1 / 13

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).

alan-acosta
Download Presentation

Rush and Cluster Immunotherapy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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.

More Related