Efficacy, safety, and immunological effects of a 2-year immunotherapy with Depigoid® birch pollen extract: a randomized, double-blind, placebo-controlled study

Summary Background Rhinoconjunctivitis due to birch pollen sensitization is common in Northern Europe. A depigmented polymerized birch pollen extract – Depigoid® has been developed for immunotherapy. Objective To evaluate its clinical efficacy, safety, and effects on immunological parameters. Methods Sixty-one patients aged 7–69 years were included in a randomized, double-blind, placebo-controlled trial of subcutaneous immunotherapy (SCIT) using depigmented polymerized birch pollen extract. SCIT consisted of four increasing doses at 7-day intervals, followed by maintenance injections of 500 DPP (corresponding to 30 μg Bet v1 before depigmentation) at 6-week intervals for 18 months. The primary outcome was the combined symptom and medication score during the 2006 birch pollen season. The frequency of peripheral blood mononuclear cells (PBMC)producing IL-4, IL-10, IL-12, and IL-13 was assessed in a subgroup of patients by ELISPOT assay. Results After 18 months of treatment, the median combined symptom and medication score (upper/lower quartile) of treated patients was significantly lower than those on placebo: 8.0 (5.8–10.3) and 12.6 (8.6–16.2), respectively (P=0.004). Systemic reactions occurred in 29 patients (12 active, 17 placebo), were grades 1 or 2, and none required specific treatment. After 18 months of treatment, mean serum concentrations of specific IgE increased significantly in both groups (P<0.0001) whereas serum concentrations of both specific IgG1 and IgG4 only increased significantly in the SCIT group (P=0.002) and not in the placebo group. The seasonal increase in numbers of IL-4- and IL-13-producing PBMC was blunted by immunotherapy. Conclusions SCIT with depigmented polymerized birch pollen extract significantly reduced symptom and medication scores when compared with the placebo, was well tolerated, and resulted in immunological changes comparable with those of native pollen extracts. Cite this as: A.-S. Hoiby, V. Strand, D.S. Robinson, A. Sager and S. Rak, Clinical & Experimental Allergy, 2010 (40) 1062–1070.