(1) An Office Based, One Day Rush Immunotherapy (1DRIT) Protocol for Pollens and Environmental Aeroallergens in Children

Abstract

RATIONALE: The administered dose determines the efficacy of immunotherapy (IT). IT reaction risk is dose related. Previous studies of rush IT have used different target doses. Practitioners often limit the IT dose in children. We reviewed our experience with 1DRIT in children under 12 years.METHODS: A retrospective chart review of children under 12 who underwent 1DRIT for pollens and environmental allergens.RESULTS: 155 children, 3.4 to 12 years were treated with 1DRIT with a target maintenance dose of 0.2-0.4 ml of a 1:10 dilution of aeroallergen extract mixtures (Mixtures of standardized and non-standardized aeroallergens, designated 1:1 concentration per AAAAI Allergen I.T. Practice Parameter Guidelines). 85% had asthma. All patients were pre-treated for three days with oral corticosteroids, H1 and H2 blockers and monteleukast. 20% received one extract and 80% received two extracts. 88% received at least 0.2 ml of the 1:10 concentration vials, representing a 1 log dilution of the target maintenance dose. Allergic reactions occurred in 33% of patients. 45% of reactions were treated with antihistamine alone; 49% required epinephrine and 31% aerosol bronchodilator. No patient required IV medications or hospital admission.CONCLUSIONS: RIT may be administered to pediatric patients in a private practice setting. Although the reaction rate was 33%, reactions were easily managed. 1DRIT is a reasonable and safe approach for appropriately selected pediatric patients. RATIONALE: The administered dose determines the efficacy of immunotherapy (IT). IT reaction risk is dose related. Previous studies of rush IT have used different target doses. Practitioners often limit the IT dose in children. We reviewed our experience with 1DRIT in children under 12 years. METHODS: A retrospective chart review of children under 12 who underwent 1DRIT for pollens and environmental allergens. RESULTS: 155 children, 3.4 to 12 years were treated with 1DRIT with a target maintenance dose of 0.2-0.4 ml of a 1:10 dilution of aeroallergen extract mixtures (Mixtures of standardized and non-standardized aeroallergens, designated 1:1 concentration per AAAAI Allergen I.T. Practice Parameter Guidelines). 85% had asthma. All patients were pre-treated for three days with oral corticosteroids, H1 and H2 blockers and monteleukast. 20% received one extract and 80% received two extracts. 88% received at least 0.2 ml of the 1:10 concentration vials, representing a 1 log dilution of the target maintenance dose. Allergic reactions occurred in 33% of patients. 45% of reactions were treated with antihistamine alone; 49% required epinephrine and 31% aerosol bronchodilator. No patient required IV medications or hospital admission. CONCLUSIONS: RIT may be administered to pediatric patients in a private practice setting. Although the reaction rate was 33%, reactions were easily managed. 1DRIT is a reasonable and safe approach for appropriately selected pediatric patients.