Accelerated Immunotherapy Schedules

Abstract

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. In rush immunotherapy protocols, higher doses are administered at 15- to 60-min intervals over a 1- to 3-day period until the maintenance dose is achieved. This review will serve as an update for accelerated immunotherapy schedules. The review will include recent investigations demonstrating the safety of cluster schedules in atopic dermatitis, pediatric patients, and inhalant allergen mixtures and an accelerated protocol utilizing an infusion pump for allergen delivery. There has also been further elucidation on the immunological changes which occur during accelerated immunotherapy. Finally, new studies analyzing systemic reaction risk factors are discussed.

Immunotherapy in allergy and cellular tests

“…53,93 Encouraging results from early open-label studies have recently sparked great interest both in oral and sublingual immunotherapy, and thus several randomized controlled trials have recently been conducted to establish the safety and efficacy of these treatment strategies. 19 Although some contrasting opinions have been raised about SLIT or oral immunotherapy (OIT) in children, 99-102 the methodology is gaining increasingly interest. Particularly due to its safety and tolerability, 103 though issues have been raised about the opportunity to use either sublingual (SLIT) or sub-cutaneous (SCIT) immunotherapy.…”

“…19,[123][124][125][126][127][128] Systematic reviews have tried to focus onto the issue and shed a light about current approaches in diagnosing and managing food allergy. 129 In peanut allergy, for example, many efforts have been recently made, 120,123,130 albeit doubts remain about reliability and clinical effectiveness of peanut allergy oral immunotherapy (OIT).…”

“…17,18 Oral immunotherapy has been reviewed for peanut, milk, and egg allergy. 19 The World Allergy Organization guidelines for the management of anaphylaxis have reviewed the current literature about the management of atopic hypersensitivity reactions and chronic allergy through AIT, recently reaching also interesting protocol suggestions and recommendations. 20,21 However, these guidelines lack of further and detailed information about the use of diagnostic tools such as basophil activation tests (BATs).…”

Safety of an Accelerated Build-up Phase With Pollen Allergoids: A Retrospective Study

“…This problem affects both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), even if some data suggest that adherence is better in patients receiving SCIT [3]. Other than clinical reasons, one of the most relevant factors for poor adherence to SCIT is the inconvenience related to the commute necessary to receive the allergy injections [4]; consequently, many attempts have been made to shorten treatment by reducing the number of injections [5].…”

“…This possibility has several advantages. Patients can benefit earlier from the treatment, since the clinical benefits of AIT appear very shortly after the maintenance dose is reached [5]. Shortening the escalation period can also address the problem of poor adherence, since adherence to SCIT is affected by logistic difficulties in attending the health care facility to receive the medication [4].…”