Immunological comparison of allergen immunotherapy tablet treatment and subcutaneous immunotherapy against grass allergy

BackgroundIgE-mediated allergic rhinitis to grass pollen can successfully be treated with either allergen immunotherapy tablets (SLIT tablet) or SQ-standardized subcutaneous immunotherapy (SCIT). The efficacy of these two treatment modalities for grass allergy is comparable, but the immunological mechanisms may differ. ClinicalTrials.gov ID: NCT01889875. ObjectivesTo compare the immunological changes induced by SQ-standardized SCIT and SLIT tablet. MethodsWe randomized 40 individuals with grass pollen rhinitis into groups receiving SCIT, SLIT tablet, or neither and followed them for 15months with regular serum measurements of specific IgE, IgG4, IgE-blocking factor, facilitated antigen presentation (FAP), and basophil activation test (BAT). Nasal challenges were used to assess changes in nasal sensitivity. ResultsAfter 15months of treatment IgG4, IgE-blocking factor, FAP, and BAT values differed significantly in both SCIT and SLIT-tablet treatment groups when compared to the control group. Both SCIT and SLIT-tablet groups were significantly different from the control group after 1-3months of treatment. In general, the changes induced by SCIT reached twice that of SLIT tablet, with the exception of specific IgE where SLIT tablet induced initial threefold increase compared with SCIT. A slight but significant increase in IgE and BAT after season was seen only in the control group. Significant differences between SCIT and SLIT tablet were observed early, but the differences diminished with the length of treatment, especially for FAP inhibition. ConclusionsBoth SCIT and SLIT tablet induce significant changes in specific antibodies (IgE and IgG4) and competition assays (IgE-blocking factor, FAP, and BAT). Overall, SCIT induced larger (two- to threefold) changes than SLIT tablet, with the exception of FAP, where SLIT tablet showed a gradual increase ending at the same level as SCIT. Maximal change was generally reached after 3months' treatment.