title: A 1-day imported fire ant rush immunotherapy schedule with and without premedication.
abstract: BACKGROUND
  Rush immunotherapy (RIT) schedules can expedite protection in individuals sensitive to imported fire ant (IFA) stings.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of 1-day RIT with IFA whole body extract (WBE) and determine the benefit of premedication with antihistamines and prednisone.
  
  
  METHODS
  Patients with systemic reactions to IFAs and evidence of specific IgE by skin test or serologic test started a 1-day RIT protocol without premedication. The 1-day RIT protocol consisted of a total of 10 injections every 30 to 60 minutes to achieve a 0.3-mL 1:100 (wt/vol) dose. A higher systemic reaction rate (SRR) prompted protocol revision to include a 3-day course of oral 20 mg of prednisone twice daily, 150 mg of ranitidine, and 10 mg of loratadine started 2 days before the 1-day RIT. Patients returned on days 8 and 15 to receive a 0.5 mL 1:100 (wt/vol) maintenance injection. The effectiveness of the RIT was evaluated with a sting challenge on approximately day 22.
  
  
  RESULTS
  Eighty of the 96 patients enrolled initiated the 1-day RIT. The first nonpremedicated group exhibited a SRR of 24.3% (9 of 37 patients), whereas the revised premedicated group had a SRR of 9.5% (4 of 42 patients; P = .07). The most severe reaction during RIT included dizziness, angioedema, and urticaria. Sting challenges on 53 patients resulted in 1 mild rhinitis reaction (efficacy, 98.1%).
  
  
  CONCLUSIONS
  One-day RIT with IFA WBE for IFA hypersensitivity is efficacious. Although there was a trend with premedications to reduce SRRs during the RIT, safety data with premedication require confirmation in a larger trial.
authors.affiliation: San Antonio Military Medical Center, San Antonio, Texas. Electronic address: april.arseneau.1@us.af.mil.
authors.forename: April M
authors.initials: AM
authors.lastname: Arseneau
authors.forename: Teresa D
authors.initials: TD
authors.lastname: Nesselroad
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Dietrich
authors.forename: Laura M
authors.initials: LM
authors.lastname: Moore
authors.forename: Steven
authors.initials: S
authors.lastname: Nguyen
authors.forename: Larry L
authors.initials: LL
authors.lastname: Hagan
authors.forename: Michael S
authors.initials: MS
authors.lastname: Tankersley
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000008:administration & dosage*; D000818:Animals; D001000:Ants / Q000276:immunology*; D001733:Bites and Stings / Q000276:immunology; D045424:Complex Mixtures / Q000008:administration & dosage*; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000628:therapy*; D017336:Loratadine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011899:Ranitidine / Q000008:administration & dosage; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000485:Allergens; D045424:Complex Mixtures; D006633:Histamine Antagonists; D017336:Loratadine; D011899:Ranitidine; D011241:Prednisone