Method Of Desensitization Research Articles

Allergy to monoclonal antibodies: cutting-edge desensitization methods for cutting-edge therapies

Monoclonal antibodies are important therapeutic tools, but their usefulness is limited in patients who experience acute infusion reactions, most of which are consistent with type I hypersensitivity reactions including anaphylaxis. Patients who experience acute infusion reactions face the prospect of stopping treatment or switching to an alternative, and potentially more toxic or inferior treatment. Another option that overcomes the treatment hurdle of these reactions is rapid desensitization, a procedure in which the offending agent is re-administered in a step-wise, highly controlled fashion. While the risk of reactions is not completely eliminated, desensitization has proven to be a highly effective re-administration strategy for most patients who otherwise would not be able to tolerate their monoclonal antibody therapy owing to drug-induced anaphylaxis. This article reviews the current literature on desensitization and other readministration protocols to monoclonal antibodies with an emphasis on four agents: rituximab, infliximab, cetuximab and trastuzumab.

In vitro study of the influence of dentin desensitizing and sealing on the shear bond strength of two universal resin cements.

To test whether or not dentin desensitizing or sealing methods influence the bond strength of universal resin cements. The bond strength of two universal resin cements (RelyXUnicem, Self-adhesive Prototype Cement) to human dentin was assessed after different dentin surface treatments (test). A conventional resin cement (Panavia 21) served as control. The influence of the following pretreatment methods was tested and compared to freshly ground dentin: dentin desensitizing by means of glutaraldehyde-containing primers (Gluma Desensitizer, Syntac Primer/Adhesive), or dentin sealing by means of bonding agents (Heliobond, ClearfilSE Bond). Additionally, the influence of provisional cement (Freegenol) was analyzed after its application and subsequent mechanical removal. Bond strength after thermocycling was measured in a shear test (n = 10). Data were analyzed with one-way ANOVA, followed by a post-hoc Tukey test (p < 0.05). Both test cements exhibited significantly lower bond strength to freshly ground dentin than the control cement. The desensitization methods did not affect the bond strength of the test cements. Furthermore, the sealing methods significantly increased the bond strength of both test cements as compared to freshly ground dentin. The application and subsequent removal of the provisional cement only had a minor influence on the bond strength of the test cements. The contamination with provisional cement, however, significantly affected the bond strength of the control cement compared to the values achieved on freshly ground dentin. Desensitization or sealing of dentin have a beneficial effect on the bond strength of universal resin cements. The application of a provisional cement prior to adhesive cementation exhibits no significant influence on the bond strength of the universal resin cements.

A novel, accelerated method of desensitization in a patient with a documented hypersensitivity reaction to clopidogrel

Current standard of care following a percutaneous coronary intervention with stent placement necessitates the use of dual anti-platelet therapy with aspirin and commonly clopidogrel. There is a subset of patients who have a significant clopidogrel allergy and life-threatening hypersensitivity reactions. Desensitization is the process of inducing tolerance to a sensitizing agent via repeated exposure to the agent. There have been previously reported protocols for clopidogrel desensitization. These protocols differ in length and dose escalation and a universally accepted clopidogrel desensitization protocol has yet to be established. We discuss here a novel accelerated approach to clopidogrel desensitization in a patient with a documented hypersensitivity reaction.

New desensitization method for complement-mediated hypersensitivity reactions

New desensitization method for complement-mediated hypersensitivity reactions

Overshadowing: A Silver Lining to a Dark Cloud in Horse Training

Overshadowing is a process known in behavioral science that occurs when two stimuli of different strengths are applied simultaneously to a nonhuman animal. Typically, the stronger stimulus overshadows the weaker one, resulting in attenuation of the weaker stimulus. This phenomenon explains ways in which the decreased responsiveness and consequent conflict behaviors (and possibly learned helplessness and wastage) in some performance horses can result from the application of two concurrent aversive stimuli. Despite some adverse consequences in the context of ridden horses, overshadowing can have serendipitous benefits because it offers an efficient method of desensitization for certain stimuli that are sometimes highly aversive: the saddle/girth pressure, clippers, aerosols, and needles. Desensitization with concurrent overshadowing appears to be comparatively rapid, particularly with highly aversive stimuli, possibly because attentional mechanisms are diverted to the more salient stimulus. It is important to note that, following the overshadowing procedure, the effects appear to be retained when assessed on subsequent days. Using 4 examples, this article presents a preliminary exploration of the beneficial use of a poorly understood, underutilized—yet promising—phenomenon that warrants further investigation.

