Effect of modified immunotherapy with an allergen–pullulan conjugate in patients with Japanese cedar pollinosis

ABSTRACT Immunologic mechanisms of allergen immunotherapy are still incompletely understood. Immunotherapy of a higher maximum tolerance dose with reduced risks of systemic reactions, such as anaphylaxis, needs to be developed. Seasonal allergic rhinitis (SAR) is a type I allergic disease characterized by typical seasonal symptoms of rhinitis and an increase in mast cells and T helper (Th) 2-type cells, as well as tissue eosinophilia. The present study was designed to investigate the effect of a modified immunotherapy (IT) with an allergen-pullulan conjugate (CS-560) in patients with SAR to Japanese cedar pollen (Japanese cedar pollinosis) using objective parameters, such as analyzing the alteration in the proportion of effector cells like mast cells, eosinophils and T cells, and the Th2 and Th1 cytokine profile. We also analyzed the efficacy of modified IT on the severity of symptoms, using subjective parameters, such as the symptom-medication score. Immunotherapy for 15 months duration with the modified drug CS-560 in patients with Japanese cedar pollinosis induced an immune deviation from a Th2-to a Th1-type cytokine profile and inhibited the in-season