AB94 Abstracts J ALLERGY CLIN IMMUNOL

FEBRUARY 2016

307 A Randomized Placebo-Controlled Trial of

Intradermal Grass Pollen Immunotherapy for
Seasonal Allergic Rhinitis
Anna D. Slovick, MRCS, DOHNS, MBBS, BSc1, Abdel Douiri, PhD1,
Rachel Muir, PhD2, Andrea Guerra, MD1, Kostas Tsioulos, MD1, Evie
Haye, BSc1, Emily Lam, MSc1, Joanna Kelly1, Janet Peacock, PhD1,
S. Ying, MD, PhD1, Mohamed H. Shamji, BSc, MSc, PhD, FAAAAI3,
David Cousins, PhD1, Stephen R. Durham, MA, MD, FRCP3,4, Stephen
Till, MD, PhD1; 1King’s College London, London, United Kingdom,
2
GSTT, London, United Kingdom, 3MRC & Asthma UK Centre in
Allergic Mechanisms of Asthma, London, United Kingdom, 4National
Heart and Lung Institute, Imperial College London, United Kingdom.
RATIONALE: We previously reported that repeated intradermal injection
of grass pollen (nanograms of allergen) almost completely suppresses
allergen-induced cutaneous late phase responses (JACI 2012 130(4):918-
24). Similar suppression of late responses is seen after high dose subcutaneous
SATURDAY
adjusted odd ratios (AOR) from 6 prospective studies (n522,184) (AOR
5 0.92 [0.64-1.33] for top vs. bottom category of 25OHD).
CONCLUSIONS: Available evidence from this meta-analysis suggests
that the 25OHD level may not relate with neither the prevalence of the
current AR nor the development of AR. Since these studies were very
heterogeneous and the retrospective or the observational cohort studies,
large randomized controlled trials are needed to determine whether vitamin
D supplementation may be beneficial in the prevention of AR.
309 Nasal Challenge with Ragweed Pollen Extract
(RWPE) Increases the Level of Fortilin in Nasal
Lavage Fluid from Subjects with Allergic Rhinitis
Julia W. Tripple, MD1, Koa Hosoki, MD, PhD1, Istvan Boldogh, PhD1,
David Rogers Redding, MD2, Sanjiv Sur, MD1, Ken Fujise, MD1; 1Uni-
versity of Texas Medical Branch, Galveston, TX, 2Redding Allergy and
Asthma Center, Atlanta, GA.

and sublingual immunotherapy. We therefore evaluated the efficacy of grass
pollen intradermal immunotherapy (IDIT) for treatment of allergic rhinitis.
METHODS: 93 adults with grass pollen allergic rhinitis were randomized
to receive 7 pre-seasonal IDIT injections (7 ng of Phl p 5 major allergen) or
histamine control at 2-weekly intervals. The primary end point was
combined daily symptom/medication scores (CSMS) during 2013 pollen
season. Skin biopsies were taken after the pollen season following
intradermal allergen challenges. Cutaneous late responses were measured
4 and either 7, 10 or 13 months post-treatment.
RESULTS: No difference in CSMS was observed between treatment
arms. Paradoxically, amongst secondary endpoints, nasal symptoms
measured with daily scores (P50.03) and visual analog scales (P50.05)
were higher in the IDIT group. IDIT also increased serum Phl p-specific
IgE (P50.001) compared to the control arm. T cells cultured from skin
biopsies of IDIT subjects showed higher and lower expression of surface
markers for Th2 (P50.04) and Th1 (P50.01) cells, respectively, together
with higher expression of IL-5 mRNA measured by microarray. Late
responses to grass pollen were still inhibited 7 months after IDIT (P50.03).
CONCLUSIONS: Although grass pollen IDIT suppressed skin late
responses, it was not clinically effective but resulted in immunological
priming and worsening of allergic rhinitis symptoms.
RATIONALE: Fortilin, also known as histamine-releasing factor [HRF]
and translationally controlled tumor protein, has been studied as a HRF and
implicated as a mediator in late phase allergic reactions. It has a
proinflammatory role in murine asthma and skin immediate hypersensi-
tivity. However, the ability of allergen challenge to modulate the levels of
fortilin in the nasal secretion of subjects with allergic rhinitis has not been
reported.
METHODS: Nine adult subjects with allergic rhinitis and positive skin
prick testing to ragweed pollen extract (RWPE) were recruited for this
study. The mean age of the subjects was 41.6 years. Intranasal challenge
with saline and provoking doses of RWPE solution were performed on two
different days. During nasal challenge, symptom scores were recorded at
baseline, 30 min, and hourly for a total of 6 hours. Nasal lavage was
performed at baseline, 30 min and 5 hours post-challenge, and the collected
nasal fluid was analyzed for fortilin levels by ELISA.
RESULTS: Compared to saline challenge, RWPE challenge rapidly
increased congestion, drainage, sneezing, and total symptom scores at 30
min post-challenge (p<0.05). These scores decreased 2 hours post-
challenge. Compared to saline challenge, ragweed extract increased the
level of fortilin 5 hours after challenge (p<0.05), but not at 30 min post
challenge.
CONCLUSIONS: Exposure to ragweed pollen induces a delayed

308 Vitamin D Level in Allergic Rhinitis: A Systemic

Review and Meta-Analysis
secretion of fortilin in the nasal airway of ragweed-IgE skin test positive
subjects with allergic rhinitis. Fortilin may play a role in the pathophys-
iology of allergic rhinitis.
Yoon Hee Kim, Min Jung Kim, MD, In Suk Sol, Seo Hee Yoon, Young A.
Park, MD, Kyung Won Kim, Myung Hyun Sohn, MD, PhD, Kyu-Earn
Kim, MD, PhD; Department of Pediatrics, Severance Hospital, Institute
of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei
University College of Medicine, Seoul, South Korea.
RATIONALE: Vitamin D has emerged to play a key role in the allergic
disease by influencing to the immune system. We aimed to systematically
review observational studies investigating the level of vitamin D on the
prevalence of the current allergic rhinitis (AR) and the development of AR.
METHODS: We searched MEDLINE, EMBASE, the Cochrane Library
and KoreaMed to February 28, 2015. Two reviewers completed in
duplicate and independently study selection, data abstraction, and
assessment of risk of bias.
RESULTS: We selected 10 cross-sectional studies about the current
25OHD levels and the prevalence of the current AR and 6 prospective
studies about the development of AR relating with the previous 25OHD
levels. Meta-analysis was performed to pool odd ratios from 10 cross-
sectional studies (n542,925) (odd ratio [OR] 5 0.95 [0.76-1.20] for top
vs. bottom category of 25OHD) and 6 prospective studies (n522,184) (OR
5 0.89 [0.70-1.15] for top vs. bottom category of 25OHD). The
prospective studies analyzed additionally with adjusting of the general
epidemiologic characteristics. Meta-analysis was performed to pool