Mechanisms of allergic rhinitis and the effects of immunotherapy
Research type
Research Study
Full title
Mechanisms of allergic rhinitis and the effects of immunotherapy (peripheral lymphocytes, effector cells and blocking antibodies)
IRAS ID
182838
Contact name
Stephen Durham
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
4 years, 0 months, 3 days
Research summary
Immunotherapy involves the repeated giving of high doses of the allergen to which the patient is sensitive in order to prevent symptoms and need for rescue medication on subsequent exposure to the relevant allergen(s). Traditionally the allergen is injected under the skin weekly in gradually increasing doses for 12-16 weeks followed by monthly ‘maintenance’ injections thereafter for 3 years. Although highly effective the treatment may provoke allergic reactions and, extremely rarely, anaphylaxis after injections. The sublingual route (daily allergen tablets/drops placed under the tongue) has emerged as an alternative effective and safer method. Unlike anti-allergic drugs both sublingual and subcutaneous (injection) immunotherapy have been shown to produce ‘tolerance’ – defined as the persistence of benefit after cessation of treatment -for at least 2-3 years after stopping treatment.
With this study we aim to gain a better understanding of the underlying mechanisms of rhinitis and the effects of immunotherapy and consider this important for two reasons:
Firstly because this permits the development of novel allergen-based treatments (allergy vaccines) that may be either more effective by inducing Th1 cells/Tregs and/or more safe by reducing the necessary dose of allergen for treatment, thereby avoiding or reducing allergic side effects.
Secondly, the discovery of effective biological markers (‘biomarkers’) to predict clinical response to immunotherapy and thereby allow selection of those patients most likely to from the treatment.In order to take our recent novel observations forward we need to extend our pilot studies to include individuals allergic not only to grass pollen, but also to perennial allergens, for example, house dust mite. In order to understand their biological relevance we need to do a series of measurements and comparison studies on T cell and B cell subsets, basophils, antigen presenting cells and antibodies in blood obtained from allergic individuals and the results compared to blood from normal healthy control individuals. We also wish to examine changes in these cell types and antibodies during natural allergen exposure by taking blood samples from individuals in and outside the pollen season. We also propose pilot studies in which we compare our mechanistic results in untreated allergic individuals with those patients that have received a course of immunotherapy (either injection and/or tablet) as part of their usual NHS treatment) and also to include a group who have discontinued their immunotherapy after a full 3 year course to see whether or not the changes we observe after successful treatment result in long-term benefits for years after stopping the treatment.
REC name
South West - Cornwall & Plymouth Research Ethics Committee
REC reference
16/SW/0010
Date of REC Opinion
21 Mar 2016
REC opinion
Further Information Favourable Opinion