Omalizumab Pretreatment Decreases Acute Reactions After Rush Immunotherapy for Ragweed-Induced Seasonal Allergic Rhinitis

[Guest guest]

this was in the medscape weekly digest. i thought some of you might find it

interesting. to use the link below, i belive you need to be a medscape member,

but its free and filled with lots of info!

~heather

http://www.medscape.com/viewarticle/523256?src=mp

Viewpoint: Omalizumab Pretreatment Reduces Acute

Reactions After Rush Immunotherapy for Ragweed-Induced Seasonal Allergic

Rhinitis

Posted 02/14/2006

Mark T. O'Hollaren, MD

Omalizumab Pretreatment Decreases Acute Reactions After Rush Immunotherapy

for Ragweed-Induced Seasonal Allergic Rhinitis Casale TB, Busse WW, Kline JN,

et al

J Allergy Clin Immunol. 2006;117:134-140

Summary The authors of this study point out that allergen immunotherapy (ie,

allergy shots) has been used for over 90 years. Immunotherapy has been shown to

be effective for the treatment of allergic diseases caused by sensitivity to

inhaled allergens (eg, allergic rhinitis and allergic asthma) as well as

Hymentoptera sensitivity (anaphylaxis due to bee stings). Unlike pharmacologic

therapy, immunotherapy may provide long-term benefits and is the only

immunomodulatory treatment available that may modify the natural history of

allergic disease. Immunotherapy has been shown to decrease the incidence of

sensitivity to new allergens, as well as reduce the development of asthma in

children who are treated while they have allergic rhinitis.

Patient compliance with immunotherapy may be reduced, in some because of the

extended course of treatment required and in others because of the small (but

measurable) chance of a severe allergic reaction to an allergy injection.

The investigators used rapid desensitization (1-day rush immunotherapy [RIT])

both with and without omalizumab pretreatment, and continued ongoing omalizumab

for 12 weeks after RIT. One hundred twelve patients completed this 3-center,

4-arm, double-blind, parallel-group, placebo-controlled trial. Patients

receiving omalizumab and RIT had fewer adverse events than those receiving RIT

alone. Subsequent analysis showed that omalizumab reduced the risk for

anaphylaxis during RIT by approximately 80%. Those receiving omalizumab plus RIT

had fewer symptoms than those receiving RIT alone. The study authors conclude

that the addition of omalizumab may enhance the safety and effectiveness of RIT

and may allow treating physicians to reach higher doses of allergen

immunotherapy.

Viewpoint Dr. Casale and his distinguished group of co-investigators have

conducted an important study investigating some of the basic questions in regard

to the possible use of omalizumab (a humanized monoclonal immunoglobulin [ig]G

antibody directed against human IgE) to promote safer, rapid desensitization to

an aeroallergen (in this case, ragweed) with rush allergen immunotherapy.

This is a very intriguing study. It perhaps raises more questions than it

answers, among those being the optimal duration of omalizumab after reaching

maintenance doses of immunotherapy. Further research is needed to determine when

it is safe to stop omalizumab, and what effect discontinuation may have on

immunotherapy reaction rates with subsequent maintenance injections. RIT is also

not the standard method used in allergy offices around the country because of

the increased risk for anaphylaxis that is associated with this form of

treatment. This study does, however, begin to open the view to a potential new

vista in the care of patients with allergic disease, namely, the simultaneous

use of multiple immunomodulators to improve treatment outcomes.

Abstract

Funding Information

Supported by an independent educational grant from ALTANA Pharma

Mark T. O'Hollaren, MD, Director, Allergy Clinic, Portland, Oregon;

Clinical Professor of Medicine, Oregon Health & Science University, Portland,

Oregon

Disclosure: Mark T. O'Hollaren, MD, has disclosed that he has served as an

advisor or consultant to and has served on the speaker's bureaus for

GlaxoKline, Merck, Aventis, AstraZeneca, Pfizer, Schering, and IVAX Labs.

Medscape Allergy & Clinical Immunology. 2006;6(1) ©2006 Medscape

" There is a time in every man's education when he arrives at the conviction that

envy is ignorance; that imitation is suicide; that he must take himself for

better, for worse, as his portion; that though the wide universe is full of

good, no kernel of nourishing corn can come to him but through his toil bestowed

on that plot of ground which is given to him to till. "

-- Ralph Waldo Emerson

---------------------------------

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[Guest guest]

Glad I wasn't a contestant in this one!

Thanks for sharing, .

