Subcutaneous immunotherapy (SCIT) (#ACAAI19 Twitter summary)

Kevin Parks MD @kparksmd: Oppenheimer: wide variability in Der f1 and Der f2 content in extracts used for HDM SLIT (European study) - hence our practice parameter continues to discourage non-FDA approved SLIT products.

Doing SLIT for Timothy grass pollen doesn't have bystander effect, ie did not reduce birch pollen.

IT data seem consistent in duration of therapy conferring long-term remission of symptoms: minimum 3 years continuous therapy is key (SLIT or SCIT). Would be nice if the US indication for SLIT reflected worldwide data.

Tankersley: use ONE immunotherapy build up schedule to avoid dosing errors by staff.

Tankersley's TN study on a Saturday morning IT clinic: 91% did not wait at all in the office; 4.7% waited 1-9 minutes; 3.4% waited 10-20 minutes. We're probably a little delusional about post-IT wait patterns. Most people just bail.

Tankersely: if you have mold spores and pollens in the same vial, you're giving placebo IT (highlighting proteolytic enzymatic activity). Probably true. Maybe some weed pollens are more resistant but good advice.

Gerald Lee MD @DrGerryLee: Tankersley recommends a close followup appointment to improve adherence to new immunotherapy starts. How soon do you followup after starting IT?

Mike “Tank” Tankersley’s Tips:

Robert Rogers @choirdoc Dr. Nelson reviewing immunotherapy during #ACAAI19 Lit Review. Always excellent. Showing data that inhalant allergen immunotherapy markedly reduces new onset asthma as well as increasing the likelihood of becoming asthma medication-free in those with asthma.

Kevin Parks MD @kparksmd: Jay Portnoy MD surveys IT session attendees in the room (some selection bias obviously), and about 1/2 already offer cluster IT, about 1/4 have experience with RIT.

Portnoy: we do rush VIT in 150 minutes (patients reach maintenance dose in one day) with fewer systemic reactions compared to inhalant IT.

Robert Rogers @choirdoc Most amazing fact learned today: there have been no infections of any type reported in 17.3 million(!) allergy injections. How will we measure improvement based on the proposed new compounding guidance?

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