I'm a fan of SLIT over SCIT (oral vs. injected) for allergy desensitization. A couple other options (honey, anyone?) touched on.
Practitioner. 2011 May;255(1740):27-31, 2.
Dentify the culprit allergen in seasonal allergic rhinitis.
Prashantha M, Drewe E.
Nottingham University Hospitals NHS Trust.
Seasonal allergic rhinitis (SAR) is the main form of rhinitis in children whereas in adults it accounts for about a third of cases of rhinitis. It is a risk factor for the development of asthma and chronic rhinosinusitis. The most common allergic triggers are grass and tree pollens, allergy to moulds and weeds is less common. Identifying the months of the year when an individual is symptomatic will help define the culprit allergen. If there is a clear recurring seasonal history the diagnosis may be made on the strength of the history. Skin prick tests are available in specialist clinics and are a useful tool in differentiating SAR from non-allergic rhinitis and defining the culprit allergen(s). Specific IgE tests for suspected allergens can be performed if skin tests are not available. A positive specific IgE test to an allergen does not necessarily mean that clinical allergy is present, it may reflect sensitisation of the immune system. Although, in general, specific IgE tests have a high negative predictive value they are less sensitive than skin prick tests for grass pollen and moulds. Allergen avoidance is the first step in the management of any allergic rhinitis. Oral non-sedating antihistamines are recommended as first-line treatment for mild SAR, higher doses may be necessary in moderate to severe SAR. Intranasal corticosteroids should be used in moderate to severe forms of SAR and also in mild forms where treatment with antihistamines has failed. There are no major differences in terms of efficacy between different corticosteroid preparations. Long-term growth studies in children using fluticasone, mometasone and budesonide (but not beclometasone) have been reassuring.
Allerg Immunol (Leipz). 1987;33(4):215-21.
[Allergologic-immunochemical study of tree and bush pollen. II--Study of the sensitization spectrum of patients with seasonal rhinitis in the spring].
[Article in German]
Jung K, Schlenvoigt G, Jäger L.
Institut für Klinische Immunologie, Friedrich-Schiller-Universität, Jena.
80 patients sera were investigated by means of radioallergosorbent test (RAST) and enzyme linked immunosorbent assay (ELISA). Specific IgE antibodies against ten various tree pollens were determined. There is a significant correlation between RAST and ELISA results. It was found that birch, beech, alder, hazel and oak pollens are most important as causes of springtime hay fever. 75% of patients had increased specific IgE-titres against these pollens whereas maple, poplar, elm, sallow and ash allergens more often gave negative or only weak positive test results.
Clin Exp Allergy. 2011 Sep;41(9):1313-1323. doi: 10.1111/j.1365-2222.2011.03803.x. Epub 2011 Jul 15.
A national audit of pollen immunotherapy for children in the United Kingdom: patient selection and programme safety.
Vance GH, Goldring S, Warner JO, Cox H, Sihra B, Hughes S, Gardner J, North J, Roberts G, Proudfoot CA, Clarke A, Luyt DK, Gillies D, Fox AT.
Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK Imperial College and St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK Imperial College and Imperial College Healthcare NHS Trust Biomedical Research Centre, London, UK Colchester Hospital University NHS Foundation Trust, Essex, UK Royal Manchester Children's Hospital, Central Manchester Foundation Trust, London, UK Royal Free Hampstead NHS Trust, London, UK City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Sandwell, UK Faculty of Medicine, University of Southampton, Southampton, UK Southampton University Hospital NHS Trust, Southampton, UK Countess of Chester Hospital Foundation Trust, Chester, UK Departments of Medicine and Paediatrics, University of Cambridge, Addenbrookes Hospital, Cambridge, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK Harrogate and District NHS Foundation Trust, Harrogate, UK MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Background Specific immunotherapy (SIT) is an effective treatment for grass and/or tree pollen-induced severe allergic rhinoconjunctivitis. However, there are limited detailed data on the use of immunotherapy in children in the United Kingdom. Objectives We audited NHS paediatric practice against current national guidelines to evaluate patient selection, SIT modalities and adverse events (AEs). Methods Paediatricians offering pollen SIT were identified through the British Society of Allergy and Clinical Immunology Paediatric Allergy Group (BSACI-PAG) and the database of SIT providers compiled for the Royal College of Physicians and Royal College of Pathologists 2010 joint working group. Standardized proformas were returned by 12 of 20 centres (60%), including 12 of 14 centres offering subcutaneous immunotherapy (SCIT) (85%). Results Three hundred and twenty-three children, with mean age 11 years at initiation (69% boys), had undergone 528 SIT cycles (SCIT 31%) over 10 years. Fifty-five percent of all patients had asthma. Among SCIT programmes 24.5% patients had perennial (± seasonal) asthma; 75.6% of asthmatics undertaking SCIT had treatments at BTS/SIGN step 2 or above. AEs occurred frequently (50.4% of all SIT cycles) but were mild. In sublingual immunotherapy (SLIT) treatment, local intraoral immediate reactions were most common (44.9% SLIT cycles), as compared with delayed reactions around the injection site in SCIT (28.3% SCIT cycles). An asthma diagnosis had no impact on the number of cycles with AEs, or the severity reported. Few cycles (2.9%) were discontinued as a result of AE(s). Conclusions and Clinical Relevance Pollen SIT is available across England, though small numbers of children are being treated. Current national guidelines to exclude asthmatic children in SIT programmes are not being adhered to by most specialist paediatric allergy centres. SCIT and SLIT has been well tolerated. Review of patient selection criteria is needed and may allow greater use of this therapeutic option in appropriate clinical settings. Cite this as: G. H. S. Vance, S. Goldring, J. O. Warner, H. Cox, B. Sihra, S. Hughes, J. Gardner, J. North, G. Roberts, C. A. Proudfoot, A. Clarke, D. K. Luyt, D. Gillies and A. T. Fox, Clinical & Experimental Allergy, 2011 (41) 1313-1323.
© 2011 Blackwell Publishing Ltd.
Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001936.
Allergen injection immunotherapy for seasonal allergic rhinitis.
Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S.
Royal Brompton Hospital, Department of Allergy and Respiratory Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, UK, SW3 6LY. firstname.lastname@example.org
Allergic rhinitis is the most common of the allergic diseases. Despite improved understanding of the pathophysiology of allergic rhinitis and advances in its pharmacological treatment, its prevalence has increased worldwide. For patients whose symptoms remain uncontrolled despite medical treatment, allergen injection immunotherapy is advised. An allergen-based treatment may reduce symptoms, the need for medication and modify the natural course of this disease.
To evaluate the efficacy and safety of subcutaneous specific allergen immunotherapy, compared with placebo, for reducing symptoms and medication requirements in seasonal allergic rhinitis patients.
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2006), MEDLINE (1950 to 2006), EMBASE (1974 to 2006), Pre-MEDLINE, KOREAMED, INDMED, LILACS, PAKMEDINET, Scisearch, mRCT and the National Research Register. The date of the last search was February 2006.
All studies identified by the searches were assessed to identify randomised controlled trials involving participants with symptoms of seasonal allergic rhinitis and proven allergen sensitivity, treated with subcutaneous allergen specific immunotherapy or corresponding placebo.
DATA COLLECTION AND ANALYSIS:
Two independent authors identified all studies reporting double-blind, placebo controlled randomised trials of specific immunotherapy in patients with seasonal allergic rhinitis due to tree, grass or weed pollens. Two authors independently performed quality assessment of studies. Data from identified studies were abstracted onto a standard extraction sheet and subsequently entered into RevMan 4.2.8. Analysis was performed using the Standardised Mean Difference (SMD) method and a random-effects model; P values < 0.05 were considered statistically significant. The primary outcome measures were symptom scores, medication use, quality of life and adverse events.
We retrieved 1111 publications of which 51 satisfied our inclusion criteria. In total there were 2871 participants (1645 active, 1226 placebo), each receiving on average 18 injections. Duration of immunotherapy varied from three days to three years. Symptom score data from 15 trials were suitable for meta-analysis and showed an overall reduction in the immunotherapy group (SMD -0.73 (95% CI -0.97 to -0.50, P < 0.00001)). Medication score data from 13 trials showed an overall reduction in the immunotherapy group (SMD of -0.57 (95% CI -0.82 to -0.33, p<0.00001)). Clinical interpretation of the effect size is difficult. Adrenaline was given in 0.13% (19 of 14085 injections) of those on active treatment and in 0.01% (1 of 8278 injections) of the placebo group for treatment of adverse events. There were no fatalities.
