Surveillance of systemic reactions to subcutaneous immunotherapy injections: year 1 outcomes of the ACAAI and AAAAI Collaborative Study

Bernstein, David I.; Epstein, Tolly; Murphy-Berendts, Karen; Liss, Gary M.

doi:10.1016/j.anai.2010.04.008

Cited by 94 publications

(52 citation statements)

References 15 publications

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“…Most reactions were considered mild, and death due to SCIT was rare (ie, incidence is about one per million to one per 2 million injections). 36,84 As far as safety of SCIT in AR, the most recent Cochrane review found that epinephrine was administered in 0.13% of injections in the treated group compared with 0.01% in the placebo group, with no fatalities reported. Local reactions were common in the treated group compared with placebo (92% vs 33%), with the majority not requiring any additional treatment.…”

Section: The Effect Of Slit In Armentioning

confidence: 99%

Allergen Immunotherapy in Allergic Respiratory Diseases

Viswanathan

Busse

2012

Chest

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Over the past 2 decades, the prevalence of allergic respiratory diseases has increased, in part refl ecting changes in lifestyle and environment that promote a T-helper (Th) 2 cell phenotype. 1 It has been estimated that up to 20% of the US and Western Europe populations may be affl icted by allergic respiratory diseases. 2,3 A recent estimate of the total national medical expenditure attributable to adult asthma was reported as $18 billion, with the largest contributors being prescription drugs and inpatient hospitalizations. 4,5 Although allergen avoidance is an integral component and step of therapy, it is often impractical and insuffi cient. As a consequence, the mainstay of allergic disease management has been pharmacotherapy, especially antihistamines, bronchodilators, and inhaled/intranasal corticosteroids, which are targeted to regulate infl ammation of the upper and lower airways. Although these treatments are effective and, in most cases, safe, they offer no lasting benefi t once treatment is stopped and have limited intrinsic disease-modifying effects. Moreover, it has become apparent that allergic diseases are the result of immune dysregulation and refl ect an impairment in the natural tolerance that develops to allergens. 6,7 Immunotherapy has the potential to modify fundamental, underlying disease mechanisms and to have, Allergen-specifi c immunotherapy (SIT) involves the repeated administration of allergenic extracts to atopic individuals over a period of 3 to 5 years either subcutaneously (SCIT) or sublingually (SLIT) for the treatment of allergic respiratory diseases, including asthma and allergic rhinitis (AR). In studies, SCIT and SLIT have been shown to improve existing symptoms of asthma and AR and to also have the capability to cause disease-modifying changes of the underlying atopic condition so as to prevent new allergic sensitization as well as arrest progression of AR to asthma. Recent evidence suggests that immunotherapy brings about these effects through actions that use T-regulatory cells and blocking antibodies such as IgG 4 and IgA 2, which can then result in an "immune deviation" from a T-helper (Th) 2 cell pattern to a Th1 cell pattern. Numerous meta-analyses and studies have been performed to evaluate the existing data among these studies, with the consensus recommendation favoring the use of immunotherapy because of its potential to modify existing diseases. Signifi cant adverse reactions can occur with immunotherapy, including anaphylaxis and, very rarely, death. A primary factor in considering SIT is its potential to provide longlasting effects that are able to be sustained well after its discontinuation. Given the signifi cant burden these allergic diseases impose on the health-care system, SIT appears to be a cost-effective adjunctive treatment in modifying the existing disease state. CHEST 2012; 141(5):1303-1314Abbreviations: AR 5 allergic rhinitis; BHR 5 bronchial hyperresponsiveness; PEF 5 peak expiratory fl ow; SCIT 5 subcutaneous immunotherapy; SIT 5 allergen-specifi c...

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Section: The Effect Of Slit In Armentioning

confidence: 99%

Allergen Immunotherapy in Allergic Respiratory Diseases

Viswanathan

Busse

2012

Chest

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“…[30]. However, subcutaneous immunotherapy (SCIT) is associated with a significant risk of severe adverse events [37,38]. Thus, efforts have been done towards alternative routes (local and noninjection) for allergen delivery [39].…”

Section: Mechanisms Of Allergen-specificmentioning

confidence: 99%

“…However, current approaches show limitations concerning the long-term efficacy and safety due to local side effects and risk of anaphylaxis. Effective and safe vaccines require the use of effective and safe adjuvants [20][21][22][23]. Therefore, this paper provides an overview of the currently adjuvants used for allergen immunotherapy.…”

Section: Introductionmentioning

confidence: 99%

Genetic toxicology and preliminaryin vivostudies of nitric oxide donor tocopherol analogs as potential new class of antiatherogenic agents

Cabrera

López

Gómez

et al. 2011

Drug and Chemical Toxicology

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In the last decades, significant progress in research and clinics has been made to offer possible innovative therapeutics for the management of allergic diseases. However, current allergen immunotherapy shows limitations concerning the long-term efficacy and safety due to local side effects and risk of anaphylaxis. Thus, effective and safe vaccines with reduced dose of allergen have been developed using adjuvants. Nevertheless, the use of adjuvants still has several disadvantages, which limits its use in human vaccines. In this context, several novel adjuvants for allergen immunotherapy are currently being investigated and developed. Currently, nanoparticles-based allergen-delivery systems have received much interest as potential adjuvants for allergen immunotherapy. It has been demonstrated that the incorporation of allergens into a delivery system plays an important role in the efficacy of allergy vaccines. Several nanoparticles-based delivery systems have been described, including biodegradable and nondegradable polymeric carriers. Therefore, this paper provides an overview of the current adjuvants used for allergen immunotherapy. Furthermore, nanoparticles-based allergen-delivery systems are focused as a novel and promising strategy for allergy vaccines.

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“…With conventional immunotherapy, the rates of severe systemic reactions are probably Ͻ1%, whereas with rush immunotherapy reported reaction rates have been in some instances Ͼ30%. [6][7][8][9] In addition, as with any adverse reaction to a therapeutic agent, reporting rates are probably not completely trustworthy. Also, response rates to surveys designed to assess incidence are usually, low, Ͻ30%.…”

Section: Incidencementioning

confidence: 99%