Sublingual immunotherapy (SLIT) with grass pollen allergen for grass pollen induced rhinoconjunctivitis in children

ISRCTN ISRCTN89345534
DOI https://doi.org/10.1186/ISRCTN89345534
Secondary identifying numbers NTR284
Submission date
20/12/2005
Registration date
20/12/2005
Last edited
17/08/2009
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Eye Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English Summary

Not provided at time of registration

Contact information

Dr Esther Röder
Scientific

Erasmus Medical Center
Department of General Practice
P.O. Box 1738
Rotterdam
3000 DR
Netherlands

Phone +31 (0)10 4088014
Email e.roder@erasmusmc.nl

Study information

Study designRandomised triple blind placebo controlled parallel group trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)GP practice
Study typeTreatment
Scientific title
Study acronymSTARDROP
Study hypothesisIn comparison with placebo SLIT will lead to a clinical relevant symptom reduction in 6 to 18 years old children with a rhinoconjunctivitis due to grass pollen allergy.
Ethics approval(s)Received from local medical ethics committee
ConditionRhinoconjunctivitis, Grass pollen allergy
InterventionActive treatment:
Oralgen® Grass Pollen (9.500 BU/ml), consists of a mixture of aqueous extracts of the pollen of five grass pollen species in a glycerinated isotonic phosphate buffered solution.

The following grass pollen species are included:
1. Phleum pratense: Timothy, (Timotheegras)
2. Dactylis glomerate: Orchard grass, (Kropaar)
3. Anthoxantum odoratum: Vernal grass, Sweet grass, (Reukgras)
4. Holcus lanatus: Velvet grass, (Echte witbol)
5. Lolium perenne: Ryegrass, Perennial grass, (Engels raaigras)

Other ingredients include sodium chloride, sodium dihydrogen phosphate, disodium hydrogen phosphate, glycerol and water.

Control treatment:
The placebo consists of the non-active excipients, as mentioned above. Placebo treatment group.
The placebo consists of the non-active excipients, as mentioned above. Placebo treatment will be delivered in such a way that neither patients nor investigators or other research personnel can make a distinction between verum and placebo vials.

Dose schedule:
The treatment is divided in two phases: a dose escalation phase of 20 days, and a maintenance phase of 2 years. Treatment starts on day 1 with a single drop (one drop 0.05 ml = 475 BU); the dose is increased with one drop per day until day 20 (20 drops = l ml = 9.500 BU). The maintenance dose is 20 drops (= 9500 BU) twice weekly.
Intervention typeOther
Primary outcome measureThe primary endpoint is the mean daily total symptom score as administered by the patient in the second year of treatment during the period May-August on the days at which grass-pollen counts exceeded a predefined cut-off level. This second year can be replaced by the first year outcomes depending on the resulting pollen counts (see below).

Cut-off level grass pollen count.
For each day during the period May-August the grass-pollen count will be determined using data from the station in Leiden. The median value of these pollen counts will be used as cut-off-level in this analysis. Subsequently for each study day it will be determined whether the actual pollen count was above or below the resulting cut-off-level.

Year of evaluation.
In case during the second year, in the period of May 15 until June 30, the mean daily seasonal grass pollen count is less than or equal to 25 pollen grains/m3, while this limit was exceeded for the first year, the first year diary outcomes will be considered as primary and will replace the second year diary outcomes.
The replacement for individual patients of the second year by the first year diary outcomes will also take place in case the diary during the second year is insufficiently completed (less than 50% of relevant days) while at the same time the first year is not a lost season.

Efficacy is measured by patient-assessed symptom scores.
Main allergic symptoms are considered to be the following: sneezing; itching nose; watery running nose; nasal blockage; itching eyes.
The intensity of these symptoms is subjectively assessed according to a grading scale: 0 = no complaints; 1 = minor complaints; 2 = moderate complaints; 3 = serious complaints; i.e. the maximal score amounts to a value of 15.
The period of measurement will be May till August in the years 2002 and 2003; 2003 and 2004. During these periods symptom scores are assessed daily by the patient and recorded in the patient diary.
Secondary outcome measures1. Investigator assessed symptom-scores during the planned visits in the flowering season
2. Number of medication free days
3. Rescue medication
4. Generic quality of life assessment with COOP/WONCA charts
5. Rhinitis specific quality of life assessment (Juniper)
6. Lower airway symptoms
7. Adverse-effects
8. Compliance
Overall study start date01/09/2001
Overall study end date01/09/2004

Eligibility

Participant type(s)Patient
Age groupChild
Lower age limit6 Years
Upper age limit18 Years
SexBoth
Target number of participants204
Participant inclusion criteria1. Age; between 6 and 18 years.
2. Patients known in general practice with documented clinical history of grass pollen allergy with moderate disease intensity as retrospectively derived from the use of symptomatic allergy medication during the previous grass pollen season i.e. regular use of cromoglycates as nasal spray and/or eye drops and/or regular use of anti-histamine tablets or sprays and/or limited use of local acting or systemically administered corticosteroids
3. Moderate grass pollen allergy as retrospectively derived from allergy symptom scores during the previous grass pollen season. Therefore, the following 5 symptoms are evaluated for the previous season:
3.1 Nasal blockage
3.2 Sneezing
3.3 Itching nose
3.4 Watery running nose
3.5 Itching eyes
The intention of each of these 5 symptoms is (subjectively) assessed by the patient according to a grading scale: 0 = no complaints; 1 = minor complaints; 2 = moderate complaints; 3 = serious complaints (maximal total value is 15). At conclusion the retrospective total value should amount at least a value of 5.
4. Positive grass pollen specific IgE Rast test i.e. RAST score = 2+
Participant exclusion criteria1. Clinical history of severe asthmatic symptoms requiring inhalant therapy with daily pulmonary steroids during at least 3 months a year
2. Allergic sensitivity to epithelial, in case the domestic animal is present in the family home
3. The intention to subject the patient to surgery of the nasal cavity in the course of the study
4. Previous immunotherapy
5. Contraindications to sublingual immunotherapy ie:
5.1 Malignancies and serious disorders of the oral cavity
5.2 History of status asthmaticus and anaphylactic shock
5.3 Aggressively developing asthmatic symptoms
5.4 Serious chronic inflammations, chronic disorders associated with fever, particularly of the bronchial tubes
5.5 Irreversible, secondary changes in reactive organs (emphysema, bronchiectasis)
5.6 Autoimmune diseases and immunodeficiency
5.7 Concurrent therapy involving immunosuppressives
5.8 Systemic and collagen diseases
5.9 Tuberculosis of the lung and tuberculosis
5.10 Serious psychological disorders
5.11 Documented hypersensitivity to glycerol
5.12 Pregnancy
5.13 Use of beta-blockers
6. Inability to communicate in the Dutch language
7. Exposure to any investigational drug within 30 days of enrolment
Recruitment start date01/09/2001
Recruitment end date01/09/2004

Locations

Countries of recruitment

  • Netherlands

Study participating centre

Erasmus Medical Center,
Rotterdam
3000 DR
Netherlands

Sponsor information

Artu Biologicals Europe B.V. (Netherlands)
Industry

Vijzelweg 11
Lelystad
8243 PM
Netherlands

Phone +31 (0)320 267900
Email info@artu-biologicals.com
ROR logo "ROR" https://ror.org/022w0b336

Funders

Funder type

Charity

Foundation for the Prevention of Asthma (Stichting Astma Bestrijding [SAB]) (Netherlands)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 01/04/2007 Yes No