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

J ALLERGY CLIN IMMUNOL
VOLUME 120, NUMBER 3
Cox et al S67
T H 1 rather than T H 2 phenotypes. 343 The results of clinical
trials with a conjugate of the immunostimulatory sequence
to the major allergen of ragweed, Amb a 1 (AIC), have
been reported. 34,343 In a double-blind, placebo-controlled
study of 25 adults who received 6 weekly injections of the
AIC or placebo vaccine before ragweed season, the AIC
group had better peak-season rhinitis scores on the visual
analog scale (P 5 .006), peak-season daily nasal symptom
diary scores (P 5 .02), and midseason overall quality-oflife
scores (P 5 .05) than the placebo group during the first
ragweed season, and this effect was observed in the subsequent
ragweed season. 344
Humanized anti-IgE mAb has been shown to have
clinical effects in both allergic rhinitis and asthma. 345-348
Theoretically, this new therapeutic modality could be
used as protective cover for clinical applications of rapid
forms of immunotherapy. It is possible that preadministration
of anti-IgE could provide a more effective protective
effect than premedication with antihistamines and therefore
permit a rush allergen immunotherapeutic regimen
with reduced risk of serious systemic reactions. 282
AUTHOR’S NOTE
Examples of allergen immunotherapy prescription and
administration forms, immunotherapy labels, conventional
and cluster build-up schedules, immunotherapy
dose adjustments for unscheduled gaps in allergen immunotherapy
injection intervals, summaries of documentation
guidelines, systemic reaction reporting sheets, and 2
systemic reaction grading systems (the European
Academy of Allergy and Clinical Immunology’s grading
of severity for systemic side effects and the Portnoy
method for numeric grading of reactions to allergen
immunotherapy) can be found in the Appendix section.
These forms can also be found along with examples of
immunotherapy instruction and consent forms, preinjection
health questionnaires, and indications for beginning
and continuing immunotherapy forms at www.aaaai.org.
REFERENCES
1. American College of Medical Quality’s policy on development and use
of practice parameters for medical quality decision-making. Available
at: http://www.acmq.orq/profess/PDFs/policy5.pdf. Accessed September
26, 2006.
2. American Academy of Allergy, Asthma and Immunology, American
College of Allergy, Asthma and Immunology. Allergen immunotherapy:
a practice parameter. Ann Allergy Asthma Immunol 2003;
90(suppl 1):1-40.
3. Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Clinical guidelines:
developing guidelines. BMJ 1999;318:593-6.
4. Aaronson DW, Gandhi TK. Incorrect allergy injections: allergists’ experiences
and recommendations for prevention. J Allergy Clin Immunol
2004;113:1117-21. III
5. Joint Commission National Patient Safety Goals. Available at: http://
www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/.
Accessed December 26, 2006.
6. Niggemann B, Jacobsen L, Dreborg S, Ferdousi HA, Halken S, Host A,
et al. Five-year follow-up on the PAT study: specific immunotherapy
and long-term prevention of asthma in children. 2006:855-9. III
7. Polosa R, Li Gotti F, Mangano G, et al. Effect of immunotherapy on
asthma progression, BHR and sputum eosinophils in allergic rhinitis.
Allergy 2004;59:1224-8. III
8. Polosa R, Al-Delaimy WK, Russo C, Piccillo G, Sarva M. Greater risk
of incident asthma cases in adults with allergic rhinitis and effect of allergen
immunotherapy: a retrospective cohort study. Respir Res 2005;
6:153. III
9. Moller C, Dreborg S, Ferdousi HA, et al. Pollen immunotherapy reduces
the development of asthma in children with seasonal rhinoconjunctivitis
(the PAT-study). J Allergy Clin Immunol 2002;109:251-6.
Ib
10. Williams PB, Ahlstedt S, Barnes JH, Soderstrom L, Portnoy J. Are our
impressions of allergy test performances correct? Ann Allergy Asthma
Immunol 2003;91:26-33.
