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

Abstract

283We sent a questionnaire to allergy centers that adopted the shortened build-up schedule. The questionnaire included the following items: age, gender, symptoms, extract composition, maximum dose reached (yes/no), number of injections, local reactions (>5 cm, <10 cm), large local reactions (>10 cm), and systemic reactions. The shortened regimen was administered with Allergovit (Allergopharma GmbH & Co. KG), an AIT pollen extract that has been chemically modified with formaldehyde to produce an allergoid. Allergovit is specified in therapeutic units per mL (TU/mL) and provided in 2 strengths (A, 1000 TU/mL; and B, 10 000 TU/mL). The abbreviated updosing regimen consists of 4 injections, and the schedule is completed within 3 weeks only, while the conventional regimen comprises 7 injections. Patients received 2 weekly strength A injections and 2 strength B injections, with volumes of 0.2 and 0.6 mL, respectively. In grass pollen Allergovit extracts, the maximum dose of 0.6 mL corresponds to a content of 25 μg of grass group 5 allergens. The Figure shows a comparison of the classic and abbreviated build-up schedules.We collected 156 cases of patients with seasonal allergic rhinoconjunctivitis who had been chosen for the short buildup; 85 of these patients also had asthma symptoms. Mean age was 36.0 years (range, 7-76), and there were 89 males and 67 females. The distribution by extract was as follows: grasses, 46; Parietaria, 36; ragweed, 26; birch, 13; mixed trees, 10; various mixtures, 25.All patients but one reached the maximum scheduled dose, and 138 patients (88.5%) completed the treatment without reactions. A further 138 patients (88.5%) also reached the maximum dose with the 4 scheduled injections. Eighteen patients required 1 extra injection, 9 for concomitant nontreatment-related events and 9 for adverse reactions.Overall, 12 mild treatment-related local reactions (>5 cm, <10 cm) and 2 severe local reactions (>10 cm) were recorded (2.2% of the total 649 injections; 9.0% of patients). A severe local reaction was the reason why 1 patient did not reach the maximum dose. No systemic reactions were observed.

Adherence to Allergen Subcutaneous Immunotherapy is Increased by a Shortened Build-Up Phase: A Retrospective Study

“…Rush schedules can also increase AIT adherence [13], but it is well known that these schedules carry a higher risk of adverse reactions [24,25]. e abbreviated updosing evaluated in this survey has instead already proved to be safe and well tolerated in previous studies, due to the hypoallergenic properties of allergoids [12,26]. Backtracking the prescription refills is an objective, easy method to evaluate AIT adherence, but of course, it cannot guarantee that patients actually took the treatment [21].…”

“…An abbreviated build-up scheme with pollen allergoids (Allergovit ® , Allergopharma GmbH and Co. KG, Reinbek, Germany) has already proved to be safe and feasible [12].…”