Sublingual Cockroach Safety in Adults With Cockroach Allergy & Perennial Allergic Rhinitis With or Without Asthma
Condition: Allergy; Asthma
MeSH terms: Rhinitis; Asthma; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Hypersensitivity
Study type: Interventional
Phase: Phase 1

Summary: 
      Immunotherapy may help reduce symptoms of allergy and asthma. Problems concerning compliance
      and adverse events with subcutaneous allergen immunotherapy have generated interest in
      delivering immunotherapy sublingually (under the tongue). The purpose of this study is to
      evaluate the safety of a cockroach extract given sublingually to people with perennial
      (year-round) allergic rhinitis, with or without asthma.
    

Detailed description: 
      The prevalence of asthma has dramatically increased in many parts of the world. Currently,
      there is no effective way to prevent development of allergic rhinitis and asthma and no cure.
      Sublingual immunotherapy (SLIT), a type of therapy in which allergens are placed under the
      tongue, may be a way to control and possibly prevent allergic rhinitis and asthma. However,
      detailed research of this approach is limited.

      The purpose of this study is to evaluate the safety and tolerability of a sublingual
      cockroach extract given to people with perennial allergic rhinitis. Participants in this
      study will include people both with and without asthma.

      Participation in this study will last a little more than 2 weeks. Participants will be
      stratified by age (oldest to youngest age group) and degree of cockroach sensitivity. Each
      age group will be enrolled after the previous group's safety data have been reviewed. At
      study entry (Day 0), participants will receive a dose of placebo and then up to seven
      incremental doses of cockroach extract at 15-minute intervals while observed by the clinic
      nurse. Doses will continue to be given until a sign or symptom occurs that indicates the
      participant is having difficulty tolerating the drug, or until the maximum study dose is
      reached.

      At the Principal Investigator's discretion, participants who were able to achieve the maximum
      study dose will be invited to continue onto the 2-week treatment course of the study. These
      participants will return on Days 1 and 2 to the clinic to self-administer the maximum study
      dose of cockroach extract. After self-administering the maximum study dose, participants will
      be observed by the clinic nurse for 30 minutes. On Days 3 through 14, participants will take
      the maximum study dose of cockroach extract daily at home. Participants will be asked to keep
      a diary and record signs or symptoms experienced after taking each dose.

      Skin tests, breathing tests, and blood collection will occur at study screening. At study
      entry, participants will be taught to use an EpiPen in the event of a severe allergic
      reaction at any time during the study. A physical exam/fitness assessment will be done at
      study screening, study entry, and the final visit. Unused extract will be collected at the
      final visit from participants who entered the 2-week treatment course of the study.

      The reference for this study is SCSS (Sublingual Cockroach Safety Study) in the provided
      citation: Wood RA, Togias A, Wildfire J et al. Development of cockroach immunotherapy by the
      Inner-City Asthma Consortium. J Allergy Clin Immunol. 2014 Mar;133(3):846-52. PubMed ID:
      24184147).
    

Intervention name(s): Glycerinated German cockroach allergenic extract; Placebo
Intervention type(s): Drug; Drug
Intervention description(s): Initially each subject underwent a 1-day, 8-dose escalation (e.g., one dose of placebo, 0.14 milliliters [mL], followed by 7 escalating doses of Glycerinated German Cockroach Allergenic Extract until the Maximum Study Dose [0.42 mL, 1:10 wt/vol] or Maximum Tolerated Dose was achieved). This maximum dose became the daily dose - maintenance dose- of Glycerinated German Cockroach Allergenic Extract for the following 14 days.The maintenance dose of 0.42 mL was calculated to contain 3685 bioequivalent allergy units (BAU), with approximately 4.2 mg of German cockroach allergen Bla g 2 and 50 mg of Bla g 1 per dose. Route of administration: sublingual-oral route.; Placebo was administered only as the first dose (e.g., representing no Glycerinated German Cockroach bioequivalent allergy units) during the initial 1-day, 8-dose escalation, otherwise referred to as the Preliminary Dosing Visit. Refer to the Glycerinated German cockroach allergenic extract treatment for more details. Route of administration: sublingual-oral route.
Other intervention name(s): Blattella germanica allergenic extract; Cockroach antigen (CR antigen); Glycerinated German cockroach allergenic extract placebo
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Perennial Allergic Rhinitis; Asthma; Sublingual Immunotherapy (SLIT)