Premedication reduces the incidence of systemic reactions during inhalant rush immunotherapy with mixtures of allergenic extracts.
BACKGROUND
Rush immunotherapy, while having many potential benefits, is associated with an increased incidence of systemic reactions.


OBJECTIVE
To determine whether pretreatment with medications reduces the rate of systemic reactions during rush immunotherapy and to identify predictors of such reactions if possible.


METHODS
We conducted a double-blind, placebo-controlled study of 22 allergic children ages 6 to 18 years who received rush immunotherapy. Active treatment consisted of a combination of H1 and H2 histamine antagonists and a corticosteroid in gelatin capsules given prior to administration of rush immunotherapy whereas placebo patients received lactose. Rush immunotherapy consisted of eight injections of increasing doses of a mixture of allergens to which each patient was skin-reactive over 1 1/2 days. Serial skin tests and peak expiratory flow rate measurements were performed during the procedure. Following the initial series of injections, patients were followed for 8 weeks and had blood drawn at 2-week intervals for measurements of specific IgG and IgE.


RESULTS
Systemic reactions were observed in 3 (27%) active and 8 (73%) placebo patients (Fisher's exact test: P = .047). The mean time for systemic reactions was 63 minutes after a previous injection. The most common dose causing a systemic reaction was 0.3 mL of 1:1000 (wt/vol). The best predictors of development of a systemic reaction were degrees of skin sensitivity to the extract before and after premedication. Local reactions were not associated with subsequent systemic reactions. Specific IgG rose by 2 weeks while specific IgE did not change significantly during the 8-week follow-up period. Pretreatment did not change the number of systemic reactions seen with subsequent injections.


CONCLUSIONS
Premedication significantly reduces the incidence of systemic reactions during rush immunotherapy and is therefore recommended. Degree of skin sensitivity to the injected extract may eventually prove to be a clinically useful predictor for the development of systemic reactions.
Portnoy
J
J
Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, Missouri.
Bagstad
K
K
Kanarek
H
H
Pacheco
F
F
Hall
B
B
Barnes
C
C
D000293:Adolescent; D000485:Allergens / Q000008:administration & dosage*; D016589:Astemizole / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D011292:Premedication / Q000379:methods; D011899:Ranitidine / Q000008:administration & dosage; D012882:Skin Tests
D000485:Allergens; D016589:Astemizole; D011899:Ranitidine; D011241:Prednisone