows an early estimation of allergic rhinoconjunctivitis symptoms before an upcoming season. Thus, the CPT can be used as a valuable parameter to predict the beneficial outcome of ongoing SLIT. Trial registration Both trials registered with the Medical Ethics Committee of the North Rhine Medical Council (EudraCT numbers 2012-004916-79 (grass pollen trial) and 2013-002129-43 (tree pollen trial)) and the German Federal Ministry of Health (Paul-Ehrlich-Institut).http://link.springer.com/article/10.1186/s13601-018-0214-yConjunctival provocation testConjunctival allergen challengeEarly responderSublingual immunotherapy |
| spellingShingle | Janina Köther Alicia Mandl Silke Allekotte Anatoli Astvatsatourov Janin Chwieralski Jan-Patrick Liedtke Ursula Pieper-Fürst Esther Raskopf Kija Shah-Hosseini Ralph Mösges Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy Clinical and Translational Allergy Conjunctival provocation test Conjunctival allergen challenge Early responder Sublingual immunotherapy |
| title | Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy |
| title_full | Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy |
| title_fullStr | Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy |
| title_full_unstemmed | Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy |
| title_short | Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy |
| title_sort | early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy |
| topic | Conjunctival provocation test Conjunctival allergen challenge Early responder Sublingual immunotherapy |
| url | http://link.springer.com/article/10.1186/s13601-018-0214-y |
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