Origin of EEG biofeedback for remediating misbehavior.

ABSTRACT In the 1960s, behavior therapy techniques were emerging from the laboratory. These techniques were proving successful in changing a variety of behavioral problems. In the area of psychiatric rehabilitation, Quirk learned to apply Mary Cover Jones' method of desensitization to psychotics despite Wolpe's self-reported inability to make Reciprocal Inhibition Therapy (RIT) work with psychotics. Von Hilsheimer suggested that he monitor stress by Galvanic Skin Resistance (GSR) and Quirk developed a library of lanternslides to substitute for verbal statements in the Wolpe hierarchies of stressful stimuli. He automated this method and named it. SCARS (Stimulus Conditioned Autonomic Response Suppression). This method was later used in offender rehabilation with correctional populations. This paper reviews this history. Quirk then applied the same methods and Sterman's EEG biofeedback training (increasing SMR at C-3/C-4) in a pilot study of 40 matched pairs of jailed felons at the Ontario Correctional Institute (OCI) near Toronto, Canada; and in a larger pilot study of 110 matched pairs. From 1970 through 1995 Quirk and von Hilsheimer trained 2776 felons at the OCI by this combined method (temperature, GSR and EEG). 15% were rearrested in the 3 years following release. This compares well to the range of re-arrest in studies summarized by Alter et al (1996)--42 % to 78%. This line of research represents an early beginning to the field of applied behavioral neurology and the work has strong implications for behavior analysts treating offenders today. Keywords: EEG biofeedback, behavior therapy, applied behavioral neurology, desensitization, offender treatment Introduction In the late 1950s, behavior therapy based on operant and respondent conditioning procedures moved out of the laboratory (see Wolpe, 1958) and into the direct treatment of people. Many of the procedures were used to reduce anxiety (e.g., Paul, 1966 or Lang, and Lazovik, 1963). Basic research studies were showing that operant conditioning procedures could be applied without the subject's awareness and could change autonomic responses (Gavalas, 1967). Studies at Harvard Medical showed that operant conditioning could be used through biofeedback technology to change blood flow and blood pressure (Shapiro, Crider, Tursky, 1964; Shapiro & Crider, 1967; Shapiro, Tursky, & Schwartz, 1970; Schwartz, 1973) and studies with post stroke patients, cerebral palsy, spinal injuries showed that biofeedback could restore motor control (Basmajian, 1977; Fernando & Basmajian, 1978; Runck, 1980). This encouraged many in clinical practice to begin to experiment with the idea of directly manipulating brainwave frequencies through operant procedures, which were correlated with behavioral disruption. This research could be seen as the early beginning of work called applied behavioral neuroscience (today referred to as Neurotherapy), as you will see it is a area of research that might be of value to current behavior analysts, especially those working within the prison or criminal justice systems. This paper represents a brief and at times a personal history of this area. INTRODUCTION: ICTAL AND SUBICTAL DYSFUNCTION Two of Quirk's colleagues, North and Breen, liked a method of scoring the Bender-Gestalt published in a book by Hutt. However, the Bender figures weren't really adaptable to the Hutt method. So North and Breen created new figures and called the test the Diagnostic Differential Test (DDT). Quirk took a course in administering the DDT and became expert at its interpretation. One of the neurologists on staff who used Doug as a consultant gave him a list of 10 patients, whose serial EEGs eventually demonstrated epilepsy but who did not have seizures. He was asked what test to use to figure out how to recognize them more reliably than with the EEG. Doug found a file into which he had put the DDT's those individuals' had taken. …

