A modified schedule of multiple aeroallergen ultra-rush immunotherapy in perennial allergic rhinitis: safety, efficacy, and T lymphocyte cell population studies
Main Article Content
Keywords
allergens, allergic rhinitis, immunotherapy, hypersensitivity
Abstract
Background: This study assessed whether a modified immunotherapy schedule for allergic rhinitis could be safe and efficient. Ultra-rush immunotherapy (URIT) rapidly desensitizes patients to aeroallergens.
Objective: We aimed to develop a modified URIT protocol in 3 days to achieve the target dose while observing whether it could improve this situation and decrease the time to achieve the maintenance dose.
Methods: The URIT was exercised in 21 patients with perennial allergic rhinitis. Premeditations were given to the patients 3 days prior to the immunotherapy and during the 3 days injections immunotherapy: pred nisolone, ranitidine, and Airokast/montelukast. Finally, the T cell population frequencies of patients prior to and after immunotherapy, including T helper 1, T helper 2, cytotoxic T lymphocytes, and regulatory T cells, were studied using flow cytometry. During the URIT protocol, 21 patients received 291 injections.
Result: Six patients (28.6%) showed systemic reactions in our study. All systemic reactions occurred on the third day by the 1:1 dilution of the maintenance dose. These systemic reactions occurred in three patients after 13 injections, and the three remaining patients showed systemic reactions following the last injection. No systemic reaction was observed on the first and second day of the therapy, and the risk of systemic reaction with every injection was about 2%. Among the T cell populations, CD3+ and CD8+ cells decreased significantly.
Conclusion: The findings emphasized that URIT, alongside premedication with a high dose of antihistamine, helped to achieve the maintenance dose and control clinical manifestations.
References
2. Long AA. Findings from a 1000-patient internet-based survey assessing the impact of morning symptoms on individuals with allergic rhinitis. Clin Ther. 2007;29(2):342–51. 10.1016/j.clinthera.2007.02.007
3. Meltzer EO, Blaiss MS, Derebery MJ, Mahr TA, Gordon BR, Sheth KK, et al. Burden of allergic rhinitis: Results from the pediatric allergies in America survey. J Allergy Clin Immunol. 2009;124(3):S43–70. 10.1016/j.jaci.2009.05.013
4. Brożek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 Revision. J Allergy Clin Immunol. 2010;126(3):466–76. 10.1016/j.jaci.2010.06.047
5. Kalmarzi RN, Ataee P, Fathollahpour A, Behzadifar M, Moradi M, Sharifian F, et al. The prevalence of allergic rhinitis among iranian children: A systematic review and meta--analysis. Endocr Metab Immune Disord Drug Targets. 2020;20(2):189–97. 10.2174/1871530319666190515100735
6. Eng P, Borer-Reinhold M, Heijnen I, Gnehm H. Twelve-year follow-up after discontinuation of preseasonal grass pollen immunotherapy in childhood. Allergy. 2006;61(2):198–201. 10.1111/j.1398-9995.2006.01011.x
7. Pajno G, Barberio G, De Luca F, Morabito L, Parmiani S. Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study. Clin Exp Allergy. 2001;31(9):1392–7. 10.1046/j.1365-2222.2001.01161.x
8. Hoseini RF, Jabbari F, Rezaee A, Rafatpanah H, Yousefzadeh H, Ariaee N, Sadri H. House dust mite sublingual-swallow immunotherapy in perennial rhinitis: A double-blind, placebo-controlled Iranian study. J Biol Regul Homeost Agents. 2018;32(1):83–8.
9. Padró C, Gutiérrez D, Moreno F, Parra A, Rial MJ, Lleonart R, et al. Effectiveness and safety of a microcrystalline tyrosine-adjuvanted Dermatophagoides pteronyssinus allergoid immunotherapy in adult patients with allergic asthma and rhinitis: A real-life prospective observational study. Immun Inflamm Dis. 2022;10(5):e585. 10.1002/iid3.585
10. Greiwe J, Bernstein JA (Editors). Accelerated/rush allergen immunotherapy. Allergy Asthma Proc. 2022. 10.2500/aap.2022.43.210108
11. Mauro M, Russello M, Alesina R, Sillano V, Alessandrini A, Dama A, et al. Safety and pharmacoeconomics of a cluster administration of mite immunotherapy compared to the traditional one. Eur Ann Allergy Clin Immunol. 2006;38(1):31–4.
