Physiological Study to Determine the Allergic Skin Activity After Different Skin Preparation
The objectives of this monocentric investigator initiated exploratory clinical trial is to optimize allergen delivery across the epidermal barrier. The cornified outer epidermal layers represent the main barrier towards entry into the viable epidermal layers. In the latter we aim to target the allergen for uptake by professional antigen presenting cells, called Langerhans cells. At the same time as little allergen as possible should be delivered to the dermis. The latter contains a high density of sensitized mast cells eliciting local reactions and also a high density of blood vessels which could lead to systemic distribution of allergen and therefore to systemic allergic reactions.
In birch pollen allergic individuals we will compare different methods of preparing the skin before application of the allergen. We will subsequently apply titrated allergen doses to the prepared skin areas to determine at which dose we start observing mast cell degranulation manifesting as hives.
This will allow for determination of the maximal tolerated allergen dose for each skin preparation method.
The skin preparation methods compared will be:
- Single pricking with prick lancet (Entaco LTD., Redditch, Worcestershire, UK, distributed by Stallergenes®).
- Tape stripping with conventional adhesive Tape (Tesa-film®).
- Microchanneling with Micro Needle Patch (Micro Skin System, 3M®). The methods are strongly connected to routine diagnostics of allergies with low risk associated.
The clinical trial protocol has been submitted to the local Ethics Committee.
This comparison of skin preparation methods and the determination of the maximal tolerated allergen dose will help us to further improve epicutaneous allergen immunotherapy, which has the potential to make allergen specific immunotherapy not only considerably shorter and safer, but also more convenient for patients. Skin preparation by microneedle patches is significantly less painful than conventional injection and can be self administered. This should help improve the acceptance of allergen specific immunotherapy, as well as treatment compliance.
Birch Pollen Allergy
Other: prick lancet
Other: Tape stripping
|Study Design:||Endpoint Classification: Pharmacodynamics Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Comparison of the Influence of Different Skin Conditions on the Allergic Skin Reactivity to Epicutaneous Allergen Exposure|
- Wheal size of the immediate reaction in mm2. [ Time Frame: 15 minutes ] [ Designated as safety issue: No ]
- Late phase response. [ Time Frame: 3 days ] [ Designated as safety issue: No ]Evaluation of late phase reaction (eczema development).
|Study Start Date:||July 2012|
|Study Completion Date:||September 2012|
|Primary Completion Date:||September 2012 (Final data collection date for primary outcome measure)|
Skin Preparation Testing
The methodology of this study is an intra-individual comparison. Each study participant is treated with three skin preparation techniques (pricking, tape stripping, microneedle array)on both volar forearms.
Other: prick lancet
For the pricking skin preparation, sterile prick lancets for 1mm point skin testing will be used. They are used for allergy diagnostics in daily routine.
Other Name: Prick Lancet; Worcestershire, UK; distr. by Stallergenes®.Other: Tape stripping
For the tape stripping in the skin preparation test conventional self adhesive tape by Tesafilm® is used.
Other Name: TesafilmOther: Microneedle
To induce a large number of microchannels with a maximal depth of 150µm into the cornea layer a small patch of 351 tiny needles is used, which is on the market in the US and is intended for preparing the skin for transdermal application of topical dermatology products.
Other Name: solid Microstructured Transdermal System (sMTS) by 3M®
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|University Hospital Zurich, Division of Dermatology|
|Zurich, ZH, Switzerland, 8091|
|Principal Investigator:||Thomas Kuendig, MD||University Hospital Zurich, Division of Dermatology|