Texan Allergy & Sinus Center Mountain Cedar Intra-Lymphatic Immunotherapy Study

TX-SMILE is an investigator-initiated, multi-center, randomized, double-blind,
parallel-group, placebo-controlled study to evaluate the efficacy, safety, and tolerability
of an alternative injection site and associated adjustments to dosing and treatment regimen
for allergen immunotherapy with a commercially-available, FDA-approved allergenic extract for
the immunotherapy treatment of allergic rhinitis and conjunctivitis due to pollen from the
conifer Mountain Cedar (Juniperus ashei).

The purpose of this study is to evaluate the effect of a three-dose treatment series of
ultrasonography-guided, intra-lymphatic immunotherapy injections over a two-month period
prior to the start of the 2018-2019 Mountain Cedar allergy season in central Texas. Patients
will be evaluated for safety and tolerability during the treatment period and for efficacy
during the 2018-2019 Texas Mountain Cedar pollen season.

Inclusion Criteria:

1. Both male and female adult patients with a history of Season Allergic Rhinitis (SAR)
with bothersome symptoms due to Mountain Cedar pollinosis confirmed using the Modified
Quantitate Test (MQT; defined as a wheal greater than or equal to 3 millimeters larger
than the diluent control)

2. Patients must be willing to provide written, informed consent

3. Patients must be willing and able to comply with study procedures

4. Women of childbearing potential must agree to use an acceptable form of contraception
during the trial

Exclusion Criteria:

1. Patients less than 18 years of age

2. Clinically-significant chronic sinusitis, as determined by the investigator

3. History of anaphylaxis during Mountain Cedar skin prick testing

4. Participation in another clinical trial or use of an experimental medication within 30
days of enrollment

5. Medically significant co-morbidities that, in the opinion of the investigator, place
the subject at increased risk during the study, including but not limited to:

1. Autoimmune diseases, other than allergic rhinitis (AR), stable allergic asthma,
eczema and food sensitivities

2. Pulmonary or respiratory diseases other than stable asthma

3. Cancer other than basal cell carcinoma

4. Coronary artery disease or hypertension treated with beta-blockers

5. Clinically significant impairment of renal or hepatic function

6. Use of concomitant medications that, in the opinion of the investigator, may reduce
the effectiveness of rescue treatments for anaphylaxis (e.g. beta-blockers) or alter
the immune response to allergen immunotherapy (e.g., immunosuppressants, systemic
corticosteroids)

7. Previously completed immunotherapy for Mountain Cedar pollinosis, that in the opinion
of the investigator would interfere with the assessment or treatment of the patient

8. Inability to access suitable lymph nodes for intralympahtic injections

9. Plans to leave the area for a significant period of the upcoming Mountain Cedar pollen
season

10. Pregnant or lactating females