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Rapid Desensitisation Quickly Increases Allergen Immunity, But Is Still Risky: Presented at ACAAI

By Carole Bullock

DALLAS, TX -- November 15, 2007 -- Maintenance immunotherapy for allergic rhinitis can be quickly reached; however, patients should be closely supervised, said investigators reporting here at the American College of Allergy, Asthma and Immunology (ACAAI) 65th annual meeting.

"Rush immunotherapy builds up the immune response and you get to the target sooner," said William Smits, MD, Allergist, Allergy and Asthma Center, Fort Wayne, Indiana. Dr. Smits presented study findings here on November 11.

He said, conventional immunotherapy is effective in treating allergic rhinitis, allergic asthma, and chronic rhinosinusitus, but has a downside: poor compliance,
delayed efficacy and patient frustration.

The 2,017 study participants, aged 1.7 to 77 years, had positive subcutaneous skin tests to allergies and had allergic rhinitis, asthma, or chronic rhinosinusitus.

Prednisone, 60 mg daily for adults, 2 mg/kg daily for children and H₁ antihistamines, cetirizine, fexofenadine, or loratadine, was administered as premedication for 3 days to 1,216 patients; 801patients received a 3-day premedication regimen of prednisone and H₁ and H₂ blockade. Similar H₁ antagonists were used and the H₂ antagonists included ranitidine, famotidine or cimetidine.

The final dose of the protocol ranged from 0.1 to 0.5 cc of a 1:1000 dilution of allergen extracts manufactured by ALK (Round Rock, Texas) and Greer Laboratories (Lenoir, North Carolina).

Systemic reactions occurred less frequently using a lower targeted final dose, experienced by 35 patients (1.8%), and 1 patient experienced anaphylaxis, Dr. Smits reported.

Researchers concluded that rapid desensitization for maintenance immunotherapy can be done, "quickly, safely and effectively under careful supervision."

There are risks for the procedure, including anaphylaxis, Dr. Smits noted, but the study did demonstrate that "overall, systemic reactions occurred less frequently (possibly) due to a lower targeted final dose and more aggressive premedication than previous literature descriptions."

There was no funding for the study and the author had no relevant disclosures.


[Presentation title: Safe and Effective Rapid Desensitization: A Cumulative Experience of 2017 Patients. Abstract 30]

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