Early Efficacy Analysis of Cluster and Conventional Immunotherapy in Patients With Allergic Rhinitis

Abstract

Background: Specific immunotherapy is an important immune-modifying treatment for patients with allergic rhinitis (AR). We compared the early efficacy and safety of cluster and conventional immunotherapies for patients with AR. Methods: One hundred forty-nine patients with persistent AR were enrolled in a randomized and open-label trial and were divided into the following 4 groups: 60 children treated conventionally, 33 children treated using the cluster schedule, 23 adults treated conventionally, and 33 adults treated using the cluster schedule. Patients in the cluster groups reached the maintenance dose within 6 weeks, while those receiving conventional therapy reached the maintenance dose within 14 weeks. Symptom scores and skin prick test scores (SPTs) were used to evaluate clinical efficacy and adverse reactions. Results: After buildup phase of treatment, symptom scores, and SPTs were significantly lower than those prior to treatment in each group ( P < .05). No significant differences were found in the efficacy of nasal symptoms scores among four groups ( P > .05).However, the efficacy of SPTs using conventional schedule was higher than cluster schedule in children groups (group A and B, 57.7 vs 30.2%, P = .001). Besides, the efficacy of SPTs in adults was higher than children when using the cluster treatment (group D and B, 53.0 vs 30.2%, P = .008). No severe adverse reaction occurred. Conclusions: Conventional and cluster immunotherapy schedules have similar efficacies, which do not vary with age; both schedules are safe and reliable. Also, SPT facilitate evaluation of clinical efficacy.

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…In summary, cluster SCIT has a similar safety profile as conventional SCIT and fewer systemic reactions than rush SCIT 2612,2618,2622 . Importantly, the safety of cluster SCIT is comparable to standard regimens overall because the number of injections required for buildup can be less, not because the per injection risk is necessarily lower.…”

“…Two additional RCTs not included in the meta‐analysis show improvement in symptom/medication scores for cluster SCIT over placebo using depot or polymerized pollen extracts 2555,2571 . Compared to conventional SCIT, cluster SCIT demonstrates similar efficacy for multiple extracts including pollens and HDM 2566,2617,2622–2624 . Cluster and rush SCIT have not been directly compared in RCTs (Table XI.D.5.c).…”

Allergen immunotherapy in China

“…Cluster immunotherapy typically takes 4–8 weeks to reach a maintenance dose and requires patients to receive multiple allergen injections (generally two to four injections) sequentially in a single day of treatment on non-consecutive days. A randomized and open-label trial enrolled 149 AR patients to compare the efficacy of conventional and cluster immunotherapy during the build-up phase in adults and children ( 148 ). After the completion of the build-up phase of immunotherapy, a significant decrease in symptom scores was observed among the majority of patients, regardless of whether they followed the conventional or accelerated cluster schedules.…”