Is immunotherapy safe for treatment of severe asthma.

Purpose Of Review: The benefits of allergen immunotherapy (AIT), including subcutaneous allergen immunotherapy (SCIT) and sublingual allergen immunotherapy (SLIT), for IgE-mediated asthma are well established, especially for dust mite. This review will explore whether the benefits of AIT outweigh the risks in severe asthmatic patients.

Recent Findings: Studies have mostly included mild and moderate asthmatic patients, but at least a few studies do show improvements in asthma symptoms and medication use in severe asthmatic patients.

American Academy of Asthma, Allergy & Immunology membership experience with venom immunotherapy in chronic medical conditions and pregnancy, and in young children.

Background: Few data exist regarding the use of venom immunotherapy (VIT) in specific high-risk chronic medical conditions and pregnancy, and in young children.

Methods: A Web-based survey was sent to American Academy of Asthma Allergy & Immunology members to explore their VIT experience in potential high-risk medical conditions and pregnancy, and in young children. Major problems were defined as "activation of underlying disease and/or VIT not well tolerated (systemic adverse events) and/or VIT discontinued for medical reasons.

American Academy of Allergy, Asthma & Immunology membership experience with allergen immunotherapy safety in patients with specific medical conditions.

Background: Little data in the literature exist concerning patients with certain underlying medical conditions who receive allergen subcutaneous immunotherapy (SCIT).

Objective: To survey allergists' experience with SCIT in patients with medical conditions considered to impose an elevated risk for untoward outcomes.

Methods: A Web-based survey was conducted among members of the American Academy of Allergy, Asthma & Immunology to query about their experience with SCIT in patients with certain medical conditions.

Accelerated immunotherapy schedules.

Rush and cluster immunotherapy schedules are accelerated immunotherapy build-up schedules. A cluster immunotherapy schedule involves the patient receiving several allergen injections (generally 2-4) sequentially in a single day of treatment on nonconsecutive days. The maintenance dose is generally reached in 4-8 weeks.

Accelerated immunotherapy schedules and premedication.

Subcutaneous immunotherapy is divided into a buildup and a maintenance phase. Accelerated immunotherapy has the advantage of a reduced number of office visits. Rush and cluster immunotherapy schedules are the most common accelerated schedules used in the United States.

The REPEAT study: recognizing and evaluating periodic local reactions in allergen immunotherapy and associated systemic reactions.

Background: prior studies have demonstrated that large local reactions (LLRs) to subcutaneous immunotherapy do not predict systemic reactions (SRs). However, a recent study demonstrated an increase in LLRs among systemic reactors in practices using routine local reaction dose adjustments.

Objective: to investigate the association between LLRs and SRs within a practice that does not dose adjust for LLRs.

Assessing the safety of subcutaneous immunotherapy dose adjustments.

Background: Subcutaneous immunotherapy injections are often dose adjusted owing to late injections, for newly mixed vials after refills, or after systemic reactions (SRs) to reduce the subsequent SR risk. This practice is not strongly evidence based.

Objectives: To analyze the safety of the Wilford Hall Medical Center dose-adjustment schedule.

Local production of IgE in the respiratory mucosa and the concept of entopy: does allergy exist in nonallergic rhinitis?

Objective: To review research regarding locally produced IgE and its impact on patients with chronic rhinitis.

Data Sources: PubMed search with the following keywords: entopy, local IgE, nonallergic rhinitis, idiopathic rhinitis, vasomotor rhinitis, and allergic rhinitis.

Study Selection: Articles were selected based on their relevance to entopy and locally produced IgE and its clinical effect and relationship to idiopathic rhinitis (IR).

Imported fire ant field reaction and immunotherapy safety characteristics: the IFACS study.

Background: Imported fire ants (IFAs) are endemic in the southeastern United States, including Texas; can sting multiple times; and are a well-known cause of anaphylaxis. There are few data available on how many stings typically lead to systemic reactions (SRs). Likewise, there are no reports currently in the literature that characterize the safety of IFA subcutaneous immunotherapy (SCIT).

Comparison of serum-specific IgE (ImmunoCAP) and skin-prick test results for 53 inhalant allergens in patients with chronic rhinitis.

Prior studies comparing skin testing to serum-specific IgE testing for inhalant allergy focused on older technologies or small numbers of allergens. The purpose of this study was to compare ImmunoCAP (CAP) testing to skin prick testing (ST) for 53 inhalant allergens. Subjects > or =18 years old with chronic rhinitis and who had at least 1 positive ST to a 53 inhalant allergen panel underwent testing to an analogous CAP panel.

The LOCAL Study: Local reactions do not predict local reactions in allergen immunotherapy.

Background: Although previous immunotherapy studies have demonstrated that a local reaction does not predict a systemic reaction, no study has investigated whether a local reaction predicts a local reaction.

Objective: To determine whether a local reaction predicts a local reaction at the next immunotherapy injection.

Methods: A retrospective analysis of an electronic immunotherapy database over a 12-month period was performed at a single site that did not dose-adjust for local reactions.

T-cell epitopes of aeroallergens.

Objective: To describe the current knowledge of the T-cell epitopes of common aeroallergens, how they were discovered, and implications for future therapy.

Data Sources: PubMed search of English-language articles without date limits pertaining to T-cell epitopes of aeroallergens included on a standard skin test panel.

Study Selection: A total of 127 articles were screened based on the results of the PubMed search and cross-indexed as needed.

A case of severe refractory chronic urticaria: a novel method for evaluation and treatment.

With cholinergic urticaria (ChU), the ultimate diagnosis often depends on the demonstration of characteristic urticaria by appropriate provocation. Several treatment options may be helpful but traditional options (antihistamines, leukotriene inhibitors, and immunosuppressives) may be exhausted by the refractory ChU patient. Here, we describe such a case.

The role of intradermal skin testing in inhalant allergy.

Objective: To provide an overview of the role of intradermal skin testing (IDST) in inhalant allergy.

Data Sources: A literature search was conducted in MEDLINE to identify peer-reviewed articles related to IDST using the following keywords: skin testing, intradermal, intracutaneous, aeroallergen, and inhalant allergen. In addition, references cited within these articles were also reviewed.

The GILL study: glycerin-induced local reactions in immunotherapy.

Background: The mechanism of local reactions is not well defined. Glycerin, an excellent preservative used commonly in immunotherapy extracts, is a recognized irritant.

Objective: This study was undertaken to examine whether higher glycerin concentration in immunotherapy extracts is associated with an increase in local reaction rates during immunotherapy.

Prevalence of positive skin test responses to 53 allergens in patients with rhinitis symptoms.

Prior studies looking at allergic sensitization have focused on narrow age ranges or small numbers of allergens. This study is the first to examine the prevalence of positive skin test responses in a symptomatic military population with a wide age range of patients and large number of allergens. This study was a retrospective analysis of our skin test database.

Aeroallergen sensitization rates in military children with rhinitis symptoms.

Background: Childhood sensitization rates for many aeroallergens are underreported.

Objectives: To examine aeroallergen sensitization rates in military children undergoing skin testing for rhinitis and investigate the timing of atopic development for perennial and seasonal allergens.

Methods: A skin testing database was retrospectively analyzed.