Addy

>

> this was in the medscape weekly digest. i thought some of you

might find it interesting. to use the link below, i belive you need

to be a medscape member, but its free and filled with lots of info!

>

> ~heather

>

> http://www.medscape.com/viewarticle/523256?src=mp

>

> Viewpoint: Omalizumab Pretreatment

Reduces Acute Reactions After Rush Immunotherapy for Ragweed-Induced

Seasonal Allergic Rhinitis

>

> Posted 02/14/2006

> Mark T. O'Hollaren, MD

> Omalizumab Pretreatment Decreases Acute Reactions After Rush

Immunotherapy for Ragweed-Induced Seasonal Allergic Rhinitis Casale

TB, Busse WW, Kline JN, et al

> J Allergy Clin Immunol. 2006;117:134-140

> Summary The authors of this study point out that allergen

immunotherapy (ie, allergy shots) has been used for over 90 years.

Immunotherapy has been shown to be effective for the treatment of

allergic diseases caused by sensitivity to inhaled allergens (eg,

allergic rhinitis and allergic asthma) as well as Hymentoptera

sensitivity (anaphylaxis due to bee stings). Unlike pharmacologic

therapy, immunotherapy may provide long-term benefits and is the

only immunomodulatory treatment available that may modify the

natural history of allergic disease. Immunotherapy has been shown to

decrease the incidence of sensitivity to new allergens, as well as

reduce the development of asthma in children who are treated while

they have allergic rhinitis.

> Patient compliance with immunotherapy may be reduced, in some

because of the extended course of treatment required and in others

because of the small (but measurable) chance of a severe allergic

reaction to an allergy injection.

> The investigators used rapid desensitization (1-day rush

immunotherapy [RIT]) both with and without omalizumab pretreatment,

and continued ongoing omalizumab for 12 weeks after RIT. One hundred

twelve patients completed this 3-center, 4-arm, double-blind,

parallel-group, placebo-controlled trial. Patients receiving

omalizumab and RIT had fewer adverse events than those receiving RIT

alone. Subsequent analysis showed that omalizumab reduced the risk

for anaphylaxis during RIT by approximately 80%. Those receiving

omalizumab plus RIT had fewer symptoms than those receiving RIT

alone. The study authors conclude that the addition of omalizumab

may enhance the safety and effectiveness of RIT and may allow

treating physicians to reach higher doses of allergen immunotherapy.

> Viewpoint Dr. Casale and his distinguished group of co-

investigators have conducted an important study investigating some

of the basic questions in regard to the possible use of omalizumab

(a humanized monoclonal immunoglobulin [ig]G antibody directed

against human IgE) to promote safer, rapid desensitization to an

aeroallergen (in this case, ragweed) with rush allergen

immunotherapy.

> This is a very intriguing study. It perhaps raises more

questions than it answers, among those being the optimal duration of

omalizumab after reaching maintenance doses of immunotherapy.

Further research is needed to determine when it is safe to stop

omalizumab, and what effect discontinuation may have on

immunotherapy reaction rates with subsequent maintenance injections.

RIT is also not the standard method used in allergy offices around

the country because of the increased risk for anaphylaxis that is

associated with this form of treatment. This study does, however,

begin to open the view to a potential new vista in the care of

patients with allergic disease, namely, the simultaneous use of

multiple immunomodulators to improve treatment outcomes.

> Abstract

>

> Funding Information

> Supported by an independent educational grant from ALTANA Pharma

>

>

> Mark T. O'Hollaren, MD, Director, Allergy Clinic, Portland,

Oregon; Clinical Professor of Medicine, Oregon Health & Science

University, Portland, Oregon

>

> Disclosure: Mark T. O'Hollaren, MD, has disclosed that he has

served as an advisor or consultant to and has served on the

speaker's bureaus for GlaxoKline, Merck, Aventis, AstraZeneca,

Pfizer, Schering, and IVAX Labs.

>

> Medscape Allergy & Clinical Immunology. 2006;6(1) ©2006

Medscape

>

>

>

> " There is a time in every man's education when he arrives at the

conviction that envy is ignorance; that imitation is suicide; that

he must take himself for better, for worse, as his portion; that

though the wide universe is full of good, no kernel of nourishing

corn can come to him but through his toil bestowed on that plot of

ground which is given to him to till. "

> -- Ralph Waldo Emerson

>

>

>

>

>

> ---------------------------------

> Autos. Looking for a sweet ride? Get pricing, reviews, &

more on new and used cars.

>

>