Sei sulla pagina 1di 1



307 A Randomized Placebo-Controlled Trial of

Intradermal Grass Pollen Immunotherapy for
Seasonal Allergic Rhinitis
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
Anna D. Slovick, MRCS, DOHNS, MBBS, BSc1, Abdel Douiri, PhD1, current AR nor the development of AR. Since these studies were very
Rachel Muir, PhD2, Andrea Guerra, MD1, Kostas Tsioulos, MD1, Evie heterogeneous and the retrospective or the observational cohort studies,
Haye, BSc1, Emily Lam, MSc1, Joanna Kelly1, Janet Peacock, PhD1, large randomized controlled trials are needed to determine whether vitamin
S. Ying, MD, PhD1, Mohamed H. Shamji, BSc, MSc, PhD, FAAAAI3, D supplementation may be beneficial in the prevention of AR.
David Cousins, PhD1, Stephen R. Durham, MA, MD, FRCP3,4, Stephen
Till, MD, PhD1; 1King’s College London, London, United Kingdom,
GSTT, London, United Kingdom, 3MRC & Asthma UK Centre in 309 Nasal Challenge with Ragweed Pollen Extract
(RWPE) Increases the Level of Fortilin in Nasal
Lavage Fluid from Subjects with Allergic Rhinitis
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 Julia W. Tripple, MD1, Koa Hosoki, MD, PhD1, Istvan Boldogh, PhD1,
of grass pollen (nanograms of allergen) almost completely suppresses David Rogers Redding, MD2, Sanjiv Sur, MD1, Ken Fujise, MD1; 1Uni-
allergen-induced cutaneous late phase responses (JACI 2012 130(4):918- versity of Texas Medical Branch, Galveston, TX, 2Redding Allergy and
24). Similar suppression of late responses is seen after high dose subcutaneous Asthma Center, Atlanta, GA.

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