11. Sampson HA, Munoz-Furlong A, Bock SA, et al. Symposium on the
definition and management of anaphylaxis: summary report. J Allergy
Clin Immunol 2005;115:584-91.
12. The diagnosis and management of anaphylaxis: an updated practice
parameter. J Allergy Clin Immunol 2005;115(suppl 2):S483-523.
13. Durham SR, Walker SM, Varga EM, et al. Long-term clinical efficacy
of grass-pollen immunotherapy. N Engl J Med 1999;341:468-75. Ib
14. Des Roches A, Paradis L, Knani J, et al. Immunotherapy with a standardized
Dermatophagoides pteronyssinus extract. V. Duration of the efficacy
of immunotherapy after its cessation. Allergy 1996;51:430-3. III
15. Kao N. Terminology used for allergen immunotherapy. Ann Allergy
Asthma Immunol 2000;84:273-4.
16. Alvarez-Cuesta E, Bousquet J, Canonica GW, Durham SR, Malling HJ,
Valovirta E. Standards for practical allergen-specific immunotherapy.
Allergy 2006;61(suppl 82):1-20.
17. Allergen immunotherapy: therapeutic vaccines for allergic diseases.
Geneva: January 27-29 1997. Allergy 1998;53(suppl):1-42.
18. Nicklas RA, Bernstein IL, Blessing-Moore J, et al. Practice parameters
for allergen immunotherapy. J Allergy Clin Immunol 1996;98:1001-11.
19. Noon L. Prophylactic inoculation against hay fever. Lancet 1911;1:
1572-3.
20. Freeman J. Further observations of the treatment of hay fever by hypodermic
inoculations of pollen vaccine. Lancet 1911;2:814-7.
21. Freeman J. ‘‘Rush Inoculation,’’ with special reference to hay fever
treatment. Lancet 1930;1:744-7.
22. Ewbank PA, Murray J, Sanders K, Curran-Everett D, Dreskin S, Nelson
HS. A double-blind, placebo-controlled immunotherapy dose-response
study with standardized cat extract. J Allergy Clin Immunol 2003;111:
155-61. Ib
23. Creticos PS, Van Metre TE, Mardiney MR, Rosenberg GL, Norman
PS, Adkinson NF Jr. Dose response of IgE and IgG antibodies
during ragweed immunotherapy. J Allergy Clin Immunol 1984;73:
94-104. Ib
24. Frew AJ, Powell RJ, Corrigan CJ, Durham SR. Efficacy and safety of
specific immunotherapy with SQ allergen extract in treatment-resistant
seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006;117:
319-25. Ib
25. Lent AM, Harbeck R, Strand M, et al. Immunologic response to administration
of standardized dog allergen extract at differing doses. J Allergy
Clin Immunol 2006;118:1249-56.
26. Nanda A, O’Connor M, Anand M, et al. Dose dependence and time
course of the immunologic response to administration of standardized
cat allergen extract. J Allergy Clin Immunol 2004;114:1339-44. Ib
27. Van Metre TE, Adkinson NF, Amodio FJ, et al. A comparative study of
the effectiveness of the Rinkel method and the current standard method
of immunotherapy for ragweed pollen hay fever. J Allergy Clin Immunol
1980;66:500-13. III
28. Van Metre TE, Adkinson NF, Lichtenstein LM, et al. A controlled
study of the effectiveness of the Rinkel method of immunotherapy
for ragweed pollen hay fever. J Allergy Clin Immunol 1980;65:
288-97. III
29. Till SJ, Durham SR. Immunological responses to allergen immunotherapy.
Clin Allergy Immunol 2004;18:85-104.
30. Till SJ, Francis JN, Nouri-Aria K, Durham SR. Mechanisms of immunotherapy.
J Allergy Clin Immunol 2004;113:1025-35.
31. Durham SR, Ying S, Varney VA, et al. Grass pollen immunotherapy
inhibits allergen-induced infiltration of CD41 T lymphocytes and eosinophils
in the nasal mucosa and increases the number of cells