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Rush and Cluster Immunotherapy

Rush and Cluster Immunotherapy. Harold S. Nelson, MD Professor of Medicine National Jewish Health University of Colorado Health Science Center Denver, Colorado. 47/125 experienced systemic reactions: - Urticaria (4) - Anaphylactic shock (8) - Asthma exacerbations (35).

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Rush and Cluster Immunotherapy

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  1. Rush and Cluster Immunotherapy • Harold S. Nelson, MD • Professor of Medicine • National Jewish Health • University of Colorado Health Science Center • Denver, Colorado

  2. 47/125 experienced systemic reactions: - Urticaria (4)- Anaphylactic shock (8)- Asthma exacerbations (35). Baseline FEV1 < 80% 73% systemic reactions. Baseline FEV1 ≥ 80% 13% systemic reactions. Difference all due to fewer asthma exacerbations. Immunotherapy with aStandardized Dermatophagoides pteronyssinus Extract: III. Systemic reactions during the rush protocol in patients suffering from asthma. J Bousquet et al. J Allergy Clin Immunol 1989;83:797-802

  3. To decrease systemic reactions serially introduced:- Premedication: Oral CS, ketotiefen, Theophylline (Group B)- Premedication plus SIT givien only if FEV1 > 70% and stopped for locals > 10 cm (Group C)- Above plus RIT only four doses first day, then single doses days 2, 5, 8, 11, & 14. (D) Immunotherapy with aStandardized Dermatophagoides pteronyssinus Extract: IV. Systemic reactions according to the immunotherapy schedule A Hajjaoui, et al. J Allergy Clin Immunol 1990;85:473-9

  4. Systemic reactions according to the immunotherapy schedule A Hajjaoui, et al. J Allergy Clin Immunol 1990;85:473-9

  5. Double-blind Comparative Study of Cluster and Conventional Immunotherapy Schedules with Dermatophagoides pteronyssinus. • 239 patients with allergic rhinitis or asthma sensitive to house dust mites. • Built up to a maintenance dose containing 3.2 g Der p 1 in an alum precipitated extract. • Half by cluster with 15 shots in 6 weeks and half by 13 single weekly injections. AI Tabar, et al. J Allergy Clin Immunol 2005;116:109-18

  6. Double-blind Comparative Study of Cluster and Conventional Immunotherapy Schedules with Dermatophagoides pteronyssinus. • Systemic reactions, all mild, occurred during the build-up stage in:Cluster: 3% of patients and 0.15% of injections.Weekly: 4% of patients and 0.31% of injections. AI Tabar, et al. J Allergy Clin Immunol 2005;116:109-18

  7. DecreasedPrick Skin Tests 10 Cut Tol Index * * * * * P=0.04 * * Cluster Conventional 1 - 0 10 20 30 40 50 60 Weeks P0 P6 P12 P18 P52 Cumlative Dose IT BU Cluster 25.3 25.3 41.3 Conventional 0.85 22.65 48.65 *Difference from P0; p<0.05 AI Tabar, et al. J Allergy Clin Immunol 2005;116:109

  8. Rhinitis Global Symptom-Medication Score 1 Mean global score (standard error) 0.9 Cluster 0.8 Conventional 0.7 P=0.001 0.6 0.5 * ** 0.4 * ** * 0.3 0.2 0.1 0 T1’ T0 T1 TF N 168 56 55 143 * Difference from T0 (wilcoxon, p<0.05) **Difference from T0 (wilcoxon, p<0.001) AI Tabar, et al. J Allergy Clin Immunol 2005;116:109

  9. Conclusions • Build-up using alum-precipitated D. pteronyssinus extract in a 6 week cluster regimen was as well tolerated as a conventional 12-week program of single injections. • Patients receiving cluster had more rapid onset of immunologic response and more rapid relief of symptoms. AI Tabar, et al. J Allergy Clin Immunol 2005;116:109

  10. Experience at National Jewish with Cluster Immunotherapy using Aqueous Extracts

  11. Cluster Immunotherapy Schedule: Injections B.I.W.

  12. Cluster Immunotherapy: The National Jewish Experience • 3 dose-ranging studies, 2 with cat dander extract and 1 with A-P dog extract. • 14 subjects received cluster to maintenance dose of 15 g Fel d 1 and 7 to maintenance dose of 15 g of Can d 1. • 1 mild systemic reaction (patient reached projected maintenance with one extra injection).

  13. Antihistamine pretreatment with cluster immunotherapy: Premedication with loratadine reduced the percent of patients with systemic reactions from 79% to 33% (p = .002). Systemic reactions were more severe in the placebo group. Nielsen L, et al. JACI 1996;97:1207-13. • Administration of immunotherapy by a cluster regimen:- achieves both clinical and immunologic response more rapidly- does so with little or no increase in the risk of systemic reactions.

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