Immunotherapy Flashcards
SLIT contraindications
- uncontrolled asthma
- hx hypersensitivity to the ingredients in SLIT
- hx of severe local rxn to SLIT
- hx of EoE
- hx of reaction on any SLIT products
- active mouth ulcers, lichen planus or dental extractions
Indications for allergen specific IT (AIT)
- pts with stinging insect allergy
- pts with allergic rhinitis or allergic asthma who have evidence of sIgE to clinically relevant allergies, this includes patients who:
- do not achieve control of sx with avoidance measures and pharma
- do not want ongoing to long term meds
- experience undesirable SE with meds
- pats with AD and associated aeroallergen sensitization (may be considered) - can consider VIT in patients who get disabling large local reactions (B)
- can help AD in patients with aeroallergen sensitization (B)
CI to AIT
- pts with severe or uncontrolled asthma
- significant co morbid disease such as CVD
- patients on BB (absolute CI to AIT, relative with VIT)
special considerations in AIT
- Children < 6 years
- Pregnancy
- Elderly
- pts with malignancy, ID or AI disease
Oralair contain which grasses?
timothy cocksfoot rye grass meadow grass sweet vernal grass
age for oralair
age 5-50
start 16 weeks before season
grasstex age indication, initiation timing, dose
> 5 years old and 8 weeks before season
dose is 2800 BAU
ragwitek age indication, initiation, dose
5 y.o
12 weeks before the season
12 Amb a 1 U
acarizax age indication, initiation and dose
18-65 years, any time of year, 1 sublingual tablet daily
Tree pollen season in
- BC
- Prairie
- ON and QC
- Maritimes and NFL/L
- early feb to mid july (costal, deciduous)
late march to mid july (interior, deciduous) - first week april to june
- april
- late march to june
name some deciduous trees
alder, birch, oak, elm, willow, poplar
Grass pollen season in
- BC
- Prairies
- ON and QC
- Maritime and NFL?L
- end of april to september
- may to september
- late may to june
- mid may to sept
Mould spores by province:
- BC
- Prairies
- ON and QC
- Maritimes
- present throughout the year, except for a few weeks when ground is frozen
- Spring , summer and early fall
- spring, summer and early fall
- late summer and early fall
Weed pollen by province
- BC - minimal ragweed
- mostly nettles and sage, some ragweed in Manitoba
- ON - Aug to first frost
- Maritimes - Aug to first frost
How to make IT safe in your office
- enquire about current medical conditions
- peak flow check if history of asthma
- waiting time of 30 mins after shot
- ensure pt is informed of S/S
- switch pts off BB and ACEi
Name some RFs which place pts on AIT at risk for anaphylaxis
- severe uncontrolled asthma
- asthma sx present immediately before getting AIT
- history of sx reactions to AIT
- dosage errors
- first injection from a vial
- use of BB or ACEi
- home AIT or unsupervised clinic setting
Advantages and disadvantages of SLIT
Advan:
- home administration
- fewer systemic reactions
- less complex dosing regimen
disadvan:
- relies on patient administration
- possibly less efficacious than AIT
- requires daily admin vs weekly
what antigen is used in honey bee vaccine?
phosphlipase A2
what antigen is used in yellow jacket vaccine?
hyaluronidase ves v2 or antigen 5
name some errors that can leads to a systemic reaction when on IT
- dosing error
- wrong patient
- IV injection
- new maintenance with new vial
- BB
- pt has uncontrolled asthma
long term mgmt of venom allergy
- wear long sleeved clothing when outdoors
- avoid walking outside barefoot
- avoid brightly coloured clothing
- carry EpiPen
- obtain medical alert bracelet
- avoid food outdoors, especially open cans
efficacy of IT in asthma
- improved sx scores
- decreased medication use
- decreased exacerbations
- reduced bronchial hyper responsiveness
- improved pulm. function
- may prevent onset of asthma in atopic individuals
Benefits of IT in asthma (studies)
- modification of the natural history of disease
- reduction in the need for chronic meds
- treatment of both lower and upper airway disease
evidence for SCIT and AD
AD may respond to SCIT if the pt is sensitized to inhalant allergens - based on systematic review and a meta analysis of 8 studies with 385 subjects-
what are the AIT preparations?
- aqueous
- glycerinated
- lyophilized
dust mite SCIT and SLIT dosing
- SCIT: D. Farinea 1000 AU/ml and D. pteronyssinus 100 AU/ml
- Acarizax 12 SQ-HDM SL tb OD
Indications for Benralizumab and dosing
- severe asthma with eosinophilic phenotype
- > 12 years old
- eos > 300
- 30 mg SQ Q 4 weeks for 3 months then every 8 weeks
Indications for Reslizumab and dosing
- > 18 years old
- Eos > 400
- 3 mg/kg Q 4 weeks
Dupilumab dose and eos indication
- no lower eos limit, 150 and 300 accepted
- max dose 600 mg, usually 300 mg Q weekly
Indications and dosing for Mepolizumab
- add on maintenance treatment for with severe asthma , > 6 years old and older with an eosinophilic phenotype
- EGPA
- tx for age 12 + with HES > 6 months with no identifiable cause
- eos > 150
- dosing: 100 mg Q4 weeks
- EGPA and HES - 300 mg Q 4 wks (100 mg syringes)
Xolair indications
- refractory asthma on step 4 and 5 of GINA
- > 6 years old with sens. to inhaled aeroallergen on SPT or sIgE AND a total serum IgE and body weight within the dosing ranges AND more than a specific number of asthma exacerbations per year
IgE 30 -700 adults
IgE 30-1300 kids
weight 20- 150 kg
factors to ensure scientific validity in a trial
- randomization
- control groups
- blinded study
- clearly defined exposures
- use of objective data sources
Grasstek ingredients
gelatin, mannitol and sodium hydroxide
oralair ingredients
mannitol, cellulose, lactose and silica
ragwitek ingredients
gelatin (fish), mannitol, sodium hydroxide
acarizax ingredients
gelatin, mannitol, sodium hydroxide
itulatex ingredients
gelatin (fish), mannitol and sodium hydroxide
