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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Brown, Simon G. A. Wiese, Michael D. Van Eeden, Pauline Stone, Shelley F. Chuter, Christine L. Gunner, Jareth Wanandy, Troy Phillips, Michael Heddle, Robert J. |
| Description | Country affiliation: Australia Author Affiliation: Brown SG ( Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Australia. simon.brown@uwa.edu.au) |
| Abstract | BACKGROUND: Venom immunotherapy can be initiated by different schedules, but randomized comparisons have not been performed. OBJECTIVE: We aimed to compare the safety of 2 initiation schedules. METHODS: Patients of any age with prior immediate generalized reactions to jack jumper ant (Myrmecia pilosula) stings were randomized to venom immunotherapy initiation by a semirush schedule over 10 visits (9 weeks) or an ultrarush schedule over 3 visits (2 weeks). In a concurrent treatment efficacy study, the target maintenance dose was randomized to either 50 µg or 100 µg. The primary outcome was the occurrence of 1 or more objective systemic reactions during venom immunotherapy initiation. Analyses were by intention to treat. We also assessed outcomes in patients who declined randomization. RESULTS: Of 213 eligible patients, 93 were randomized to semirush (44 patients) or ultrarush (49 patients) initiation. Objective systemic reactions were more likely during ultrarush initiation (65% vs 29%; P < .001), as were severe reactions (12% vs 0%; P= .029). Times to maximal increases in venom-specific IgG(4) were no different between treatments, whereas the maximal increase in venom-specific IgE occurred earlier with ultrarush treatment. Similar differences between methods were observed in patients who declined randomization. One hundred seventy-eight patients were randomized to maintenance doses of either 50 µg (90 patients) or 100 µg (88 patients). The target maintenance dose had no effect on the primary outcome, but multiple-failure-per-subject analysis found that the 50 µg dose reduced the likelihood of reactions. CONCLUSION: Ultrarush initiation increases the risk of systemic reactions. A lower maintenance dose reduces the risk of repeated reactions, but the effect on treatment efficacy is unknown. |
| File Format | HTM / HTML |
| ISSN | 00916749 |
| e-ISSN | 10976825 |
| Journal | Journal of Allergy and Clinical Immunology |
| Issue Number | 1 |
| Volume Number | 130 |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2012-07-01 |
| Publisher Place | United States |
| Access Restriction | Open |
| Subject Keyword | Discipline Immunology Immunology Arthropod Venoms Administration & Dosage Desensitization, Immunologic Adverse Effects Hypersensitivity, Immediate Therapy Insect Bites And Stings Animals Drug Administration Schedule Etiology Randomized Controlled Trial Research Support, Non-u.s. Gov't |
| Content Type | Text |
| Resource Type | Article |
| Subject | Immunology and Allergy Immunology |
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