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Accelerated Immunotherapy: Why Are We Going So Slow?

Abstract

Purpose of review

Accelerated schedules for administering subcutaneous aeroallergen immunotherapy have the potential to provide convenience, reduce the cost, and improve compliance over conventional (weekly) schedules. In this review, we describe studies of cluster and rush immunotherapy (RIT), the risk of systemic allergic reactions (SARs) for various schedules, and methods to reduce that risk.

Recent findings

Cluster schedules are associated with a slightly increased risk of a SAR that can be reduced by taking an H1 antihistamine on the day of injections. The risk of a SAR can also be reduced with depo extracts, fewer injections per cluster, and administration of fewer than 3 clusters per week. RIT is associated with a 27 to 38% risk of a SAR that can be reduced with administration of corticosteroids, an H1 and H2 antihistamine and possibly a leukotriene blocker for 3 days prior to the procedure and by stopping at a lower dose. Reactions tend to occur 1–2 h after the last injection on the day of RIT, and there is an increased risk of a reaction if subsequent weekly doses are missed.

Summary

Accelerated immunotherapy schedules can offer benefits over weekly schedules; however, the increased risk of a SAR needs to be considered when deciding to recommend such a schedule.

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References and Recommended Reading

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Correspondence to Jay M. Portnoy MD.

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Jessica Van Mason declares that she has no conflict of interest.

Jay M. Portnoy declares that he has no conflict of interest.

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Key points

• Cluster schedules are associated with a slightly increased risk of a SAR that can be reduced by taking an H1 antihistamine on the day of injections

• RIT is associated with a 27 to 38% risk of a SAR

• The risk of a SAR can be reduced with administration of corticosteroids, an H1 and H2 antihistamine and possibly a leukotriene blocker for 3 days prior to RIT

• Reactions during RIT tend to occur 1–2 h after the last injection so patients should be observed for that amount of time

This article is part of the Topical Collection on Specific Immunotherapy

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Van Mason, J., Portnoy, J.M. Accelerated Immunotherapy: Why Are We Going So Slow?. Curr Treat Options Allergy 6, 396–409 (2019). https://doi.org/10.1007/s40521-019-00212-3

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Keywords

  • Desensitization
  • Rush immunotherapy
  • Cluster immunotherapy
  • Premedication