Article

Safety and tolerability of seasonal ultra-rush, high-dose sublingual-swallow immunotherapy in allergic rhinitis to grass and tree pollens: an observational study in 193 children and adolescents.

Klinik für Pädiatrische Pneumologie und Allergologie, Neonatologie und Intensivmedizin, Elisabeth-Kinderkrankenhaus, Oldenburg, Germany.
Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología (Impact Factor: 2.64). 02/2009; 19(2):125-31.
Source: PubMed

ABSTRACT We conducted a large observational study in 193 children and adolescents with allergic rhinitis due to grass or tree pollens to evaluate the safety and tolerability of an ultrarush high-dose sublingual immunotherapy (SLIT) regimen reaching a maintenance dose of 300 index of reactivity within 90 minutes.
Children and adolescents aged 5 to 17 years with at least a 1-year medical history of allergic rhinitis with or without mild to moderate asthma due to tree pollens (birch, alder, hazel) or grass pollens (cocksfoot, meadow grass, rye grass, sweet vernal grass, timothy) were recruited. Standardized grass and tree pollen allergen extracts were used for ultrarush titration and subsequent coseasonal maintenance.
During ultrarush titration, 60 patients (31%) reported 117 predominantly mild and local adverse events, which resolved within 150 minutes. During the maintenance phase, 562 adverse events were reported; the most frequent local events were oral pruritus, burning sensation, lip or tongue swelling, and gastrointestinal symptoms, and the most frequent systemic events were rhinoconjunctivitis and asthma. There was 1 clinically significant asthma event in an 11-year old boy with known asthma in whom SLIT was resumed after an interval of 4 days.
Ultrarush titration was safe and well tolerated. Pediatric patients with asthma should be carefully monitored and adequately trained to use their rescue medications.

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    ABSTRACT: Die Pollenallergie, besonders beim Kind, ist keine Bagatelle: ihre Morbidität ist hoch, auch wenn eine gewisse Stabilisie-rung ihrer Häufi gkeit im Kindesalter auf hohem Niveau einge-treten ist, die Lebensqualität für die betroffenen Kinder und ihre Eltern ist eingeschränkt, die Therapiekosten sind hoch. Die Pollenallergie hat einen signifi kanten sozialen und ökono-mischen Impact, gemessen an den Abwesenheiten im Schul-unterricht, Leistungsverminderung sowohl in der Schule als auch bei sportlichen Aktivitäten und später im Erwerbsleben. D ie Pollinosis gilt seit der Einführung des "Atopie"-Begriff es durch Coca und Cooke im Jahre 1923 [1] als der Prototyp ei-ner *reinen", IgE-vermittelten atopischen Erkrankung. Tatsäch-lich entstehen die allergischen Reaktionen der Konjunktiven und der Respirationsschleimhäute bei Kontaktaufnahme mit den ane-mophilen Pollen, auf welche eine IgE-Sensibilisierung besteht, so-bald der individuelle Schwellenwert überschritten ist. Im Gegensatz zur Pollinosis ist die Rolle der IgE in der Pathogenese der atopi-schen Dermatitis (atopischen Ekzems, Neurodermitis) noch unklar, es gibt auch einen Phänotyp des atopischen Ekzems, bei welchem keine spezifi schen IgE nachweisbar sind (sog. "intrinsic" Typ) [2]. Auch ist das allergische Asthma nicht der Prototyp einer "reinen" IgE-bedingten Allergie, da bei Asthma häufi g auch intrinsische Faktoren, Infekte, psychosomatische Einfl üsse und Reizstoff e symp-tomauslösend sind. Wegen fehlender familiärer Disposition und al-lergischer Reaktionen auf Umweltallergene in der Luft oder in der Nahrung gehört die Insektenstichallergie, wie auch die Arzneimit-telallergie, nicht zu den Atopien.
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    ABSTRACT: Background. Specific immunotherapy (SIT) with an ultrarush administration schedule with Purethal for tree pollen allergens has been evaluated to assess its efficacy and safety. Methods. The study group consisted of 22 patients with symptoms of allergic rhinitis and confirmed allergy to tree pollens. Patients were randomized and given an administration schedule of either ultrarush therapy or conventional preseasonal SIT. Treatment was performed during three consecutive years. Results. After three years of treatment, a similar reduction in nasal symptoms was observed; according to the visual analog scale, there was a decrease from 3.991 ± 0.804 points to 1.634 ± 0.540 in the ultrarush group and from 3.845 ± 0.265 to 1.501 ± 0.418 in the group desensitized using the conventional method (P > 0.05). There was also a comparable reduction in the use of relief drugs during pollen season and an increase in the serum concentration of IgG4 to tree pollens. No significant differences in the safety profile were observed. Conclusion. An administration schedule of ultrarush SIT with Purethal Trees is a safe treatment in preliminary observations. This therapy is comparable with conventional administration of SIT in the field of efficacy and safety.
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