Effect of House Dust Mite Allergen Challenge in Persons Using 1200 mg Gamma Tocopherol Supplements
Condition: Allergic Rhinitis; Mild Asthma
MeSH terms: Rhinitis; Rhinitis, Allergic
Study type: Interventional
Phase: Phase 1

Summary: 
      Twenty, house dust mite (HDM)-allergic non-smoking subjects with or without mild asthma
      between the ages 18-50 will be recruited. The primary endpoint will be nasal eosinophilia.
      Each volunteer will be screened with skin testing, pulmonary function testing and induced
      sputum. If eligible they will return for baseline nasal allergen challenge and lavage.
      Approximately two weeks later they will return for gamma tocopherol (gT) dosing visit. After
      completing 14 days of daily high dose (1200mg) gT, they will return for a second nasal
      allergen challenge. This visit will also include pulmonary function testing and blood draw.
      The purpose of this study is to determine if high dose gamma tocopherol therapy can reduce
      allergen induced nasal inflammation.
    

Detailed description: 
      This will be done using a single-group, prospective, descriptive proof of concept study
      design (Phase I) in which HDM-allergic adults will undergo baseline nasal allergen challenge
      and nasal lavage, then receive 2 weeks of treatment with gT followed by a second challenge
      and nasal lavage.

      Primary outcome: Post-treatment change in concentration of house dust mite-induced
      eosinophils in nasal lavage fluid (NLF), compared to pre-treatment baseline.

      Secondary outcomes: (a) NLF inflammatory mediators including eicosanoid products of COX-2
      pathway, inflammatory cytokines relevant to innate immunity and allergic inflammation, cells
      other than eosinophils including neutrophils, total protein; (b) similar endpoints in induced
      sputum; (c) sub-analysis of all data for subjects with mild asthma.

      Safety outcomes: Post-treatment change in coagulation markers (PT, PTT).

      Study Protocol:

      Visit 1(Screening): Study subjects consenting for the protocol will be scheduled for an
      initial baseline screening visit which will include urine pregnancy test, medical history and
      physical exam, immediate-hypersensitivity skin testing for D. farinae and other common
      allergens, baseline spirometry, nasal lavage for cell differentials and cytokines, induced
      sputum for cell differentials and cytokines, venipuncture for up to 30ml of blood for
      complete blood, count coagulation factors, cytokines and vitamin levels.

      Visit 2: Allergen challenge visit will occur within 2 months of screening. Medical history
      including medications will be reviewed. Urine pregnancy test, physical exam, baseline nasal
      symptom score will be obtained prior to challenge. Study volunteer will undergo graded nasal
      allergen challenge with D. farinae using left naris with symptom score recorded after each
      dose. Nasal allergen challenge will be provided in a graded dose fashion 0 AU, 100 AU, 500 AU
      and then 1,000 AU separated by 15 minutes. Dilutions will be provided by the University of
      North Carolina Hospitals Investigational Drug Service. Over 10 minutes, symptoms will be
      monitored and scored, based on symptoms in the allergen challenge nostril. If there are no
      positive clinical symptoms, increasing concentrations of dust mite allergen dilution are
      deposited into the nose. Nasal challenge with saline will be given in the contralateral
      nostril with similar volumes as used for allergen challenge followed by spirometry and vital
      signs. Subjects will remain in the research lab and undergo vital signs and spirometry 4
      hours post challenge and at the investigator's discretion. Nasal lavage will occur 4 hours
      after allergen challenge for measurements as noted above. If volunteer was a sputum producer
      in the first visit, sputum induction will be performed, also 4 hours after nasal allergen
      challenge. Venipuncture for complete blood count coagulation factors, cytokines and vitamin
      levels will also be collected.

      Visit 2a: This visit will occur within 24 hr after Visit 2. Volunteer will have vital signs
      recorded, review of symptoms, physical examination and spirometry.

      Visit 3(Initial dosing visit): This visit will occur at least 2 weeks after Visit 2. Any
      changes in medical history, medications or adverse events (AE's) since prior visit will be
      reviewed. Urine pregnancy test will be performed for females of child bearing potential.
      Subjects will receive a 14 day supply (28 softgel capsules, approximately 600 grams of gT
      each) dispensed by the University of North Carolina Hospitals Investigational Drug Service
      and provided by YASOO Medical. Subjects will be observed while taking the initial oral dose
      of 2 softgel capsules (approximately 1200 grams) of gT and will be discharged home with
      individual oral doses of study drug for the following 13 days. Subjects will be given a daily
      medication diary to record when the dose was taken and any changes in health or medications.

      Visit 4: This visit is a safety visit after 6-8 days of gT therapy. The subjects will undergo
      vital signs measurements, spirometry and physical exam specifically focused on signs of
      bruising or bleeding. Venipuncture (approximately 10ml) will be performed to obtain CBC and
      coagulation factors since high dose gT theoretically may affect platelet function and
      coagulation.

      Visit 5: After two weeks of daily gT the subject volunteer will return for another nasal
      allergen challenge. Medical history will be updated, any AE's or new medications since visit
      4 will be reviewed. Pregnancy testing, spirometry and vital signs will be performed. After
      baseline nasal symptom score is obtained a graded nasal allergen challenge will be performed
      as in visit 2. Spirometry will be performed after challenge to assure volunteer has tolerated
      allergen challenge. Nasal lavage will be performed 4 hours after allergen challenge for
      measurements as noted above. If a volunteer was a sputum producer in previous visit, sputum
      induction 4 hours after allergen challenge for measurements as above. Venipuncture for blood
      studies (including safety labs) as indicated in visit above will be performed.

      Visit 5a: This visit will occur within 24 hours of Visit 2. Volunteer will undergo vital
      signs measurement, review of symptoms, physical exam and spirometry.

      Visit 6: Five to ten days after challenge, volunteer will return for discontinuation visit
      which will include vital signs, physical exam and spirometry.
    

Intervention name(s): Gamma Tocopherol
Intervention type(s): Drug
Intervention description(s): 14 days of daily high dose (1200mg) Gamma Tocopherol. Subjects will receive a 14 day supply (28 softgel capsules, approximately 600 grams of gT each) dispensed by the University of North Carolina Hospitals Investigational Drug Service and provided by YASOO Medical.
Other intervention name(s): gT; Vitamin E; Tocopherol; Vitamin
Intervention MeSH terms: Vitamins; Vitamin E; Tocopherols; Tocotrienols; alpha-Tocopherol; gamma-Tocopherol
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: allergic rhinitis; mild asthma; dust mite allergy; gamma tocopherol