Allergenic characteristics of a modified peanut allergen

Attempts to treat peanut allergy using traditional methods of allergen desensitization are accompanied by a high risk of anaphylaxis. The aim of this study was to determine if modifications to the IgE-binding epitopes of a major peanut allergen would result in a safer immunotherapeutic agent for the treatment of peanut-allergic patients. IgE-binding epitopes on the Ara h 2 allergen were modified, and modified Ara h 2 (mAra h 2) protein was produced. Wild-type (wAra h 2) and mAra h 2 proteins were analyzed for their ability to interact with T-cells, their ability to bind IgE, and their ability to release mediators from a passively sensitized RBL-2H3 cell line. Multiple T-cell epitopes were identified on the major peanut allergen, Ara h 2. Ara h 2 amino acid regions 11-35, 86-125, and 121-155 contained the majority of peptides that interact with T-cells from most patients. The wAra h 2 and mAra h 2 proteins stimulated proliferation of T-cells from peanut-allergic patients to similar levels. In contrast, the mAra h 2 protein exhibited greatly reduced IgE-binding capacity compared to the wild-type allergen. In addition, the modified allergen released significantly lower amounts of beta-hexosaminidase, a marker for IgE-mediated RBL-2H3 degranulation, compared to the wild-type allergen.

Intranasal Lysine‐Aspirin in Aspirin‐Sensitive Nasal Polyposis: A Controlled Trial

Intranasal lysine-aspirin has been used as a method of desensitization in patients with aspirin-sensitive nasal polyps to control their recurrence and prevent frequent surgical intervention. However, the studies are limited in number, and their design is open to criticisms. Thus, we conducted a controlled trial to study the clinical effectiveness of topical lysine-aspirin in patients with aspirin-sensitive nasal polyposis. Prospective, randomized, double blind, placebo controlled, crossover trial. Aspirin-sensitive patients confirmed by intranasal challenge were enrolled and randomized to receive 16 mg of topical lysine-aspirin every 48 hours or placebo for 6 months before crossover. Polyp growth and nasal and chest symptoms were monitored using acoustic rhinometry, nasal inspiratory peak flow, peak expiratory flow rate, and a daily diary of symptom scores. Twenty-two patients were enrolled. After withdrawals and drop outs, data were available on 11 patients for analysis. Multivariate analysis of measured parameters did not reveal a significant clinical benefit to patients receiving topical lysine-aspirin compared with placebo. Deterioration was similar while on lysine-aspirin or placebo. This is the first controlled clinical trial of topical desensitization in aspirin-sensitive nasal polyp patients. Despite the failure to demonstrate clinical benefit, tissue studies have shown a significant improvement at the microscopic level. Further work with larger numbers of patients along with conventional treatment may show a clinical improvement in these patients.

Emotional release technique: A new desensitization method.

Objective - A recent pilot study of the Emotional Release Technique was conducted to determine the effects of this new technique on clients, to decide whether further investigation of this technique is warranted, and, if so, to gain insight into how that research should be structured. Method - Six participants were trained in this new desensitization technique and assessed using a pretest/posttest design. Results - Five sixths of the participants showed improvements on the assessment instrument after 25 minutes of technique use in a group setting. There was also a statistically significant difference between the pretest and posttest scores. Conclusions - The Emotional Release Technique needs further research with more participants to assess its use as a new desensitization technique.

Emotional Release Technique: A New Desensitization Method

Emotional Release Technique: A New Desensitization Method

Insulin allergy; desensitization with crystalline zinc-insulin and steroid tapering

The insulin analogues, aspart and lispro, have been considered safe alternatives for patients with insulin allergy, because of their decreased immunogenicity. However, recent several reports showed that neither of them was completely free from allergic reactions. We also experienced a patient with insulin allergy not only to human regular insulin but also to both of the insulin analogues. Interestingly, the insulin analogues, which readily dissociate from polymer to monomer, induced the most severe allergic reaction among several types of human insulin reagents in the present case. Allergy to crystalline zinc-insulin, the three-dimensional structure of which results in delayed dissociation and absorption, was negative on intradermal tests. However, its large subcutaneous injection caused local allergic reaction. These results suggested that the allergic reaction might depend on the rapidity of insulin monomerization and absorption, and thus that the immunogenic residue of insulin is concealed when insulin is polymerized. Based on the intradermal tests, we speculated that the antigenic epitope might be B30-Thr in the present case. We also report here the modified method of insulin desensitization using crystalline zinc-insulin with prednisolone tapering. This might be a simple and useful treatment for insulin allergy.

