clinical process for properly prescribe allergen immunotherapy

Download Clinical process for properly prescribe allergen immunotherapy

Post on 01-Feb-2016

45 views

Category:

Documents

0 download

Embed Size (px)

DESCRIPTION

Clinical process for properly prescribe allergen immunotherapy. Noel Rodriguez-Perez, MD Professor of pediatrics, Allergy& Immunology State University of Tamaulipas, School of Medicine. Clinical process for properly prescribe allergen immunotherapy. - PowerPoint PPT Presentation

TRANSCRIPT

  • Clinical process for properly prescribe allergen immunotherapy Noel Rodriguez-Perez, MDProfessor of pediatrics, Allergy& Immunology State University of Tamaulipas, School of Medicine

  • Cox L, Nelson HS, Lockey RF. Journal of Allergen immunotherapy: A practice parameter third update Allergy Clin Immunol 2011;127:S1-S46Summary Statement 80: The efficacy of immunotherapy depends on achieving an optimal therapeutic dose of each of the constituents in the allergen immunotherapy extract. AClinical process for properly prescribe allergen immunotherapy

  • Allergen immunotherapy: What can and cannot be mixed?Esch RE. J Allergy Clin Immunol 2008;122:659-60.

  • CASE 1: M.D.K. Male. 16 years of agePrevious history: Cows milk allergy in infancy.Hystory: 2 years, recurrent episodes of coriza, nasal congestion, acuous rhinorrea, epifora, fotofobia, intermitent dry cough. Symptoms, perenial with exacerbations in Winter, Spring and summer. Clinical process for properly prescribe allergen immunotherapy

  • Skin test. Case 1 M.D.K

  • Case 1: M.D.K.

    1. What allergens to be included?2. How many in one vial?3. Can we mix this unrelated allergens?

  • Zuberbier T, Bachert C, Bousquet PJ, Passalacqua G, Walter Canonica G, Merk H, Worm M, Wahn U, Bousquet J. GA2LEN/EAACI pocket guide for allergen-specific immunotherapy for allergic rhinitis and asthma. Allergy 2010; 65: 15251530. Decision must be based on the allergen which causes:1. The longest duration of symptoms per year 2. The most severe symptoms 3.A major impact on quality of life 4. Which is more difficult to avoid

  • House dust mitesRelated to perennial symptomsTree pollens Late winter to early SpringGrass pollensLate Spring to early SummerWeed pollensSummer to early AutumnCASE 1: M.D.K.

  • CASE 1: M.D.K. Pollen SIT Quercus, Celtis, Sorgum, Ambrosia, RumexPollens probably effective dose range: 5 20 mcg (1:100 1:200 w/v)5 pollen mix will dilute each other times 5. Maintenance dose Vial: 1:200 V1 X C1 = V2 X C2 Were: V1 = Final volume to prepareC1 = Desired concentration of extractV2 = Volume of extract needed (unknown)C2 = Concentration of extract you will use (manufacturer concentrate)JACI. 2011;127:S1-S46

  • CASE 1: M.D.K. Pollen SIT Pollen maintenance vial.Option: 5cc 1:200 w/v V2 = (V1/ C1)xC2V2 (?) = (5cc / 1/200)x1:20 w/v = (5/200)x20 = 0.5V2 = 0.5cc of each pollen extract Mix of 5 pollen extracts: 0.5x5 = 2.5cc + 2.5cc of diluent.

    Option: 1:100V2 = (5/100)x20 = 1cc Mix of 5 pollen extracts: 5cc no diluent.

  • CASE 1: M.D.K: H.D.Mites or standarized Immunotherapy Mites maintenance vial F/Pt mix 50/50.Manufacturer concentrate: 10,000; 30,000 AU/mLEffective maintenance dose: 500 2000 AU or 10mcg/mL (Mf: 10mcg; MPt: 7 12 mcg/mL)Maintenance vial: 2000 AU/mL. V2 = (V1 x C1)/C2V2 (?) = (5cc x 2000)/10,000 AU = 1.0cc V2 = 1.0cc + 4cc Diluent ( 12mcg/mL; 6 mcg/dose)

  • Major allergen component in standarized extracts

    ExtractConcentrationMajor componentContent Effective dose/projected dosePoa annua100k BAU/mL Group 5320 g/mL5 to 20g/ 1000 to 4000AUAgropiron rep 100k BAU/mL Group 5750 g/mL 5 to 20g/ 1000 to 4000AUPhleum Prat100k BAU/mL Phl p5680 g/mL 20g/ 1000 to 4000AUCynodon dact10k BAU/mLGroup 1300 g/mL5 to 20g/ 1000 to 4000AUAmbrosia1:10 w/vAmb a 1290 g/mL 6 to 12g1000 to 4000AUD farinae10k BAU/mLGroup 160 g/mL10 gD pteronisinus10k BAU/mLGroup 165 g/mL 7 a 12 gCat10k BAU/mLFel d 150 g/mL 15 g

  • Dose of Major component in mcg/mLSuppose 5cc maintenance dose vial for 10 doses of 0.5cc with Timothy grass pollen.5cc must contain 10 times the maintenance dose. Example: Timothy grass maintenance effective dose 20mcg/mL Phl p5. 5 cc maintenance vial must contain 200mcg.Manufacturer label 100000AU/mL = 680mcg of Phl p5/mL.200 divided by 680 = 0.3cc + 4.7cc of diluent.

Recommended

View more >