1 / 13

Clinical process for properly prescribe allergen immunotherapy

Clinical process for properly prescribe allergen immunotherapy. Noel Rodriguez-Perez, MD Professor of pediatrics, Allergy& Immunology State University of Tamaulipas, School of Medicine. Clinical process for properly prescribe allergen immunotherapy.

noreen
Download Presentation

Clinical process for properly prescribe allergen 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. Clinical process for properly prescribe allergen immunotherapy • Noel Rodriguez-Perez, MD • Professor of pediatrics, Allergy& Immunology • State University of Tamaulipas, School of Medicine

  2. Clinical process for properly prescribe allergen immunotherapy Cox L, Nelson HS, Lockey RF. Journal of Allergen immunotherapy: A practice parameter third update Allergy Clin Immunol 2011;127:S1-S46 • Summary Statement 80: The efficacy of immunotherapy depends on achieving an optimal therapeutic dose of each of the constituents in the allergen immunotherapy extract. A

  3. Allergen immunotherapy: What can and cannot be mixed?Esch RE.J Allergy Clin Immunol 2008;122:659-60.

  4. Clinical process for properly prescribe allergen immunotherapy • CASE 1: M.D.K. Male. 16 years of age • Previous history: Cow’s milk allergy in infancy. • Hystory: 2 years, recurrent episodes of coriza, nasal congestion, acuous rhinorrea, epifora, fotofobia, intermitent dry cough. • Symptoms, perenial with exacerbations in Winter, Spring and summer.

  5. Skin test. Case 1 M.D.K

  6. Case 1: M.D.K. 1. What allergens to be included? 2. How many in one vial? 3. Can we mix this unrelated allergens?

  7. Zuberbier T, Bachert C, Bousquet PJ, Passalacqua G, Walter Canonica G, Merk H, Worm M, Wahn U, Bousquet J. GA2LEN/EAACI pocket guide for allergen-specific immunotherapy for allergic rhinitis and asthma. Allergy 2010; 65: 1525–1530. • Decision must be based on the allergen which causes: 1. The longest duration of symptoms per year 2. The most severe symptoms 3.A major impact on quality of life 4. Which is more difficult to avoid

  8. CASE 1: M.D.K. • House dust mites…Related to perennial symptoms • Tree pollens… Late winter to early Spring • Grass pollens…Late Spring to early Summer • Weed pollens…Summer to early Autumn

  9. CASE 1: M.D.K. Pollen SIT • Quercus, Celtis, Sorgum, Ambrosia, Rumex • Pollens probably effective dose range: 5 – 20 mcg (1:100 – 1:200 w/v) • 5 pollen mix will dilute each other times 5. • Maintenance dose Vial: 1:200 • V1 X C1 = V2 X C2 Were: • V1 = Final volume to prepare • C1 = Desired concentration of extract • V2 = Volume of extract needed (unknown) • C2 = Concentration of extract you will use (manufacturer concentrate) JACI. 2011;127:S1-S46

  10. CASE 1: M.D.K. Pollen SIT • Pollen maintenance vial. • Option: 5cc 1:200 w/v V2 = (V1/ C1)xC2 • V2 (?) = (5cc / 1/200)x1:20 w/v = (5/200)x20 = 0.5 • V2 = 0.5cc of each pollen extract • Mix of 5 pollen extracts: 0.5x5 = 2.5cc + 2.5cc of diluent. • Option: 1:100 • V2 = (5/100)x20 = 1cc • Mix of 5 pollen extracts: 5cc no diluent.

  11. CASE 1: M.D.K: H.D.Mites or standarized Immunotherapy • Mites maintenance vial F/Pt mix 50/50. • Manufacturer concentrate: 10,000; 30,000 AU/mL • Effective maintenance dose: 500 – 2000 AU or 10mcg/mL (Mf: 10mcg; MPt: 7 – 12 mcg/mL) • Maintenance vial: 2000 AU/mL. • V2 = (V1 x C1)/C2 • V2 (?) = (5cc x 2000)/10,000 AU = 1.0cc • V2 = 1.0cc + 4cc Diluent ( 12mcg/mL; 6 mcg/dose)

  12. Major allergen component in standarized extracts

  13. Dose of Major component in mcg/mL • Suppose 5cc maintenance dose vial for 10 doses of 0.5cc with Timothy grass pollen. • 5cc must contain 10 times the maintenance dose. • Example: • Timothy grass maintenance effective dose 20mcg/mL Phl p5. 5 cc maintenance vial must contain 200mcg. • Manufacturer label 100000AU/mL = 680mcg of Phl p5/mL. • 200 divided by 680 = 0.3cc + 4.7cc of diluent.

More Related