STUDY POPULATION. The study included 855 patients aged 18 to 65 from 55 centers in Canada and Europe with seasonal allergic rhinoconjunctivitis induced by grass pollen. METHODS. A double-blind, randomized, parallel-group, placebo-controlled trial was conducted during 2002– 2003. Patients had a history of allergic rhinoconjuncti- vitis during grass-pollen season for at least 2 years with a positive skin-prick–test result and serum-specific im- munoglobulin E (IgE) to Phleum pratense. Individuals were randomly assigned to receive placebo or 2500, 25 000, or 75 000 SQ-T sublingual tablets administered daily. Daily diaries of symptoms (0 –3) and rescue-med- ication use from pre– through post– grass-pollen season were kept, and a rhinoconjunctivitis quality-of-life (QoL) questionnaire was completed. Well days were calculated as those with a symptom score of 2 and no rescue-medication use. RESULTS. A total of 790 (92%) participants completed the trial that included a mean duration of treatment of 18 weeks. Treatment with 75 000 SQ-T tabs revealed an im- provement in symptom score (16%; P = .0710) and med- ication score (28%; P = .0470) when compared with pla- cebo. The QoL score and number of well days also revealed improvement of 17% (P = .006) and 18% (P = .041), respectively. The 2 lower doses did not demonstrate signif- icant change from placebo. Preseason treatment for 8 weeks with the 75 000 SQ-T dose showed an increased improvement of symptom score (21%; P = .002) and medication score (29%; P = .012) compared with placebo. In the 75 000 SQ-T group, specific IgG to P pratense was increased after 8 weeks of treatment and tripled posttreat- ment. Specific IgE levels increased after treatment initial- ized but remained unchanged thereafter. Therapy was well tolerated with only mild-to-moderate symptoms (consist- ing of primarily oral pruritis and throat irritation) noted in 53% of the patients. CONCLUSIONS. Grass-pollen SLIT has a dose-dependent ef- ficacy, is well tolerated, and provides improved QoL for patients with seasonal allergic rhinoconjunctivitis. REVIEWER COMMENTS. SLIT for grass-pollen allergy holds promise as an alternative future therapy to subcutane- ous immunotherapy that is attractive on many levels. Grass-pollen SLIT may have broader coverage range be- cause of improved accessibility and more convenient administration, less discomfort than injections, and de- creased risk of IgE-mediated severe systemic reactions. Preseason coverage with SLIT may improve symptoms and reduce medication requirements for treatment of seasonal allergic rhinoconjunctivitis. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2007-0846EEEE Teri J. Jordan, MD Stacie M. Jones, MD Little Rock, AR Clinical Efficacy and Safety of Sublingual Immunotherapy With Tree Pollen Extract in Children Valovirta E, Jacobsen L, Ljørring C, Koivikko A, Savolainen J. Allergy. 2006;61:1177–1183 PURPOSE OF THE STUDY. To investigate the clinical efficacy, safety, and dose-response relationship of sublingual im- munotherapy (SLIT) in children suffering from rhino- conjunctivitis with or without asthma. STUDY POPULATION. Eighty-eight children (aged 5–15 years) in Finland with a history of tree-pollen–induced allergic rhinoconjunctivitis with or without seasonal asthma. Skin-prick test, specific immunoglobulin E, and con- junctival provocation test were used to confirm allergy to tree pollen. METHODS. Randomized, double-blind, placebo-controlled dose-response study using a glycerinated mixture of pol- len from birch, hazel, and alder trees. Three groups receiving SLIT 5 days per week for up to 18 months were given an accumulated weekly dose of 24 000 U (dose group 1), an accumulated weekly dose of 200 000 U (dose group 2), or placebo. RESULTS. In the birch-pollen season, dose group 2 showed a significant reduction in both symptom (P = .01) and medication (P = .04) scores compared with those in the placebo group, but dose group 1 showed only a significant reduction of symptom scores (P = .03). No serious adverse events were reported. Oral local reactions were the most common adverse effect, ranging from 25% of patients in the placebo group to 50% in group 2. CONCLUSIONS. SLIT with tree-pollen extract provided dose- dependent benefits in tree-pollen–allergic children in terms of significantly reduced symptoms and medication use. The treatment was well tolerated. REVIEWER COMMENTS. The use of allergen-specific immuno- therapy by the sublingual route, SLIT, has been in- creasing in clinical practice in Europe. SLIT is espe- cially attractive for use in children, because it is a noninjection form of immunotherapy. This study showed a modest reduction (40%) in both symptom and medication scores. This is an interesting disease- modifying therapy that will need more studies to char- acterize efficacy and safety and to compare the results to that of subcutaneous immunotherapy before wider use can be recommended. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2007-0846FFFF Kirsi M. Jarvinen, MD, PhD Scott H. Sicherer, MD New York, NY PEDIATRICS Volume 120, Supplement 3, November 2007 S151 by guest on May 23, 2020 www.aappublications.org/news Downloaded from