A 1-day imported fire ant rush immunotherapy schedule with and without premedication

Ann Allergy Asthma Immunol. 2013 Dec;111(6):562-6. doi: 10.1016/j.anai.2013.08.021. Epub 2013 Sep 18.

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%).

Conclusion: 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.

Publication types

  • Clinical Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Allergens / administration & dosage*
  • Animals
  • Ants / immunology*
  • Bites and Stings / immunology
  • Complex Mixtures / administration & dosage*
  • Desensitization, Immunologic / methods*
  • Female
  • Histamine Antagonists / administration & dosage
  • Humans
  • Hypersensitivity, Immediate / therapy*
  • Loratadine / administration & dosage
  • Male
  • Middle Aged
  • Prednisone / administration & dosage
  • Ranitidine / administration & dosage
  • Skin Tests
  • Young Adult

Substances

  • Allergens
  • Complex Mixtures
  • Histamine Antagonists
  • Loratadine
  • Ranitidine
  • Prednisone