This review has shown that specific allergen injection immunotherapy in suitably selected patients with seasonal allergic rhinitis results in a significant reduction in symptom scores and medication use. Injection immunotherapy has a known and relatively low risk of severe adverse events. We found no long-term consequences from adverse events.
Otolaryngol Head Neck Surg. 2007 Apr;136(4):511-4.
Phytomedicine. 2001 Jan;8(1):8-15.
Effects of an oriental herbal medicine, "Saiboku-to", and its constituent herbs on Compound 48/80-induced histamine release from peritoneal mast cells in rats.
Ikarashi Y, Yuzurihara M, Sakakibara I, Takahashi A, Ishimaru H, Maruyama Y.
Department of Neuropsychopharmacology (Tsumura), Gunma University School of Medicine, Maebashi, Japan. email@example.com
Effects of a traditional oriental herbal medicine, "Saiboku-to" and its constituent herbs on Compound 48/80-induced histamine release from peritoneal mast cells in rats were investigated. Saiboku-to inhibited Compound 48/80-induced degranulation of and histamine release from the mast cells, suggesting that Saiboku-to not only possesses anti-histamine release effect from mast cells, but also contains active herbs with this effect. Significant inhibitions were found in 4 of 10 constituent herbs of Saiboku-to: Magnoliae Cortex, Perillae Herba, Bupleuri Radix and Hoelen. In the dose-response curves of the four herbs, the logarithmic linearity was observed for each herb, and 50% inhibitory concentration, the IC50 values, were calculated to be 56.8 microg/ml for Magnoliae Cortex, 175.8 microl/ml for Perillae Herba, 356.6 microg/ml for Bupleuri Radix, and 595.8 microg/ml for Hoelen. One mg/ml of Saiboku-to showing 75% inhibition of Compound 48/80-induced histamine release level from mast cells contains 88.5 microg of Magnoliae Cortex (it was estimated from the dose-response curve that this dose inhibits 62.68% of the Compound 48/80-induced histamine release level), 58.8 microg of Perillae Herba (21% inhibition), 205.9 microg of Bupleuri Radix (35.24% inhibition), and 147.1 microg of Hoelen (11.15% inhibition). From these results, it is suggested that the anti-histamine release effect of Saiboku-to, which contains 10 herbs, may be due mainly to the effect of Magnoliae Cortex and the synergism of the 3 other herbs.
Photochem Photobiol. 2011 Mar-Apr;87(2):474-7. doi: 10.1111/j.1751-1097.2010.00882.x. Epub 2011 Jan 24.
Intranasal phototherapy is more effective than fexofenadine hydrochloride in the treatment of seasonal allergic rhinitis: results of a pilot study.
Garaczi E, Boros-Gyevi M, Bella Z, Csoma Z, Kemény L, Koreck A.
Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary. firstname.lastname@example.org
We recently showed that intranasal phototherapy represents an efficient therapeutic modality for the treatment of patients with seasonal allergic rhinitis (SAR). The aim of this pilot study was to compare the efficacy of intranasal phototherapy with that of the new generation antihistamine fexofenadine HCl in SAR. A randomized open study was conducted in patients with a history of moderate-to-severe ragweed-induced SAR. Thirty-one patients were randomly assigned to receive either intranasal irradiation three times a week for 2 weeks, or 180 mg fexofenadine HCl per day for 2 weeks. Each patient kept a diary of symptoms for nasal obstruction, nasal itching, rhinorrhea, sneezing and palate itching. Total nasal score (TNS), a sum of scores for nasal symptoms, was also calculated. In the rhinophototherapy group the individual scores significantly decreased compared with baseline for all of the parameters. In the fexofenadine HCl group none of the scores improved significantly at the end of the treatment except sneezing. TNS was significantly decreased in the rhinophototherapy group, but no significant change was observed in the fexofenadine HCl group after 2 weeks of treatment. In conclusion, we found that intranasal phototherapy is more efficient than fexofenadine HCl in reducing clinical symptoms for SAR.
© 2011 The Authors. Photochemistry and Photobiology © 2011 The American Society of Photobiology.
