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Keywords:

  • allergic rhinitis;
  • carry-over effect;
  • grass pollen extract;
  • sublingual immunotherapy;
  • ultra-rush titration

Background:  Data supporting a carry-over effect with sublingual immunotherapy (SLIT) are scarce. This randomized, double-blind, placebo-controlled study evaluated the efficacy, carry-over effect and safety of grass pollen SLIT using co-seasonal treatment.

Methods:  Patients (7.9–64.7 years) with grass pollen allergy received ultra-rush titration with increasing doses (30, 90, 150 and 300 IR) of a 5-grass pollen mixture every 20 min at the start of the pollen seasons, followed by 300 IR daily until the end of the pollen seasons. A baseline season (no SLIT) was followed by three consecutive treatment seasons and one follow-up season. Symptoms, medication and adverse events were documented and specific immunoglobulin (Ig)E and IgG4 measured.

Results:  Data were analysed for 183 of the 213 randomized patients. Mean treatment duration varied between seasons (81.8−92.7 days). Combined scores (symptoms and medication) improved progressively across treatment seasons (up to 44.7% improvement for SLIT compared with baseline) and fluctuated between −11.3% and −14.8% for placebo (< 0.05). Similar changes were observed for symptom scores, with a successive decrease of 39.7% (SLIT) and fluctuations between +13.6% and −1.51% for placebo (< 0.05). Combined score (= 0.0508) and symptom score improvements (= 0.0144) with SLIT continued during follow up. Increases in specific IgG4 observed in the first season were sustained for SLIT vs placebo throughout treatment (= 0.0001). Titration and daily SLIT were well tolerated. No serious systemic or anaphylactic reactions were reported.

Conclusions:  Seasonal SLIT with ultra-rush titration is well tolerated and effective from the first treatment season onwards. These data indicate a carry-over effect of seasonal SLIT.