Immunotherapy Safety for the Primary Care ... - U.S. Coast Guard

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Allergen immunotherapy: A practice parameter second update Supplement Editor: Linda Cox, MD Co-editors: James T. Li, MD, Harold Nelson, MD, and Richard Lockey, MD These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology. The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing the ‘‘Allergen immunotherapy: a practice parameter second update.’’ This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice Disclosure of potential conflict of interest: L. Cox has consulting arrangements with Allergy Therapeutics, Genentech/Novartis, and Greer Laboratories and is on the speakers’ bureau for Genentech/Novartis, GlaxoSmithKline, and AstraZeneca. R. Lockey has received grant support from Greer Laboratories; served as chairman of an advisory committee for ALK-Abelló for over 7 years; and has served as an expert witness for allergen immunotherapy death for both plaintiff and defendant. H. Nelson has consulting arrangements with Genentech/Novartis, Curalogic, GlaxoSmithKline, Inflazyme Pharmaceuticals, Dey Laboratories, Dynavax Technologies, Altana, and Schering-Plough; has received grant support from Dey Laboratories, IVAX, MediciNova, Wyeth, Sepracor, Genentech, Schering-Plough, Novartis, AstraZeneca, SkyPharma, Altana, and Roche; and is on the speakers’ bureau for GlaxoSmithKline and AstraZeneca. D. Bernstein has consulting arrangements with ALK-Abelló and has received grant support from Dynavax and ALK-Abelló. J. Blessing-Moore has received grant support from Novartis-Genentech and AstraZeneca and is on the speakers’ bureau for Schering-Plough, Merck, Aventis, Novartis/Genentech, AstraZeneca. D. M. Lang has consulting arrangements with, has received grant support from, and is on the speakers’ bureau for GlaxoSmithKline, Merck, Astra- Zeneca, Centocor, Sanofi-Aventis, Schering-Plough, Verus, and Dey. J. Oppenheimer has consulting arrangements with GlaxoSmithKline, Astra- Zeneca, Sepracor, and Merck; has received grant support from AstraZeneca, Sepracor, and Merck, Boehringer Ingelheim, Novartis/Genentech, and Schering-Plough; and is on the speakers’ bureau for GlaxoSmithKline, AstraZeneca, Sepracor, and Merck. J. M. Portnoy has consulting arrangements with Greer and GlaxoSmithKline; has received grant support from Clorox; and is on the speakers’ bureau for Schering-Plough, Merck, Aventis, Secpracor, and AstraZeneca. S. A. Tilles has consulting arrangements with Genentech, Schering-Plough, and GlaxoSmithKline; has received grant support from AstraZeneca, Novartis, Medpoint, Apieron, and ALK-Abelló; and is on the speakers’ bureau for GlaxoSmithKline, Pfizer, Genentech, and Alcon. The rest of the authors have declared that they have no conflict of interest. Reprint requests: Joint Council of Allergy, Asthma and Immunology, 50 N Brockway St, #3-3, Palatine, IL 60067. J Allergy Clin Immunol 2007;120:S25-85. 0091-6749/$32.00 Ó 2007 American Academy of Allergy, Asthma & Immunology doi:10.1016/j.jaci.2007.06.019 parameters by the AAAAI or the ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Published practice parameters of the Joint Task Force on Practice Parameters for Allergy and Immunology include the following: 1. Practice parameters for the diagnosis and treatment of asthma. J Allergy Clin Immunol 1995;96(suppl): S707-S870. 2. Practice parameters for allergy diagnostic testing. Ann Allergy 1995;75:543-625. 3. Practice parameters for the diagnosis and management of immunodeficiency. Ann Allergy 1996;76:282-94. 4. Practice parameters for allergen immunotherapy. J Allergy Clin Immunol 1996;98:1001-11. 5. Disease management of atopic dermatitis: a practice parameter. Ann Allergy 1997;79:197-211. 6. The diagnosis and management of anaphylaxis. J Allergy Clin Immunol 1998;101(suppl):S465-S528. 7. Algorithm for the diagnosis and management of asthma: a practice parameter update. Ann Allergy 1998;81:415-20. 8. Diagnosis and management of rhinitis: parameter documents of the Joint Task Force on Practice parameters in Allergy, Asthma and Immunology. Ann Allergy 1998;81(suppl):S463-S518. 9. Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunol 1998;102(suppl): S107-S144. 10. Stinging insect hypersensitivity: a practice parameter. J Allergy Clin Immunol 1999;103:963-80. 11. Disease management of drug hypersensitivity: a practice parameter. Ann Allergy 1999;83(suppl): S665–S700. 12. Diagnosis and management of urticaria: a practice parameter. Ann Allergy 2000;85(suppl):S521-S544. 13. Allergen immunotherapy: a practice parameter. Ann Allergy 2003;90(suppl):SI-S540. 14. Symptom severity assessment of allergic rhinitis: part I. Ann Allergy 2003;91:105-14. 15. Disease management of atopic dermatitis: an updated practice parameter. Ann Allergy 2004;93(suppl): S1-S21. 16. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol 2004;114:869-86. 17. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol 2005;115(suppl):S483-S523. S25
S26 Cox et al J ALLERGY CLIN IMMUNOL SEPTEMBER 2007 18. Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy 2005; 94(suppl):S1-S63. 19. Attaining optimal asthma control: a practice parameter. J Allergy Clin Immunol 2005;116(suppl):S3-S11. 20. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 2005; 116(suppl):S13-S47. 21. Food allergy: a practice parameter. Ann Allergy Asthma Immunol 2006;96(suppl 2):S1-S68. 22. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol 2006;97(suppl 2):S1-S38. These parameters are also available on the internet at http://www.jcaai.org. CONTRIBUTORS The Joint Task Force has made a concerted effort to acknowledge all contributors to this parameter. If any contributors have been excluded inadvertently, the Task Force will ensure that appropriate recognition of such contributions is made subsequently. The Joint Task Force gratefully acknowledges the American Academy of Allergy, Asthma and Immunology Board of Directors and the American College of Allergy, Asthma and Immunology Board of Regents for their review and support of this document. SUPPLEMENT EDITOR Linda Cox, MD Department of Medicine Nova Southeastern University College of Osteopathic Medicine Davie, Fla CO-EDITORS James T. Li, MD, PhD Division of Allergic Diseases Mayo Clinic Rochester, Minn Richard Lockey, MD Departments of Medicine, Pediatrics, and Public Health Division of Allergy and Immunology University of South Florida College of Medicine James A. Haley Veterans’ Hospital Tampa, Fla Harold Nelson, MD Department of Medicine National Jewish Medical and Research Center Denver, Colo JOINT TASK FORCE REVIEWERS David Bernstein, MD Department of Medicine and Environmental