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Half-Day Rapid Desensitization Regimen Appears Safe and Effective: Presented at ACAAI
By Corinna S. Bowser, MD
PHILADELPHIA, PA -- November 15, 2006 -- A half-day regimen of rapid desensitization to allergens, given to more than 1,500 patients to date, is safe and effective, according to research presented here at the 2006 Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI).
The 2.1% rate of systemic reaction seen in this cohort represents an improvement over rates reported previously for rapid desensitization, also referred to as rush immunotherapy or rapid allergen vaccination (RAV).
"This protocol substantially reduces systemic reaction rates previously reported for RAV, encouraging further reconsideration of this procedure by practicing allergists," said study investigator William L. Smits, MD, researcher, Allergy and Asthma Center, Fort Wayne, Indiana.
For patients, RAV has several potential advantages over conventional immunotherapy, including cost effectiveness, rapid response, and improved patient compliance. However, the risk of systemic reactions (e.g., hives, hypotension, bronchospasm) remains higher compared with standard approaches.
Dr. Smits and colleagues have used 2 relatively similar half-day RAV schedules to rapidly desensitize 1,540 patients (age 1.7 to 77 years; 59% female) with positive skin tests to seasonal or perennial allergens. Allergic rhinitis was diagnosed in 97% of patients, 53% had an asthma diagnosis and 48% had chronic rhinosinusitus.
"The RAV dose was started and increased to a final dose of.1 to.5 cc of a 1:1000 dilution of extracts (ALK and Greer Laboratories), followed by increasing doses according to a conventional immunotherapy schedule."
Mild systemic reactions occurred in 2.1% of patients. One patient experienced anaphylaxis (.001%). These patients responded to treatment (nebulized albuterol or subcutaneous epinephrine) and went home following observation.
All patients were treated in outpatient facilities equipped to handle anaphylaxis. About two thirds of the patients received 3 days of premedication with predinsone and an H1 antihistamine, cetirizine, fexofenadine, or loratidine; the rest received a 3-day regimen including prednisone and H1 and H2 blockade.
Premedication has been shown to substantially reduce incidence of systemic reactions in patients undergoing RAV, Dr. Smits added.
[Presentation title: Safe and Effective Rapid Desensitization: A Cumulative Experience of 1540 Patients. Abstract 20]
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