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Immunotherapy Flashcards

1
Q

SLIT contraindications

A
  1. uncontrolled asthma
  2. hx hypersensitivity to the ingredients in SLIT
  3. hx of severe local rxn to SLIT
  4. hx of EoE
  5. hx of reaction on any SLIT products
  6. active mouth ulcers, lichen planus or dental extractions
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2
Q

Indications for allergen specific IT (AIT)

A
  1. pts with stinging insect allergy
  2. 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)
  3. can consider VIT in patients who get disabling large local reactions (B)
  4. can help AD in patients with aeroallergen sensitization (B)
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3
Q

CI to AIT

A
  1. pts with severe or uncontrolled asthma
  2. significant co morbid disease such as CVD
  3. patients on BB (absolute CI to AIT, relative with VIT)
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4
Q

special considerations in AIT

A
  1. Children < 6 years
  2. Pregnancy
  3. Elderly
  4. pts with malignancy, ID or AI disease
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5
Q

Oralair contain which grasses?

A 
timothy 
cocksfoot
rye grass
meadow grass 
sweet vernal grass
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6
Q

age for oralair

A

age 5-50

start 16 weeks before season

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7
Q

grasstex age indication, initiation timing, dose

A

> 5 years old and 8 weeks before season

dose is 2800 BAU

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8
Q

ragwitek age indication, initiation, dose

A

5 y.o
12 weeks before the season
12 Amb a 1 U

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9
Q

acarizax age indication, initiation and dose

A

18-65 years, any time of year, 1 sublingual tablet daily

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10
Q

Tree pollen season in

  1. BC
  2. Prairie
  3. ON and QC
  4. Maritimes and NFL/L
A
  1. early feb to mid july (costal, deciduous)
    late march to mid july (interior, deciduous)
  2. first week april to june
  3. april
  4. late march to june
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11
Q

name some deciduous trees

A

alder, birch, oak, elm, willow, poplar

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12
Q

Grass pollen season in

  1. BC
  2. Prairies
  3. ON and QC
  4. Maritime and NFL?L
A
  1. end of april to september
  2. may to september
  3. late may to june
  4. mid may to sept
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13
Q

Mould spores by province:

  1. BC
  2. Prairies
  3. ON and QC
  4. Maritimes
A
  1. present throughout the year, except for a few weeks when ground is frozen
  2. Spring , summer and early fall
  3. spring, summer and early fall
  4. late summer and early fall
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14
Q

Weed pollen by province

A
  1. BC - minimal ragweed
  2. mostly nettles and sage, some ragweed in Manitoba
  3. ON - Aug to first frost
  4. Maritimes - Aug to first frost
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15
Q

How to make IT safe in your office

A
  1. enquire about current medical conditions
  2. peak flow check if history of asthma
  3. waiting time of 30 mins after shot
  4. ensure pt is informed of S/S
  5. switch pts off BB and ACEi
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16
Q

Name some RFs which place pts on AIT at risk for anaphylaxis

A
  1. severe uncontrolled asthma
  2. asthma sx present immediately before getting AIT
  3. history of sx reactions to AIT
  4. dosage errors
  5. first injection from a vial
  6. use of BB or ACEi
  7. home AIT or unsupervised clinic setting
17
Q

Advantages and disadvantages of SLIT

A

Advan:

  1. home administration
  2. fewer systemic reactions
  3. less complex dosing regimen

disadvan:

  1. relies on patient administration
  2. possibly less efficacious than AIT
  3. requires daily admin vs weekly
18
Q

what antigen is used in honey bee vaccine?

A

phosphlipase A2

19
Q

what antigen is used in yellow jacket vaccine?

A

hyaluronidase ves v2 or antigen 5

20
Q

name some errors that can leads to a systemic reaction when on IT

A
  • dosing error
  • wrong patient
  • IV injection
  • new maintenance with new vial
  • BB
  • pt has uncontrolled asthma
21
Q

long term mgmt of venom allergy

A
  1. wear long sleeved clothing when outdoors
  2. avoid walking outside barefoot
  3. avoid brightly coloured clothing
  4. carry EpiPen
  5. obtain medical alert bracelet
  6. avoid food outdoors, especially open cans
22
Q

efficacy of IT in asthma

A
  1. improved sx scores
  2. decreased medication use
  3. decreased exacerbations
  4. reduced bronchial hyper responsiveness
  5. improved pulm. function
  6. may prevent onset of asthma in atopic individuals
23
Q

Benefits of IT in asthma (studies)

A
  1. modification of the natural history of disease
  2. reduction in the need for chronic meds
  3. treatment of both lower and upper airway disease
24
Q

evidence for SCIT and AD

A

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-

25
Q

what are the AIT preparations?

A
  1. aqueous
  2. glycerinated
  3. lyophilized
26
Q

dust mite SCIT and SLIT dosing

A
  1. SCIT: D. Farinea 1000 AU/ml and D. pteronyssinus 100 AU/ml
  2. Acarizax 12 SQ-HDM SL tb OD
27
Q

Indications for Benralizumab and dosing

A
  • severe asthma with eosinophilic phenotype
  • > 12 years old
  • eos > 300
  • 30 mg SQ Q 4 weeks for 3 months then every 8 weeks
28
Q

Indications for Reslizumab and dosing

A
  • > 18 years old
  • Eos > 400
  • 3 mg/kg Q 4 weeks
29
Q

Dupilumab dose and eos indication

A
  • no lower eos limit, 150 and 300 accepted

- max dose 600 mg, usually 300 mg Q weekly

30
Q

Indications and dosing for Mepolizumab

A
  • 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)
31
Q

Xolair indications

A
  1. refractory asthma on step 4 and 5 of GINA
  2. > 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

32
Q

factors to ensure scientific validity in a trial

A
  1. randomization
  2. control groups
  3. blinded study
  4. clearly defined exposures
  5. use of objective data sources
33
Q

Grasstek ingredients

A

gelatin, mannitol and sodium hydroxide

34
Q

oralair ingredients

A

mannitol, cellulose, lactose and silica

35
Q

ragwitek ingredients

A

gelatin (fish), mannitol, sodium hydroxide

36
Q

acarizax ingredients

A

gelatin, mannitol, sodium hydroxide

37
Q

itulatex ingredients

A

gelatin (fish), mannitol and sodium hydroxide

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