12. Van Mason J, Portnoy JM. Accelerated immunotherapy: Why are we going so slow? Curr Treat Options Allergy. 2019;6:396–409. 10.1007/s40521-019-00212-3
13. Weitzer T, Mueller R. The safety of rush immunotherapy in the management of canine atopic dermatitis—230 cases. Vet Dermatol. 2023. 10.1111/vde.13170
14. Brown SG, Wiese MD, Van Eeden P, Stone SF, Chuter CL, Gunner J, et al. Ultrarush versus semirush initiation of insect venom immunotherapy: A randomized controlled trial. J Allergy Clin Immunol. 2012;130(1):162–8. 10.1016/j.jaci.2012.02.022
15. Temiño VM, Wu P, Konig J, Fahrenholz JM (Editors). Safety of multiple aeroallergen rush immunotherapy using a modified schedule. Allergy Asthma Proc. 2013. 10.2500/aap.2013.34.3651
16. Chu CH, Caldwell JW, Cristiano LM, Petrov AA, Traister RS. Safety of a modified environmental rush immunotherapy protocol in the pediatric population. Ann Allergy Asthma Immunol. ,2022;128(5):600–1. 10.1016/j.anai.2021.12.011
17. Nelson HS. Injection immunotherapy for inhalant allergens. In: Middleton’s allergy. Cambridge, MA: Elsevier; 2014, pp. 1416–37. 10.1016/B978-0-323-08593-9.00088-7
18. Smits WL, Giese JK, Letz KL, Inglefield JT, Schlie AR, editors. Safety of rush immunotherapy using a modified schedule: A cumulative experience of 893 patients receiving multiple aeroallergens. Allergy Asthma Proc. 2007. 10.2500/aap.2007.28.2996
19. Cox L, Calderon MA. Subcutaneous specific immunotherapy for seasonal allergic rhinitis: A review of treatment practices in the US and Europe. Curr Med Res Opin. 2010;26(12):2723–33. 10.1185/03007995.2010.528647
20. Cox L. Accelerated immunotherapy schedules: Review of efficacy and safety. Ann Allergy Asthma Immunol. 2006;97(2):126–38. 10.1016/S1081-1206(10)60003-8
21. Cox L, Larenas-Linnemann D, Lockey RF, Passalacqua G. Speaking the same language: The World Allergy Organization subcutaneous immunotherapy systemic reaction grading system. J Allergy Clin Immunol. 2010;125(3):569–74. e7. 10.1016/j.jaci.2009.10.060
22. Harvey SM, Laurie S, Hilton K, Khan DA. Safety of rush immunotherapy to multiple aeroallergens in an adult population. Ann Allergy Asthma Immunol. 2004;92(4):414–9. 10.1016/S1081-1206(10)61776-0
23. Bousquet J, Hejjaoui A, Dhivert H, Clauzel A, Michel F. Immunotherapy with a standardized dermatophagoides pteronyssinus extract: III. Systemic reactions during the rush protocol in patients suffering from asthma. J Allergy Clin Immunol. 1989;83(4):797–802. 10.1016/0091-6749(89)90017-1
24. Nelson HS. The evolution of allergy immunotherapy. Ann Allergy Asthma Immunol. 2021;126(4):357–66. 10.1016/j.anai.2020.11.011
25. Mandola A, Nozawa A, Eiwegger T. Histamine, histamine receptors, and anti-histamines in the context of allergic responses. Lympho Sign J. 2019;6(2):35–51. 10.14785/lymphosign-2018-0016
26. Meghnem D, Oldford SA, Haidl ID, Barrett L, Marshall JS. Histamine receptor 2 blockade selectively impacts B and T cells in healthy subjects. Sci Rep. 2021;11(1):9405. 10.1038/s41598-021-88829-w
27. Oettgen HC. Mast cells in food allergy: Inducing immediate reactions and shaping long-term immunity. J Allergy Clin Immunol. 2022. 10.1016/j.jaci.2022.10.003
28. Dolz I, Martinez-Cocera C, Bartolome J, Cimarra M. A double-blind, placebo-controlled study of immunotherapy with grass-pollen extract Alutard SQ during a 3-year period with initial rush immunotherapy. Allergy. 1996;51(7):489–500. 10.1111/j.1398-9995.1996.tb04655.x
29. Lack G, Nelson HS, Amran D, Oshiba A, Jung T, Bradley KL, et al. Rush immunotherapy results in allergen-specific alterations in lymphocyte function and interferon-γ production in CD4+ T cells. J Allergy Clin Immunol. 1997;99(4):530–8. 10.1016/S0091-6749(97)70081-2
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