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Abstract# 54 Richard Herrscher M.D. FACAAI

EVALUATION OF THREE ALLERGEN SPECIFIC IMMUNOTHERAPY METHODS Standard Injection RUSH Injection Sublingual. Abstract# 54 Richard Herrscher M.D. FACAAI Clinical Faculty U.T. Southwestern Medical Center Dallas, Texas Medical Director AIR Care P.A. BACKGROUND.

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Abstract# 54 Richard Herrscher M.D. FACAAI

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  1. EVALUATION OF THREE ALLERGEN SPECIFIC IMMUNOTHERAPY METHODSStandard Injection RUSH Injection Sublingual Abstract# 54 Richard Herrscher M.D. FACAAI Clinical Faculty U.T. Southwestern Medical Center Dallas, Texas Medical Director AIR Care P.A.

  2. BACKGROUND • RUSH immunotherapy - one day schedule • Started using RUSH in 2000 based on description by Sharkey P, Portnoy J.Ann Allergy 1996;76:175-80 • Little is known how this schedule compares to standard immunotherapy in terms of efficacy. • SLIT (sublingual immunotherapy) • Started using SLIT in 2003 based on evidence from European studies reviewed by Canonica and Passalacqua JACI 2003;111:437-48 • Very little data using U.S. extracts.

  3. PURPOSE and METHODS • Purpose of Study • To evaluate how alternative schedules of RUSH and SLIT compare to standard injection immunotherapy (SCIT) in terms of: • Compliance - patient acceptance • Clinical efficacy • Safety

  4. PURPOSE and METHODS • Methods • Observational study. Data collection began in 2005. • Evaluated all patients starting immunotherapy from July 2003 through December 2004. • Data collection is ongoing. • Efficacy data collected prospectively with attempt to collect 6, 12 and 24 month time points. • Efficacy evaluated by patient questionnaire: Symptom and Medication reductionscores 5 point scale 0% - 25% - 50% - 75% - 100%

  5. RUSH INJECTION SCHEDULE • One - day RUSH protocol • Very similar to previously described protocols • Sharkey P, Portnoy J. Ann Allergy 1996;76:175-80 • Harvey SM, Laurie S, Hilton K, Khan DA. Ann Allergy Asthma and Immunology 2004;92:414-9 • 38% systemic reaction rate during rush protocol

  6. RUSH INJECTION SCHEDULE

  7. SLIT SCHEDULE

  8. ALLERGEN EXTRACTS/DOSE

  9. SCHEDULE PERFORMANCE% Patients Achieving Maintenance Doses 1:1 1:10 1:100 1:1000 Vial dilution Std. SCIT 100% 6 months 50% RUSH SCIT 100% SLIT 12 months 50% 100% 24 months 50%

  10. SCHEDULE PERFORMANCECumulative Allergen Dose Std. SCIT RUSH SLIT 6 months 12 months 24 months

  11. COMPLIANCE DATAupdated • All patients starting IT July-03 thru Dec-04

  12. UPDATED EFFICACY DATAPatient starts July 2003 - Dec 2004 RUSH Std. SCIT SLIT 75% P=.03 Medication/ Symptom Reduction Score P=.001 50% 50% 43.1% 34.9% 34.7% 28.1% 21.4% 25% Med/ Sx < 12 months therapy > 12 months therapy

  13. EFFICACY DATAPatient starts July 2003 - May 2005 75% RUSH Std. SCIT SLIT 56.0% P=.015 P=.025 Medication/ Symptom Reduction Score 46.5% 50% 43.1% 39.9% 41.4% 33.9% 28.4% 29.2% 23.2% 25% Med/ Sx 6 months 12 months 24 months

  14. SAFETY DATA

  15. SYSTEMIC REACTIONSmoderate - severe RUSH SLIT Std.SCIT

  16. SUMMARY • SLIT • Much safer than injection therapy. • Making it feasible for home administration. • Extends immunotherapy to group unable to comply with office injections • Is not a completely benign therapy

  17. SUMMARY • SLIT • Efficacy appears equal to standard injections. • Optimal dosing? 15X cumulative injection dose performed well in our patients. • RUSH • More efficacious early on (0-18 months), higher compliance, more systemic reactions.

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