Background: Climatic changes causing early pollen flight and new allergens prolonging the pollen season render up-dosing of allergen-specific subcutaneous immunotherapy (SCIT) outside the pollen season considerably more difficult. In addition, for patients with multiple pollen allergies, patients coming near the beginning of pollen season, and patients who wish to up-dose faster, an accelerated induction regimen would be helpful. Methods: In an open, randomized, parallel group, multicenter safety trial, an accelerated up-dosing regimen (0.1–0.3–0.5 ml in weekly intervals) was compared to conventional up-dosing (0.05–0.1–0.2–0.3–0.4–0.5 ml in weekly intervals) with an allergoid grass pollen SCIT preparation. After up-dosing, the maintenance dose was given in monthly intervals. Results: A total of 146 adult patients with rhinitis or rhinoconjunctivitis with or without mild asthma (FEV₁ >70%) due to grass pollen were randomized to either the conventional registered up-dosing or an accelerated regimen. In both groups (accelerated regimen, n = 69; conventional regimen, n = 75), a high proportion of patients (92.75 and 92.0%, respectively) successfully reached the maintenance dose without safety concerns. Furthermore, significant increases in specific IgG and IgG₄ after 4 months of treatment were observed in both groups. Conclusion: The accelerated SCIT regimen was found to be as safe as the conventional regimen and might be used to up-dose patients within 2 weeks. Moreover, the immunological effects of both up-dosing regimens were comparable.

Introduction: Respiratory symptoms are common in preschool children. However, which of these wheezers will develop asthma at school age, and what phenotype they will develop remains difficult to predict. Current models such as the asthma prediction index (API) are based on clinical parameters and have only modest predictive accuracy. Expression levels of well replicated asthma genes could potentially form novel biomarkers for asthma prediction. IL1RL1 is an asthma susceptibility gene, and has also been linked to eosinophilia. Therefore, we hypothesized that expression levels of IL1RL1 in the form of soluble IL-1RL1-a measured in serum from wheezing preschool children contribute to the prediction of asthma at school age. Moreover, since IL1RL1 was previously associated with blood eosinophilia, our second aim was to determine whether serum IL-1RL1-a levels predict eosinophilic asthma. Method: We used logistic predictive modeling in a prospective Dutch birth cohort (n = 202 wheezers), and calculated the area under the curve (AUC) of the sensitivity/1-specificity curves of potential models. Results: Neither IL-1RL1-a serum levels at age 2-3 years alone nor its combination with the API had predictive value for doctors' diagnosed asthma at age 6y (IL-1RL1-a alone: AUC = 0.50 [95 CI 0.41-0.59, P = 0.98], API + IL-1RL1-a: AUC = 0.57 [95 CI 0.49-0.66, P = 0.12]). However, IL-1RL1-a serum levels at age 2-3 years correlated with the severity of airway eosinophilia (determined by levels of exhaled fraction of NO, [FeNO]) in children who had developed asthma at age 6y (Pearson's R = −0.24, P = 0.046, N = 59). Logistic predictive modeling of eosinophilic asthma at age 6y (asthma with FeNO ≥ 20 ppb) showed that IL-1RL1-a serum levels itself and in combination with the API could predict this eosinophilic subphenotype of asthma