Cluster Immunotherapy: Rapid Desensitization
Allergen cluster immunotherapy, or allergy shots, is a disease-modifying treatment for allergic disease. It has the advantage of actually decreasing or eliminating allergic disease versus the use of medications which just treats the symptoms and the subsequent associated inflammatory changes. Traditional immunotherapy was first described and successfully used since 1911 by Leonard Noon in London. Accelerated immunotherapy schedules have been described and used since 1930 by John Freeman, who was one of the original co-developers of immunotherapy.
Cluster Immunotherapy Treatment
Cluster immunotherapy (rapid desensitization) is a method of accelerated desensitization utilizing allergy shots in clusters or groups one or two days a week until a maintenance dose is reached. This progression is usually accomplished in five or more weeks. It may be longer depending upon the rate of allergic reactions. Reaction rates using pre-medication are similar to conventional immunotherapy ranging from 0 to 33%.
The Cluster Immunotherapy Advantage
The advantage of an accelerated cluster immunotherapy program is achieving maintenance dose quicker, but it involves a more concentrated time requirement in the first five or more weeks compared to conventional immunotherapy schedules. In addition, there may be a higher risk of allergic reactions but overall appears to be comparable to traditional immunotherapy schedules. They both provide the same effectiveness once the maintenance dose is obtained.
Pre-medication is required for cluster immunotherapy two hours prior to the injection(s), typically with specific antihistamines, leukotriene modifiers or more depending upon each individual case.
Cluster Immunotherapy Schedule
A typical cluster immunotherapy schedule at Allergy & Asthma Care is as follows:
Week 1: Two days of clusters (both include three injections) with a total time of at least 1.5 hours.
Week 2: Two days of clusters (three injections, then two injections) with a total time of at least 1.5 hours and one hour respectively.
Week 3: One day of clusters (two injections) with a total time of at least one hour.
Week 4: One day of clusters (two injections) with a total time of at least one hour.
Week 5: One day of clusters (two injections) with a total time of at least one hour.
Week 6: One dose at maintenance with a total time of at least one hour.
Week 7-10: One dose at maintenance at five to seven-day intervals and then slowly spread out to increasing intervals up to a maximum of monthly injections.
Hours for Cluster Immunotherapy
(Please allow for wait time when choosing schedule.)
Monday
8:00 a.m. – 3:15 p.m.
Tuesday
8:00 a.m. – 10:15 a.m.
1:00 p.m. – 3:15 p.m.
Wednesday
8:00 a.m. – 10:15 a.m.
1:00 p.m. – 3:15 p.m.
Thursday
9:00 a.m. – 12:15 p.m.
3:00 p.m. – 4:15 p.m.
Friday
8:00 a.m. – 10:15 a.m.
1:00 p.m. – 3:15 p.m.
Saturday
8:30 a.m. – 10:00 a.m.
It is strongly suggested that all patients on allergy injections have an epinephrine auto-injector with them and show the nurses before the shot can be given.
Waiting Times for Allergy Injections (4/30/2014)
Periodically, expert panels are convened by the United States Food and Drug Administration and the U.S. National Institutes of Health to review and re-formulate national guidelines for various aspects of medical practice. These meetings allow experts to make recommendations based on the latest developments and knowledge in many fields of medicine.
Recent guidelines specify a 30 minute waiting time after allergy injections. This represents a change for our patients. The guidelines further specify longer than 30 minute waiting times in certain selected cases. Effective immediately, we are requiring our immunotherapy patients to wait 30 minutes after allergy injections as we follow the national guidelines.
We apologize for any inconvenience.
