Safety of ragweed sublingual allergy immunotherapy tablets in adults with allergic rhinoconjunctivitis

A sublingually administered allergy immunotherapy tablet (AIT) is under development to treat ragweed (Ambrosia artemisiifolia)-induced allergic rhinoconjunctivitis (ARC). This study investigates the optimal tolerable dose of once-daily ragweed pollen AIT. Subjects 18‐50 years old with ragweed-induced ARC were enrolled at two U.S. centers in a double-blind, placebo-controlled, dose-escalation study outside ragweed season. Groups (12 subjects each) were to be randomized 3:1 to 28 days of active treatment (groups assigned in sequence to 3, 6, 12, 24, 50, or 100 Amb a 1 U, without dose buildup at any level) or matching placebo. Recruitment to 50 Amb a 1-U was discontinued because of adverse events (AEs) after four AIT subjects were enrolled; 100 1 unit of ambrosia artemislifolia major allergen 1 was not initiated. Fifty-three subjects were randomized (AIT, n = 40; placebo, n = 13); four discontinued, all because of AEs (AIT, n = 3; placebo, n = 1). Treatment-related AEs (TRAEs) were more frequent with AIT (73%) than placebo (31%), increasing with dose level. AIT TRAEs were mostly mild (94%) or moderate (5%). No serious TRAEs or anaphylactic shock occurred. The most common TRAEs with AIT were localized pruritus, nasal irritation, and throat irritation. Median onset for common AIT application site reactions was ≤24 hours after first treatment (median duration, 15‐50 minutes). AIT increased immunoglobulin (Ig) significantly more than placebo (ragweed-specific IgE [6, 12, and 24 Amb a 1-U]; IgG₄ [all doses]; p < 0.05). Three subjects in dose groups ≥24 Amb a 1-U experienced symptoms suggestive of systemic reaction. Of tested doses, ragweed AIT <24 Amb a 1-U once-daily was well tolerated in subjects with ragweed-induced ARC. Clinical trial registration URL and registration number: www.clinicaltrials.gov/ct2/show/NCT01134705.