A simplified method for rapid intravenous drug desensitization

A simplified method for rapid intravenous drug desensitization

Simple intravenous antimicrobial desensitization method for pediatric patients.

The Notes section welcomes the following types of contributions: (I) practical innovations or solutions to everyday practice problems, (2) substantial updates or elaborations on work previously published by the same authors, (3) important confirmations of research findings previously published by others, and (4) short research reports, including practice surveys, of modest scope or interest. Notes should be submitted with AJHP's manuscript checklist. The text should be concise, and the number of references, tables, and figures should be limited.

Group Therapy—A Useful Treatment Modality for Women Diagnosed With Primary and Secondary Vaginismus

Literature regarding the efficacy of group therapy for treatment of sexual dysfunction is limited. A review of the literature suggests that the milieu of group therapy can provide curative factors. Seven women who were diagnosed with primary vaginismus and/or vaginismus secondary to dyspareunia, and who all had a history of unsuccessful treatments, were invited to participate in a 20-week group therapy experience. For 15 sessions the women met and participated in the therapeutic group process. They disclosed repressed feelings regarding their bodies, perceptions of sex, and the effects on their relationships with their partners. In subsequent sessions, they were taught relaxation, breathing techniques, and desensitization methods. Partners of the women were invited to join the group at the 15th session. Post therapy measures and the group satisfaction survey conducted at the end of the sessions indicated positive changes for the couples. The women reported a significant reduction in pain and sexual anxiet...

Surface desensitization of polarimetric waveguide interferometers

Nonspecific surface binding of small protein molecules presents a major obstacle to surface biosensing techniques attempting to detect very low concentrations (< 1 pg/mm/sup 2/) of large biological objects such as cells and bacteria. A new method for selective desensitization of a polarimetric waveguide interferometer eliminates the background noise from nonspecific surface binding. We demonstrate the ability to tune the phase sensitivity of a waveguide interferometer as a function of the distance of the biological or chemical analyte from the waveguide surface. This makes possible a sensor that has zero sensitivity at a particular distance where nonspecific surface binding occurs without significantly reducing the sensitivity to target larger biological species.

The Dentin Disc surface: a plausible model for dentin physiology and dentin sensitivity evaluation.

Dentin sensitivity (DS) is a painful clinical condition which may affect 8-35% of the population. Various treatment modalities have claimed success in relieving DS, although at present there does not appear to be a universally accepted desensitizing agent. Current opinion based on Brännström's Hydrodynamic Theory would suggest that following exposure of the dentin surface (through attrition, abrasion, or erosion), the presence of open dentinal tubules, patent to the pulp, may be a prerequisite for DS. The concept of tubule occlusion as a method of dentin desensitization, therefore, is a logical conclusion from the hydrodynamic theory. The fact that many of the agents used clinically to desensitize dentin are also effective in reducing dentin permeability tends to support the hydrodynamic theory. This paper reviews the in vitro evaluation of desensitizing agents, the techniques used to characterize their effects on the prepared dentin surface, and the ability of these agents to reduce permeability through tubule occlusion, and presents recent findings from ongoing research based on the Pashley Dentin Disc model. It can be concluded that the use of this model to determine surface characteristics, and reductions in dentin permeability through tubule narrowing or occlusion, provides a useful screening method for evaluating potential desensitizing agents. Interpreting changes observed in vitro is difficult, and extrapolation to the clinical situation must be tempered with caution.

An investigation of potential desensitizing agents in the dentine disc model: a scanning electron microscopy study