Int Arch Allergy Immunol. 2011;155(2):160-6. Epub 2010 Dec 23.
Birch pollen honey for birch pollen allergy--a randomized controlled pilot study.
Saarinen K, Jantunen J, Haahtela T.
South Karelia Allergy and Environment Institute, Lappeenranta, Finland. email@example.com
Only a few randomized controlled trials have been carried out to evaluate various complementary treatments for allergic disorders. This study assessed the effects of the preseasonal use of birch pollen honey (BPH; birch pollen added to honey) or regular honey (RH) on symptoms and medication during birch pollen season.
Forty-four patients (59% female, mean age 33 years) with physician-diagnosed birch pollen allergy consumed either BPH or RH daily in incremental amounts from November 2008 to March 2009. Seventeen patients (53% female, mean age 36 years) on their usual allergy medication served as the control group. From April to May, patients recorded daily rhinoconjunctival and other symptoms and their use of medication. Fifty patients completed the study.
During birch pollen season in 2009, BPH patients reported a 60% lower total symptom score (p < 0.01), twice as many asymptomatic days (p < 0.01), and 70% fewer days with severe symptoms (p < 0.001), and they used 50% less antihistamines (p < 0.001) compared to the control group. The differences between the BPH and RH groups were not significant. However, the BPH patients used less antihistamines than did the RH patients (p < 0.05).
Patients who preseasonally used BPH had significantly better control of their symptoms than did those on conventional medication only, and they had marginally better control compared to those on RH. The results should be regarded as preliminary, but they indicate that BPH could serve as a complementary therapy for birch pollen allergy.
Copyright © 2010 S. Karger AG, Basel.
Biosci Biotechnol Biochem. 2003 May;67(5):1126-9.
Effect of the flavonoid components obtained from Scutellaria radix on the histamine, immunoglobulin E and lipid peroxidation of spleen lymphocytes of Sprague-Dawley rats.
Lim BO, Choue RW, Lee HY, Seong NS, Kim JD.
Graduate School of East-West Medical Science, Department of Medical Nutrition, Kyung Hee University, 1 Hoeki-Dong, Dongdaemoon-Ku, Seoul 130-701, Korea. firstname.lastname@example.org
The effect on the IgE content induced by concanavalin A in spleen lymphocytes of the presence wogonin, ganhuangenin, wogonoside and 3,5,7,2',6'-pentahydroxyl flavanone was investigated. These flavonoid components markedly inhibited the histamine released from cells stimulated with the calcium ionophore, A23187. However, the magnitude of the inhibitory effect on the degree of lipid peroxidation by ConA of these components was in order of PHF>GHG>WG>WGS. Interestingly, WG, GHG and WGS, with a methoxyl group in the A and B rings, strongly inhibited histamine and IgE production, whereas PHF without a methoxyl group was much stronger than that for lipid peroxidation. We suggest that WG, GHG and WGS might block the pathway for the release of histamine, and that the IgE level in spleen lymphocytes is responsible for the lipid peroxidation.
J Environ Biol. 2007 Apr;28(2):271-4.
Effect of natural preservatives on the growth of histamine producing bacteria.
Paramasivam S, Thangaradjou T, Kannan L.
Centre of Advanced Study in Marine Biology, Annamalai University, Parangipettai 608 502, India.
Present study deals with the hampering of the growth of histamine producing bacteria (HPB), by using NaCl and spices which are easily available and cheaper cost wise. For this experiment, four strains of HPB viz. Vibrio parahaemolyticus, Bacillus cereus, Pseudomonas aeruginosa and Proteus mirabilis were tested against 1 to 10% concentrations of NaCl and 1 to 5% concentrations of natural preservatives (turmeric, ginger and garlic) in a basal medium. HPB showed different growth rates at different concentrations of NaCl and natural preservatives. V. parahaemolyticus, B. cereus and Ps. aeruginosa showed no growth at 10% concentration. When the HPB growth was tested with garlic, turmeric and ginger extracts, growth of all the bacteria was inhibited by garlic and turmeric extracts at 5% concentration. In ginger, V. parahaemolyticus, B. cereus and P. mirabilis were totally inhibited at 5% concentration. But Ps. aeruginosa showed very less growth at this concentration.