Increased risk of systemic reactions extends beyond completion of rush immunotherapy

Comparison of Standard, Cluster, and Rush Allergy Immunotherapy Buildup Protocols

BACKGROUND

Allergy immunotherapy (AIT) involves a dose-escalation phase following 1 of 3 protocols: standard, cluster, or rush. Although the cluster and rush protocols have been shown to decrease the time to reach maintenance dosing, there is a lack of direct comparison between the protocols.

OBJECTIVE

This study aimed to evaluate the differences in time to maintenance dosing and occurrence of adverse reactions among the dose-escalation protocols.

METHODS

A retrospective observation study of patients on AIT was conducted. Patients were categorized as participating in the standard, cluster, or rush buildup protocols. Patients on the rush protocol, unlike the standard and cluster protocols, were required to receive prednisone, montelukast, cetirizine, and famotidine on the rush day and first 2 weekly injections thereafter. Variables analyzed include patient demographics, time until maintenance dosing, rate of adverse reactions, treatments required for reactions, and AIT formulation.

RESULTS

Data were reviewed on 237 patients on the standard (n = 41), cluster (n = 122), and rush (n = 74) protocols. The maintenance dose was achieved faster with the rush (16.50 weeks) and cluster (19.33 weeks) buildup protocols than the standard (31.09 weeks) protocol (P < .001). There was no statistically significant difference between time to maintenance dosing when comparing the cluster and rush protocols (P = .322). Despite pretreatment with the rush protocol, the rate of systemic reactions was the same for the standard (9.76%), cluster (9.84%), or rush (14.86%) buildup protocols (P = .526).

CONCLUSION

Patients on the cluster buildup protocol for AIT achieved maintenance dosing in a comparable time frame as the rush protocol with a similar rate of systemic reactions and without the need for the pretreatment required with rush immunotherapy.

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

BACKGROUND

In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.

METHODS

ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work.

RESULTS

ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost.

CONCLUSION

The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Subcutaneous Immunotherapy Safety: Incidence per Surveys and Risk Factors

Subcutaneous immunotherapy (SCIT) is effective for allergic rhinitis and conjunctivitis, asthma, and insect venom hypersensitivity. The risk of severe allergic reactions induced by SCIT remains low, and mild systemic reactions have recently shown a tendency to decline. However, near-fatal and fatal anaphylactic reactions may occur. Clinicians administering allergen-specific immunotherapy should receive specialized training and be aware of risk factors and preventive measures to avoid severe allergic reactions induced by SCIT.

The Journal of Allergy and Clinical Immunology: In Practice 2017 Year in Review

An impressive number of clinically impactful studies and reviews were published in The Journal of Allergy and Clinical Immunology: In Practice in 2017. As a service to our readers, the editors provide this Year in Review article to highlight and contextualize the advances published over the past year. We include information from articles on asthma, allergic rhinitis, rhinosinusitis, immunotherapy, atopic dermatitis, contact dermatitis, food allergy, anaphylaxis, drug hypersensitivity, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help readers consolidate and use this extensive and practical knowledge for the benefit of patients.