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Similarly, while venom-specific IgG4 is induced with VIT, this is not correlated with treatment success [ 74 — 77 ]. Practical aspects of SCIT SCIT must be undertaken only by a specialist with adequate knowledge and experience in this field and in a clinical setting where support for cardiopulmonary resuscitation is readily available. Immunotherapy employing week conventional and 7—8-week cluster protocols can be undertaken in an out-patient facility, but accelerated regimens must be administered in an intensive care or high dependency unit.
Protocols for safe delivery of the service Example 2 must be in place, with particular emphasis on confirmation of identity of the patient, allergen extract and dosage during each visit. A min period of observation is mandatory following each injection in order to monitor the patient closely for development of symptoms of type 1 hypersensitivity reaction. Previous surveys have shown that common causes of allergic reactions during SCIT are misidentification of the patient, administration of the incorrect allergen and dosage errors [ 79 ].
Therefore, it is recommended that the injection vial and dosage are checked with another health care professional with experience in SCIT. Example 2. Safety checks prior to injections in an immunotherapy clinic Check patient identity. Confirm the allergen involved in treatment. Did the patient tolerate the last injection? Appropriate dose reduction and patient counselling may be necessary. In patients premedicated with antihistamine, ensure that they have taken their medication beforehand.
Enquire for intercurrent infections and any change in medical status since last injection. In female patients, enquire about pregnancy. In asthmatics, ensure asthma is stable and well controlled. Check peak expiratory flow rate PEFR at baseline and 60 min following injection or earlier if warranted. While mild, well-controlled asthma is not a contraindication for SCIT with aero-allergens, injections must not be administered during intercurrent respiratory infection when there is exaggerated bronchial reactivity, which may predispose patients to the development of a systemic reaction.
It is imperative to optimize the anti-inflammatory therapy for asthma prior to commencing VIT and to perform an objective evaluation of asthma as above. Immunotherapy and pregnancy Allergen immunotherapy in any form must not be initiated during pregnancy [ 38 ].
Although allergen immunotherapy is not known to have teratogenic effects, it should ideally be avoided in pregnancy, even in patients established on treatment who are in maintenance phase, in view of the rare but real possibility of anaphylaxis which may cause fetal hypoxia [ 38 ]. Immunotherapy and beta-blocker therapy Beta-blocker therapy is generally considered an absolute contraindication during allergen-specific immunotherapy due to the risk of refractory anaphylaxis [ 36 — 38 , 80 ].
This is related to reduced therapeutic efficacy of adrenalin in anaphylaxis due to underlying beta blockade. Therefore, as far as possible, it is better to avoid beta-blockers during immunotherapy, but there are some special circumstances in patients requiring VIT where withdrawal of beta-blockers may put the patient at risk such as of underlying tachyarrhythmias [ 80 , 81 ]. Where benefit of continuation of treatment of beta-blocker clearly outweigh the risk of their discontinuation, short-acting beta-blockers may be discontinued temporarily prior to injections or during the induction phase of VIT.
Some groups have undertaken VIT successfully alongside treatment with beta-blockers. Abstract Allergic rhinitis is a common health problem in both children and adults. Allergen-specific immunotherapy AIT has disease-modifying effects and can induce immune tolerance to allergens.
However, patient adherence to treatment with AIT seems to be quite low, mostly due to the fact that treatment with AIT is relatively time-demanding and, moreover, due to patients not receiving adequate information and education about the treatment before it starts.
AIT is undergoing innovations and improvements in clinical efficacy, safety and patient adherence, especially with new approaches using new adjuvants, recombinant or modified allergens, synthetic peptides, novel routes of administration epidermal or intralymphatic , and new protocols, which might make AIT more acceptable for a wider range of patients and novel indications. Patient education and support eg, recall systems is one of the most important goals for AIT in the future, to further enhance treatment success.
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Binding of AECAs to endothelial cells would cause endothelial activation or damage, with proinflammatory cytokine release, thus fostering a hypercoagulable state resulting from leukocyte activation by proinflammatory cytokines. This, in turn, would lead to coronary artery lesions. KD vasculitis might be initiated upon binding of AECAs to the vasa vasorum and progress to panvasculitis and a vulnerable vessel wall, resulting in an aneurysm.
The aneurysm would cause flow recirculation and alteration of wall shear stress. Consequently, platelets activated by shear stress, along with ultralarge von Willebrand factor VWF released by endothelial cells, would cause platelet-driven arterial thrombosis.
Autoimmunity-associated thrombosis initiated by binding of AECAs to endothelial cells might play a major role in the pathogenesis of certain subtypes of KD. Methods: Two different samplers were used to assess allergen exposure: a Burkard spore trap to collect pollen grains and a high-volume air sampler to collect airborne particles.
Individual filters were extracted daily in phosphate-buffered serum and analyzed by enzyme-linked immunosorbent assay based on serum containing high titers of specific immunoglobulin Ig E to grasses. The study population comprised 27 grass-allergic patients whose symptoms and medication were recorded daily. Results: Grass pollens were detected between April 28 and July Grass aeroallergens were detected not only during the grass pollination period, but also before and after this period.
Conclusions: Grass-related allergenic activity is present throughout the year, demonstrating the existence of aeroallergens outside the pollen season.
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