Health University of Cincinnati College of Medicine Cincinnati, Ohio I. Leonard Bernstein, MD Departments of Medicine and Environmental Health University of Cincinnati College of Medicine Cincinnati, Ohio David A. Khan, MD Department of Internal Medicine University of Texas Southwestern Medical Center Dallas, Tex Joann Blessing-Moore, MD Departments of Medicine and Pediatrics Stanford University Medical Center Department of Immunology Palo Alto, Calif David M. Lang, MD Allergy/Immunology Section Division of Medicine Allergy and Immunology Fellowship Training Program Cleveland Clinic Foundation Cleveland, Ohio Richard A. Nicklas, MD Department of Medicine George Washington Medical Center Washington, DC John Oppenheimer, MD Department of Internal Medicine New Jersey Medical School Pulmonary and Allergy Associates Morristown, NJ Jay M. Portnoy, MD Section of Allergy, Asthma & Immunology The Children’s Mercy Hospital Department of Pediatrics University of Missouri-Kansas City School of Medicine Kansas City, Mo Diane E. Schuller, MD Department of Pediatrics Pennsylvania State University Milton S. Hershey Medical College Hershey, Pa Sheldon L. Spector, MD Department of Medicine UCLA School of Medicine Los Angeles, Calif Stephen A. Tilles, MD Department of Medicine University of Washington School of Medicine Redmond, Wash Dana V. Wallace, MD Nova Southeastern University Davie, Fla INVITED REVIEWERS Don Aaronson, MD, Chicago, Ill David Golden, MD, Baltimore, Md Moises Calderon, MD, London, United Kingdom (UK)
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Immunotherapy Safety for the Primar
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Welcome to “Immunotherapy Safety
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Click the ⌧ next to the topic to
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Immunotherapy at Remote Sites Stand
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What Immunotherapy Is Not • Not p
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How Does Immunotherapy Work? • De
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Who Benefits? •Those with… - Al
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Immunotherapy Efficacy • Effectiv
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Not Efficacious For… • Atopic d
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The Extracts/Vaccines • Bioequiva
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Lots of Numbers! Vial v/v W/V (exam
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Immunotherapy Phases • Maintenanc
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Reaction Prevention - Avoidance •
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Reaction Therapy - BLS+ Level • T
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Treatment Guidelines • Treatment
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Frequency of Systemic Reactions •
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Immunotherapy Safety • To lessen
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Immunotherapy Safety • To lessen
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Immunotherapy Safety • After Inje
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Immunotherapy Safety • Equipment:
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What To Expect (Demand) from the Al
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Summary • Risk factors for advers
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End of Selection Go to Bookmarks &
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• Allergen immunotherapy (allergy
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J ALLERGY CLIN IMMUNOL VOLUME 120,
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15. A 12 yo male presents for his a
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Site Under Construction
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Introduction • “Anaphylaxis”
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Revised Nomenclature For Anaphylaxi
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Anaphylaxis* Is Not Rare Estimated
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Pathophysiology
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Pathophysiology
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Pathophysiology • Histamine acts
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IgE Mediated Reactions • Most Ant
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Complement-mediated • C5a, C3a, C
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Unknown Mechanisms • Exercise-ind
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Anaphylaxis Summary of Signs & Symp
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Differential Diagnosis • Pulmonar
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Anaphylaxis Grading Scale II • An
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Laboratory Studies • IgE antibodi
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Guidelines for Treatment • Treatm
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Guidelines for Treatment • Treatm
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How the Allergist/Immunologist Can
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Summary • Anaphylaxis: release of
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ANAPHYLAXIS • First reported case
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4) Hymenoptera stings Although almo
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• Sulfites are added to all the b
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mastocytosis on bone marrow biopsy.
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Antihistamines H1 antihistamines (B
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The diagnosis and management of ana
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c. The patient will be counseled co
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skin testing typically is performed
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TABLE 3 Required Information on Vac
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TABLE 6 Checklist for Safe Vaccine
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Strength of Recommendations Key cli
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Original articles Evaluation of nea
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Allergy Treatment Record Review Cha
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References Acknowledgment: Linda Co
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Immunotherapy Safety for the Primary Care ... - U.S. Coast Guard

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