Clinical experience with specific immunotherapy to horse dander.

OBJECTIVE: This open clinical study was designed to investigate the occurrence of adverse reactions of specific immunotherapy (SIT) with horse dander and to recognize signs of efficacy regarding horse-induced cutaneous and respiratory symptoms. METHODS: Twenty-four patients attending our Outpatient Clinic in Huelva (Spain) with horse-induced allergy were selected for receiving a standardized extract of horse dander (Alutard SQ). RESULTS: Local and systemic reactions (five adverse reactions in four patients) were observed during the induction phase of treatment when administering the doses with the highest allergen concentration. Systemic side effects were mild, one immediate case consisting of wheezing and prompt response to treatment and one mild conjunctival hyperemia. Doses were reduced in all cases, and good tolerance to SIT was maintained. The sensitivity of patients to horse dander as assessed by deliberate natural exposure to horse decreased significantly when patients reached maintenance dose: Conjunctivitis symptoms were reduced in all patients, rhinitic symptoms in 93%, asthmatic symptoms in 90%, and cutaneous symptoms in 87% of the patients. Subjective assessment of a patient's allergic disease on a visual analog scale (VAS) showed an improvement. Ninety-five percent of the patients were highly satisfied with the treatment (efficacy, suitability, and troubles). CONCLUSION: Specific immunotherapy with standardized horse-allergen extract is a safe treatment with the doses of allergen extract administered in the present study. In addition, it seems to have beneficial effects in patients with moderate-severe rhinoconjunctivitis and/or asthma.

Safety evaluation of rapid build-up schedules with IR-standardized allergen extracts for subcutaneous immunotherapy of allergic respiratory diseases.

INTRODUCTION: The conventional schedule used in specific subcutaneous immunotherapy (SCIT) is a slow treatment that often leads to poor compliance or discontinuation of treatment. These disadvantages have led to design administration schedules that shorten the build-up phase without increasing the adverse reactions rate. AREAS COVERED: This report reviews the available scientific documentation of the safety profile of build-up schedules for SCIT with Alustal Rapid® (a suspension of standardized allergen extracts adsorbed on aluminum hydroxide gel for specific immunotherapy) in the treatment of IgE-mediated rhinitis, conjunctivitis and bronchial asthma to inhaled allergens. EXPERT OPINION: Cluster and shortened conventional schedules may offer a safe method of SCIT for the treatment of respiratory allergy and reduce the inconvenience associated with conventional schedules by reaching the maintenance dose in less time and with fewer visits; thereby this method could reduce discontinuation rates and increase compliance.

Systemic tolerability of specific subcutaneous immunotherapy with index-of-reactivity-standardized allergen extracts administered using clustered regimens: a retrospective, observational, multicenter study.

BACKGROUND: Subcutaneous immunotherapy is an etiological therapy for certain IgE-mediated diseases. It is usually administered in 2 phases: induction and maintenance. Administration in clustered schedules during the induction phase may be a valid alternative to reach the maintenance dose early if the treatment is well tolerated. OBJECTIVES: To compare the tolerability of different clustered schedules in subcutaneous immunotherapy with standardized allergen extracts administered and to identify factors associated with increased risk of systemic reactions (SRs). METHODS: Retrospective, observational, multicenter study in patients with allergic respiratory disease. RESULTS: Data from 1,147 patients were collected. Thirty-nine patients (3.4%) experienced 42 SRs (0.6% of doses). According to the European Academy of Allergy and Clinical Immunology SR grading system, there were 7 grade 0 reactions (16.7%), 26 grade 1 reactions (61.9%), 8 grade 2 reactions (19.0%), and 1 grade 3 reaction (2.4%). There were no grade 4 SRs (anaphylactic shock). We observed a higher risk of SRs in patients who received an initial dose higher than 0.3 index of reactivity (IR); only 2 reactions occurred after administration of the initial dose of the regimen, both with 0.4 IR. The remainder appeared in subsequent injections, although never with a dose lower than 0.35 IR. CONCLUSIONS: Clustered regimens with IR-standardized extracts are an alternative to classic immunotherapy thanks to their low incidence of SRs compared with other rapid regimens during the induction phase. The ideal clustered regimen should start at an initial dose no greater than 0.35 IR to minimize the incidence of SRs.