Background Patients are often dissatisfied with the symptom control obtained from available pharmacological treatments for seasonal allergic rhinoconjunctivitis (ARC). Therefore, patients seek for alternative, nonpharmacological options to treat their symptoms. Here, we assessed the efficacy of ectoine nasal spray and ectoine eye drops in comparison to placebo to prevent nasal and ocular symptoms following exposure to pollen in patients with ARC. Methods In this double‐blind, randomized, placebo‐controlled, cross‐over study, 46 patients with ARC applied ectoine eye drops and nasal spray in immediate succession or placebo eye drops and nasal spray for 13 days before ARC symptoms were induced in an environmental exposure chamber. Primary endpoint was the baseline‐adjusted area under the curve (AUC) posttreatment total nasal symptom score (TNSS) and the total ocular symptom score (TOSS) using analysis of covariance. Secondary endpoints were, amongst others, total nonnasal symptoms score (TNNSS) and nasal patency (measured using acoustic rhinometry). Results Treatment with both ectoine and placebo reduced TNSS, TOSS, and TNNSS upon allergen exposure. The analysis of parameters at baseline and after allergen exposure demonstrated that ectoine induced a clinically relevant improvement in ARC symptoms compared to placebo: the least square mean difference for baseline‐adjusted AUC was ‒1.87 for TNSS, ‒1.45 for TOSS and ‒2.20 for TNNSS. The mean change from baseline AUC of TNNSS for ectoine was also significantly greater than for placebo (‒5.49 vs. ‒3.46; p = 0.011). Ectoine significantly improved the singular symptoms “sneezing,” “watery eyes” and “itchy eyes” (p ≤ 0.021) as well as “itchy ear/palate” (p = 0.036) in comparison to placebo. Mean cross sectional areas of the nasal cavity were reduced to a lesser extent after treatment with ectoine (‒0.020 ± 0.022) than with placebo (‒0.047 ± 0.029). The current study also demonstrated a very good safety profile of ectoine treatment. Few AEs with comparable numbers in both treatment groups were reported during the study, which were mild in severity and resolved without medical treatment. Conclusion The study suggests that ectoine is effective in reducing nasal and ocular symptoms associated with ARC. Being a natural, bacteria derived stress protection molecule functioning by a physical mode of action, it therefore represents an alternative nonpharmacological treatment option.

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CONCLUSION CRS is associated with an increased incidence of asthma, AMI, stroke, anxiety disorder, and depression. Therefore, we suggest that clinicians should monitor CRS patients carefully, and optimize management as a means to potentially decrease these other associated comorbid conditions.

Allergen-specific immunotherapy (IT) induces tolerance in food allergy. Immunological changes during IT have been investigated, however little work has looked at global gene-expression changes. We have developed a tolerance-model of peach allergy using a novel system of sublingual IT (SLIT) based on glycodendropeptides. We analysed changes in dendritic cells (DCs) from mice receiving SLIT. METHODS: RNA-Seq was used to profile transcriptional changes in lymph node DCs for mice from two groups: anaphylactic mice treated with 2nM SLIT (tolerant), anaphylactic mice treated with 5nM SLIT (desensitized) and two controls: sensitized and anaphylactic mice. Mice were challenged intraperitoneally with Pru p 3, then sacrificed. Poly(A) enriched RNA sequencing was performed using Illumina HiSeq (100bp, paired end); sequences were aligned to the mouse genome using STAR. Differential expression analysis was performed using DESeq2 and functional enrichment analysis using TopGO. RESULTS: Gene expression for the sensitized, desensitized and tolerant mice groups were compared with anaphylactic samples. Sensitized mice showed the largest number of changes, followed by desensitized, then tolerant mice. Nevertheless, there was a set of core genes that changed in all comparisons. In terms of functional enrichment analysis, there was an overrepresentation of genes involved in the innate immune response, regulation of T-cell proliferation and TNF signaling. Interestingly, genes belonging to the MHC-II complex showed altered expression in different groups. CONCLUSIONS: By exploring gene expression at the global level we are able to obtain insights into the transcriptional changes and cellular processes that occur during immunotherapy. Future work is needed to further investigate these changes.

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