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Systemic reactions to inhalant immunotherapy using 1:1 target dosing.

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The 1:1 maintenance dosing for subcutaneous immunotherapy (SRIT) showed similar systemic reaction rates compared to the previous 1:50 concentrate. This suggests the updated dosing protocol is as safe as the prior method for patients receiving SRIT.

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Area of Science:

  • Allergy and Immunology
  • Clinical Practice Guidelines
  • Pharmacovigilance

Background:

  • The 2007 immunotherapy practice parameters recommend 1:1 maintenance dosing for subcutaneous immunotherapy (SRIT).
  • Limited data exists on the safety of 1:1 dosing regarding systemic reactions (SRITs).

Purpose of the Study:

  • To evaluate the impact of 1:1 maintenance dosing on SRIT rates in a large academic setting.
  • To compare SRIT incidence and severity before and after the adoption of 1:1 dosing.

Main Methods:

  • Retrospective cohort study of nonvenom SRITs from 2005-2011.
  • Comparison of SRITs during pre-parameter dosing (pre-PD, 1:50 concentrate) and post-parameter dosing (post-PD, 1:1 concentrate).
  • Analysis included SRIT rates, World Allergy Organization (WAO) grade, and time to onset.

Main Results:

  • Overall SRIT rates were slightly higher post-PD (0.34%) vs. pre-PD (0.25%), but not significantly different when excluding transitioned patients (0.25% vs. 0.22%).
  • Non-1:1 vials comprised a larger proportion of post-PD SRITs.
  • Male sex and faster reaction onset were linked to higher WAO severity grades.

Conclusions:

  • The adoption of 1:1 maintenance dosing for SRIT did not significantly alter systemic reaction rates compared to pre-PD.
  • The 1:1 dosing strategy is considered as safe as the previous 1:50 concentrate.
  • Factors such as male sex and rapid reaction onset correlate with increased SRIT severity.