Quality of Life Research

, Volume 16, Issue 2, pp 191–201 | Cite as

Once-daily sublingual allergen-specific immunotherapy improves quality of life in patients with grass pollen-induced allergic rhinoconjunctivitis: A double-blind, randomised study

  • Sabina Rak
  • William H. Yang
  • Martin R. Pedersen
  • Stephen R. Durham


The effect of sublingual immunotherapy on quality of life (QoL) was examined in patients with grass pollen-induced rhinoconjunctivitis. Patients (n = 855) were randomised to once-daily grass allergen tablets (2,500; 25,000; or 75,000 SQ-T Phleum pratense extract; GRAZAX®) or placebo. Treatment was initiated 8 weeks before the start of the grass pollen season and continued throughout. If symptoms were present, patients received loratadine or placebo rescue medication. There were three major findings: in patients using loratadine, grass allergen tablets provided QOL benefits over placebo; Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was 17% (p = 0.006) and 20% (p = 0.020) greater with 75,000 SQ-T tablet than with placebo at first and second seasonal visit, respectively; in patients not using loratadine, grass allergen tablets improved QoL more than placebo; RQLQ score was 21% greater (p = 0.021) with 75,000 SQ-T tablet at second seasonal visit; grass tablets (without loratadine) had a greater effect on QoL than loratadine alone. RQLQ score was 26% (p = 0.014) greater with 75,000 SQ-T tablets than loratadine at second seasonal visit. These data show that sublingual immunotherapy with grass allergen tablets improves QOL in allergic rhinoconjunctivitis, reduces symptoms, and that this effect is greater than rescue antihistamine alone.


Grass pollen allergy Quality of life RQLQ Seasonal allergic Rhinoconjunctivitis Sublingual immunotherapy 