Cervical dentine sensitivity (CDS) may be defined as pain arising from exposed dentine. The prefix cervical indicates the location of the sensitivity and/or its subsequent treatment. Currently the most accepted mechanism of intradental nerve activation associated with dentine sensitivity appears to be hydrodynamic in nature. The concept of tubule occlusion as a method of dentine desensitization is a logical conclusion of the hydrodynamic theory. The authors employed the dentine disc model, qualitative scanning electron microscopy (SEM) and X-ray microanalysis to investigate whether selected desensitizing agents occlude dentinal tubule orifices. Strict control procedures have been used together with various methods of application to apply these agents to human dentine discs. SEM was used to examine the degree of deposit left by the various agents on disc surfaces and X-ray microanalysis was employed to characterize the elemental composition of the deposit. Analysis of selected agents, both prior to and after application on dentine discs was performed for comparative purposes. The degree of retention of the surface deposit upon rotation with saliva supernatant for 6 h was also studied. The results of this study indicated that ferric oxalate, the active ingredient of Sensodyne Sealant, which produced initial crystal-like structures, occluding almost all the tubule orifices was superior to potassium oxalate (Butler Protect). Of the over-the-counter (OTC) desensitizing products tested, both silica- and calcium-based abrasive components were observed both on the surface and within the tubules, indicating a certain degree of therapeutic potential for these two components. These findings suggest that certain desensitizing agents have tubule occluding properties as observed in this in vitro system which, in turn, may indicate a therapeutic potential in vivo.

Prelininary Study on the New Desensitization Method with the &quot;Sense of Melting Experience&quot;

Prelininary Study on the New Desensitization Method with the &quot;Sense of Melting Experience&quot;

Rebt: A sign of evolution or devolution? An historical perspective

The first time the terms "behavior therapy" and "behavior therapist" appeared in the scientific literature was when I argued that changes in a client's behavior are paramount, and are not secondary to the resolution of putative unconscious complexes within the psyche (Lazarus, 1958). This was a rallying point against the dominant discipline of that era--psychoanalysis. At that juncture, Ellis (1957, 1958) was propounding the virtues of rational psychotherapy (RT). Subsequently, his seminal book Reason and Emotion in Psychotherapy (Ellis, 1962) underscored the significance of the affective domain, and "rationalemotive therapy" (RET) was properly launched. Thereafter, voluminous writings on RET spelled out the need to apply various cognitive, emotive and behavioral methods, although its main emphasis was on the active-directive disputing of irrational beliefs. Meanwhile, behavior therapy was travelling on a somewhat related but rather different track. Its emphasis was mainly on precise studies into the specific effects of relaxation training and various desensitization methods (imaginal and in vivo), assertiveness and social skills training, habit reversal techniques, aversive and avoidance conditioning, and the systematic implementation of positive and negative reinforcement schedules. Cognitive factors, however, were given short shrift. For example, Wolpe, (1958), under "Subsidiary Methods" devoted only three short paragraphs to "Correcting Misconceptions" and stressed that "changing meanings does not constitute an example of fundamental psychotherapy" (pp. 199-200). When I published Behavior Therapy and Beyond (Lazarus, 1971)arguably the first book on Cognitive-behavior therapymand devoted an entire chapter to "cognitive restructuring" (including Ellis's A-B-C

Rapid Oral Desensitization to Trimethoprim-Sulfamethoxazole (TMP-SMZ): Use in Prophylaxis for Pneumocystis carinii Pneumonia in Patients with AIDS Who Were Previously Intolerant to TMP-SMZ

Trimethoprim-sulfamethoxazole (TMP-SMZ) is the drug of choice as prophylaxis for Pneumocystis carinii pneumonia in patients with AIDS. However, adverse reactions ascribed to TMP-SMZ are common in such patients. We previously described a rapid method of oral TMP-SMZ desensitization in patients with AIDS and varying degrees of intolerance to the drug. To assess the feasibility, safety, and long-term clinical utility of our desensitization protocol, we retrospectively studied 22 consecutive patients who underwent desensitization. Prior to the procedure each of the study subjects had exhibited moderate to severe reactions to TMP-SMZ. Desensitization was successfully completed in 19 (86%) of the patients. The three patients for whom desensitization failed experienced chills and/or vomiting that resolved promptly with symptomatic therapy. One of the 19 patients was unavailable for long-term follow-up. Of the remaining 18 patients, three discontinued taking TMP-SMZ within 2 weeks of desensitization because of macular rash and fever. The other 15 (71%) of the evaluable patients tolerated both desensitization and subsequent prophylaxis and took TMP-SMZ for a mean of 14 months (in some cases, for as long as 41 months). None had P. carinii pneumonia while receiving TMP-SMZ. These results indicate that most patients who are presumed to be TMP-SMZ-intolerant can be rapidly desensitized with oral TMP-SMZ and subsequently receive the drug for protracted periods as effective prophylaxis for P. carinii pneumonia.