Practical Course Allergen Immunotherapy (AIT) How to be effective. Michel Dracoulakis HSPE- FMO São Paulo-SP Brazil
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1 Practical Course Allergen Immunotherapy (AIT) How to be effective Michel Dracoulakis HSPE- FMO São Paulo-SP Brazil
2 Allergen immunotherapy - beginning Dunbar almost died with first inoculation 1911 Noon and Freeman published first work o Became standard treatment for asthma/hay fever o Diverse build up schemes and duration Indiscriminate use made the specialty untrustworthy 1963 Lowell and Franklin first placebo controlled study
3 Studies over Allergen Immunotherapy Venom Anaphylaxis o Up 98% efficacy (bee and wasp) Rhinitis o Sublingual IT (SLIT) better than anti-h1 and placebo/similar to nasal steroids o Subcutaneous (SCIT) and SLIT better than placebo Asthma o Meta-analysis confirms efficacy for children an adults Atopic Dermatitis o Trend for efficacy - need better studies J Allergy Clin Immunol 2005; 115; BMC Medicine 2014, 12:71 Cochrane Database Syst Rev. 2010;(8):CD Curr Opin Allergy Clin Immunol Aug;12(4):427-33
4 Efficacy of AIT Children carry over effect of 12 years Reduces progression to asthma Reduces new sensitizations SLIT carry over of 2 years documented in adults Long-lasting effect 15 years after 4 years of SLIT Preventive SLIT asymptomatic children o Safe / in vitro effects J Allergy Clin Immunol 2005; 115; BMC Medicine 2014, 12:71 Cochrane Database Syst Rev. 2010;(8):CD Curr Opin Allergy Clin Immunol Aug;12(4):427-33
5 Indication of AIT Identified allergen IgE mediated disorders Exposure correlate with symptoms Good extract available? o Allergen standardization Bousquet J, Lockey R, Malling HJ. ; J Allergy Clin Immunol Oct;102(4 Pt 1): Allergen immunotherapy: A practice parameter third update Cox et al; J Allergy Clin Immunol Persistent rhinitis allergic or nonallergic? Allergy 2004: 59 (Suppl. 76): 11 15
6 Indication of AIT Patient selection o Patient adherence o Symptoms intensity o Monosensitized x polysensitized o Seasonal x perennial o How much allergic is the symptom? Rhinitis allergic x non-allergic = 3:1 Mixed rhinitis 44-87% Atopic Dermatitis intrinsic, food allergy Geriatric population perception / co-morbidities J Allergy Clin Immunol 2008;122:S1-84. Int Forum Allergy Rhinol Oct;4(10):
7 Efficacy of AIT practical issues SLIT x SCIT SCIT better Up dosing protocol o Conventional Time consuming - more dropouts o Cluster Zhang et al. safe as conventional (HDM) Feng et al. meta-analysis efficacy in RQLQ o Rush Safer in Venom AIT Pre-medication Anti-histamines/Omalizumab Int Arch Allergy Immunol 2009;148: PLoS One Jan 28;9(1):e86529 J Allergy Clin Immunol 2012;130:
8 Efficacy of AIT practical issues Maintenance o Missed doses Patient evaluation Peak-Expiratory Flow Flexibility dose interval? o How much time 3-5 years Venom IT o Dose? Optimal duration of allergen immunotherapy in children with dust mite respiratory allergy - doi: /pai Bousquet J, Lockey R, Malling HJ. ; J Allergy Clin Immunol Oct;102(4 Pt 1):558-62
9 Efficacy of AIT the allergens Choice of allergens o Multiple allergens AIT o Single allergen AIT Bystander effect? Bousquet J, Lockey R, Malling HJ. ; J Allergy Clin Immunol Oct;102(4 Pt 1):558-62
10 Mixing allergens Dose o Cross-reactive allergens increased dose o Too many allergens insufficient dose Enzymatic activity Time between mixing and applying o Greater dilution = lower shelf life Bousquet J, Lockey R, Malling HJ. ; J Allergy Clin Immunol Oct;102(4 Pt 1): Allergen immunotherapy: A practice parameter third update Cox et al; J Allergy Clin Immunol. 2011
11 Tailoring AIT Recommended doses flexibility o Venom AIT 100 mcg Modifying AIT o Adverse reactions Large Local reactions Systemic reactions o Lack of response 1 year Non-allergic component Missed main triggers Continued exposure to allergen Optimal duration of allergen immunotherapy in children with dust mite respiratory allergy - doi: /pai Bousquet J, Lockey R, Malling HJ. ; J Allergy Clin Immunol Oct;102(4 Pt 1): Allergen immunotherapy: A practice parameter third update Cox et al; J Allergy Clin Immunol. 2011
12 Monitoring AIT Clinical response o Symptoms o Medications Cutaneous late responses (intradermal test) IgG4/serum inhibitory activity for IgE-allergen complex binding to B cells Basophil histamine release Basophil expression of diamine oxidase J Allergy Clin Immunol 2012;130: J Allergy Clin Immunol Nov 22 pii: S (14) doi: /j.jaci [Epub ahead of print]
13 End For questions or commentaries please contact
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University of Groningen Allergen immunotherapy for allergic rhinoconjunctivitis Nurmatov, Ulugbek; Dhami, Sangeeta; Arasi, Stefania; Roberts, Graham; Pfaar, Oliver; Muraro, Antonella; Ansotegui, Ignacio
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Clinical Policy: House dust mite allergen extract (Odactra) Reference Number: CP.PMN.111 Effective Date: 08.01.17 Last Review Date: 08.18 Line of Business: Commercial, Medicaid Revision Log See Important
Associate Professor Rohan Ameratunga Immunologist & Allergist, Auckland
Associate Professor Rohan Ameratunga Immunologist & Allergist, Auckland Update on desensitisation Associate Professor Rohan Ameratunga GLORIA Module 4: Allergen Specific Immunotherapy A New Zealand perspective
Efficacy of sublingual specific immunotherapy on allergic asthma and rhinitis in children s real life
European Review for Medical and Pharmacological Sciences Efficacy of sublingual specific immunotherapy on allergic asthma and rhinitis in children s real life G. DE CASTRO, A.M. ZICARI, L. INDINNIMEO,
Setting The setting was secondary care. The economic study was carried out in France.
Pharmacoeconomic assessment of specific immunotherapy versus current symptomatic treatment for allergic rhinitis and asthma in France Omnes L F, Bousquet J, Scheinmann P, Neukirch F, Jasso-Mosqueda G,
e. Elm Correct Question 2 Which preservative/adjuvant has the greatest potential to breakdown immunotherapy because of protease activity? a.
Allergen Immunotherapy Practical Quiz Question 1 Which of the following pollens shows cross-reactivity with birch pollen? a. Alder b. Olive c. Ash d. Black walnut e. Elm Question 2 Which preservative/adjuvant