Medical Outcome Study Short Form Health Survey


immunoglobulin E


Forced Expiratory Volume


Rhinoconjunctivitis Quality of Life Questionnaire


analysis of variance


confidence interval


intention to treat


per protocol


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dahl R, Andersen PS, Chivato T, Valovirta E, de Monchy J (2004) National prevalence of respiratory allergic disorders. Respir Med 98:398–403PubMedCrossRefGoogle Scholar
  2. 2.
    Bauchau V, Durham SR (2004) Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 24:758–764PubMedCrossRefGoogle Scholar
  3. 3.
    Bousquet J, Bullinger M, Fayol C, Marquis P, Valentin B, Burtin B (1994) Assessment of quality of life in patients with perennial allergic rhinitis with the French version of the SF-36 Health Status Questionnaire. J Allergy Clin Immunol 94:182–188PubMedCrossRefGoogle Scholar
  4. 4.
    Leynaert B, Neukirch C, Liard R, Bousquet J, Neukirch F (2000) Quality of life in allergic rhinitis and asthma: A population-based study of young adults. Am J Respir Crit Care Med 162:1391–1396PubMedGoogle Scholar
  5. 5.
    Storms WW (2004) Pharmacologic approaches to daytime and nighttime symptoms of allergic rhinitis. J Allergy Clin Immunol 114(Suppl):S146–S153PubMedCrossRefGoogle Scholar
  6. 6.
    Stuck BA, Czajkowski J, Hagner AE et al. (2004) Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: A controlled clinical trial. J Allergy Clin Immunol 113:663–668PubMedCrossRefGoogle Scholar
  7. 7.
    Marshall PS, Colon EA (1993) Effects of allergy season on mood and cognitive function. Ann Allergy 71:251–258PubMedGoogle Scholar
  8. 8.
    Simons FE (1996) Learning impairment and allergic rhinitis. Allergy Asthma Proc 17:185–189PubMedCrossRefGoogle Scholar
  9. 9.
    Majani G, Baiardini I, Giardini A et al. (2001) Health-related quality of life assessment in young adults with seasonal allergic rhinitis. Allergy 56:313–317PubMedCrossRefGoogle Scholar
  10. 10.
    Durham SR, Walker SM, Varga EM et al. (1999) Long-term clinical efficacy of grass-pollen immunotherapy. New Engl J Med 341:468–475PubMedCrossRefGoogle Scholar
  11. 11.
    Hedlin G, Heilborn H, Lilja G et al. (1995) Long-term follow-up of patients treated with a three-year course of cat or dog immunotherapy. J Allergy Clin Immunol 96:879–885PubMedCrossRefGoogle Scholar
  12. 12.
    Jacobsen L, Nuchel Petersen B, Wihl JA, Lowenstein H, Ipsen H (1997) Immunotherapy with partially purified and standardized tree pollen extracts IV Results from long-term (6-year) follow-up. Allergy 52:914–920PubMedCrossRefGoogle Scholar
  13. 13.
    Mosbech H, Osterballe O (1988) Does the effect of immunotherapy last after termination of treatment? Follow-up study in patients with grass pollen rhinitis. Allergy 43:523–529PubMedCrossRefGoogle Scholar
  14. 14.
    Canonica GW, Passalacqua G (2003) Noninjection routes for immunotherapy. J Allergy Clin Immunol 111:437–448PubMedCrossRefGoogle Scholar
  15. 15.
    Passalacqua G, Lombardi C, Canonica GW (2004) Sublingual immunotherapy: An update. Curr Opin Allergy Clin Immunol 4:31–36PubMedCrossRefGoogle Scholar
  16. 16.
    Marogna M, Spadolini I, Massolo A, Canonica GW, Passalacqua G (2004) Randomized controlled open label study of specific immunotherapy for respiratory allergy in real life: Clinical efficacy and more. Allergy 59:1205–1210PubMedCrossRefGoogle Scholar
  17. 17.
    Wilson DR, Torres LI, Durham SR. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev 2003; (2): CD002893Google Scholar
  18. 18.
    Fell WR, Mabry RL, Mabry CS. Quality of life analysis of patients undergoing immunotherapy for allergic rhinitis. Ear Nose Throat J 1997; 76: 528–532, 534–536Google Scholar
  19. 19.
    Moncayo Coello CV, Rosas Vargas MA, del Rio Navarro BE, Lerma Ortiz L, Velazquez Armenta Y, Sienra Monge JJ (2003) [Quality of life in children with allergic rhinitis before and after being treated with specific immunotherapy (cases and controls)]. Rev Alerg Mex 50:170–175 [Article in Spanish]PubMedGoogle Scholar
  20. 20.
    Walker SM, Pajno GB, Torres Lima M, Wilson DR, Durham SR (2001) Grass pollen immunotherapy for seasonal rhinitis and asthma: A randomised, controlled trial. J Allergy Clin Immunol 107:87–93PubMedCrossRefGoogle Scholar
  21. 21.
    Arikan C, Bahceciler NN, Deniz G et al. (2004) Bacillus Calmette-Guérin-induced interleukin-12 did not additionally improve clinical and immunologic parameters in asthmatic children treated with sublingual immunotherapy. Clin Exp Allergy 34:398–405PubMedCrossRefGoogle Scholar
  22. 22.
    Bousquet J, Scheinmann P, Guinnepain MT et al. (1999) Sublingual-swallow immunotherapy (SLIT) in patients with asthma due to house-dust mites: A double-blind, placebo-controlled study. Allergy 54:249–260PubMedCrossRefGoogle Scholar
  23. 23.
    Laffer S, Valenta R, Vrtala S et al. (1994) Complementary DNA cloning of the major allergen Phl p I from timothy grass (Phleum pratense); recombinant Phl p I inhibits IgE binding to group I allergens from eight different grass species. J Allergy Clin Immunol 94:689–698PubMedCrossRefGoogle Scholar
  24. 24.
    Durham SR, Yang WH, Pedersen MR, Johansen N, Rak S. Sublingual immunotherapy with once-daily grass-allergen tablets: A randomised controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006; 117: 802--9Google Scholar
  25. 25.
    Juniper EF, Guyatt GH (1991) Development and testing of a new measure of health status for clinical trials involving rhinoconjunctivitis. Clin Exp Allergy 21:77–83PubMedCrossRefGoogle Scholar
  26. 26.
    Meltzer EO, Casale TB, Nathan RA, Thompson AK (1999) Once-daily fexofenadine HCl improves quality of life and reduces work and activity impairment in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 83:311–317PubMedCrossRefGoogle Scholar
  27. 27.
    Berger WE, Kaiser H, Gawchik SM et al. (2003) Triamcinolone acetonide aqueous nasal spray and fluticasone propionate are equally effective for relief of nasal symptoms in patients with seasonal allergic rhinitis. Otolaryngol Head Neck Surg 129:16–23PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Sabina Rak
    • 1
  • William H. Yang
    • 2
  • Martin R. Pedersen
    • 3
  • Stephen R. Durham
    • 4
  1. 1.Section of AllergySahlgrenska University HospitalGöteborgSweden
  2. 2.Allergy & Asthma Research CentreOttawaCanada
  3. 3.ALK-Abelló A/SHørsholmDenmark
  4. 4.National Heart and Lung InstituteAllergy and Respiratory MedicineLondonUK

Personalised recommendations