Peter S. Creticos, M.D., Charles E. Reed, M.D., Philip S. Norman, M.D., Jane Khoury, M.S., N. Franklin Adkinson, M.D., C. Ralph Buncher, Sc.D., William W. Busse, M.D., Robert K. Bush, M.D., Jyothi Gadde, M.D., James T. Li, M.D., Ph.D., Hal B. Richerson, M.D., Richard R. Rosenthal, M.D., William R. Solomon, M.D., Paul Steinberg, M.D., and John W. Yunginger, M.D.
Background Although allergen immunotherapy is effective forallergic rhinitis, its role in treating asthma is unclear.
Methods We examined the efficacy of immunotherapy for asthmaexacerbated by seasonal ragweed exposure. During an observationphase, adults with asthma who were sensitive to ragweed keptdaily diaries and recorded peak expiratory flow rates betweenJuly and October. Those who reported seasonal asthma symptomsand medication use as well as decreased peak expiratory flowwere randomly assigned to receive placebo or ragweed-extractimmunotherapy in doses that increased weekly for an additionaltwo years.
Results During the observation phase, the mean (±SE)peak expiratory flow rate measured in the morning during thethree weeks representing the height of the pollination seasonwas 454±20 liters per minute in the immunotherapy groupand 444±16 liters per minute in the placebo group. Ofthe 77 patients who began the treatment phase, 64 completedone year of the study treatment and 53 completed two years.During the two treatment years, the mean peak expiratory flowrate was higher in the immunotherapy group (489±16 litersper minute, vs. 453±17 in the placebo group [P = 0.06]during the first year, and 480±12 liters per minute,vs. 461±13 in the placebo group [P = 0.03] during thesecond). Medication use was higher in the immunotherapy groupthan in the placebo group during observation and lower duringthe first treatment year (P = 0.01) but did not differ in thetwo groups during the second year (P = 0.7). Asthma-symptomscores were similar in the two groups (P = 0.08 in year 1 andP = 0.3 in year 2). The immunotherapy group had reduced hay-feversymptoms, skin-test sensitivity to ragweed, and sensitivityto bronchial challenges and increased IgG antibodies to ragweedas compared with the placebo group; there was no longer a seasonalincrease in IgE antibodies to ragweed allergen in the immunotherapygroup after two years of treatment. Reduced medication costswere counterbalanced by the costs of immunotherapy.
Conclusions Although immunotherapy for adults with asthma exacerbatedby seasonal ragweed exposure had positive effects on objectivemeasures of asthma and allergy, the clinical effects were limitedand many were not sustained for two years.
Source Information
From the Department of Medicine, Division of Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore (P.S.C., P.S.N., N.F.A.); the Mayo Clinic, Rochester, Minn. (C.E.R., J.T.L., J.W.Y.); the University of Cincinnati Medical Center, Cincinnati (J.K., C.R.B.); the University Hospitals Clinical Science Center, Madison, Wis. (W.W.B., R.K.B.); Asthma and Allergy Specialists, Greenbelt, Md. (J.G.); University Hospital, Iowa City, Iowa (H.B.R.); the Laboratory for Applied Immunology, Fairfax, Va. (R.R.R.); the University Hospital, Ann Arbor, Mich. (W.R.S.); and the Hennepin County Medical Center, Minneapolis (P.S.).
Address reprint requests to Dr. Creticos at the Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224-6801.
Ragweed Immunotherapy in Adult Asthma
Weiner J., Abramson M., Puy R., Wilson J., Portnoy J. M., Finegold I., Platts-Mills T. A.E., Klein J. S., Chmelik F., Doughty A., Creticos P. S., Norman P. S., Reed C., Barnes P. J.
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Full Text
N Engl J Med 1996;
335:203-206, Jul 18, 1996.
Correspondence
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