Rush immunotherapy provides accelerated allergen immunotherapy by administering shots in quick succession to reach the maintenance dose more quickly than standard immunotherapy schedules. It may be appropriate for patients with life-threatening insect venom allergies, those who live far from treatment centers, or who have busy schedules. Advantages include inducing long-lasting immunological tolerance and preventing the development or progression of allergic diseases. Additional research is still needed to determine optimal dosing strategies and durations of treatment for both subcutaneous and sublingual immunotherapy. Patients and providers should discuss the benefits, risks, and requirements of immunotherapy to make informed decisions.

1. Rush Immunotherapy
The Optimal way for the busy patient
Dr.Saied Alhabash
Medcare Sharja Hospital
Canadian Speciality hospital

5. Accelerated, or rush, or Cluster
 immunotherapy is done very quickly to increase your tolerance to an allergen.
 There are different schedules for the shots that try to achieve a maintenance dose
more quickly than standard immunotherapy.
For example, a rush immunotherapy schedule might include:
-Shots given every few hours instead of every few days or weeks.
-Maintenance dose reached in 1 to 8 days.

6. Rush Immunotherapy
 You have a life-threatening allergy to insect venom, and the insect season is about
to start.
 Shots are only available in a clinic that is far away from your home, and you cannot
come in once a week for months.
 You have severe allergic asthma.
 You are about to travel.
 Busy and rush like in Dubai

7. Advantages
 Allergy is increasing in prevalence and pharmacotherapy alone cannot control the
disease.
 Allergy immunotherapy induces immunological tolerance and changes the course of
disease.
 Allergy immunotherapy has long term effect extending beyond termination of
treatment.
 Allergy immunotherapy prevents asthma in children with rhino-conjunctivitis.
 Allergy immunotherapy improves quality-of-life in patients suffering from allergy.

9. What is immunotherapy?

10. Sublingual Immunotherapy
(SLIT)

11. Everything Evolving……

12. Evolution in Medicine……

13. Evolution in Immunotherapy……

15. Has clarified the Mechanism of Action
of Sublingual Immunotherapy or rely
on Insufficient or Empirical data?

16. (Novak N , Allergy, 66:733-739,2011)
Mechanism of Action (Ι)

17. Is SLIT Effective?

18. Study data from 2003 to 2011
60 studies (49 for meta-analysis)
About 4000 patients
Study data until 2003
22 randomized, controlled studies
About 1000 patients

19. Improves the Quality of Life
in SLIT Patients;

20. (Morris MS , Journal of Allergy, 2012:ID 253879,2012)
Quality of Live

21. Is SLIT Safe?

22. (Radulovic S, Allergy, 66:740-752,2011)
Safety of SLIT

23. Is it Equally Effective the SLIT Therapy in
Mono-Sensitized and Poly-Sensitized
Patients ?

24. (Malling HJ , Clin Exp Allergy, 39:387-393,2009)

25. There is Dirrect Comparison Between
SLIT and SCIT ?

29. Very Critical points in Immunotherapy
 Allergy Prick test Vs Ig E specific
 Matching between Symptoms and exposure
 Individualizing every patient

31. Allergy Prick test
 Avoid Antiallergy medication before
 Relatively Subjective
 More convincing for the patient
 Insurance Issues
 Financial Issues

32. Repiratory Allergy Panel
 Ig E Each
 Costly
 Less specific and more sensitive

35. What make allergy in UAE
 HDM : the most popular
 Pets(cat, Camel, cockroach)
 FungiPollen

36. Fungi
 Cladosporiym
 Aspergillus
 Alternaria
 Candida

37. Trees and Shrubs
 Grass Pollen(Bermuda, Timothy )
 Trees (Acacia,Birch,plumeria ‫,فتنة‬blumeria, Artemisia vulgaris.rosemarinus ‫اكليل‬
‫,الجبل‬ dolinex ‫,بونيسيانا‬amaranthus ‫القطيفة‬
Careless Weed, Amaranth/Green
Amaranthus hybridus
 Strawberry
 Fragaria chiloensis

38.  Mango Blossom*
 Mangifera indica
 Bougainvillea ‫المجنونة‬
 Camillia

52. Ig E Vs Ig G
 Delayed response- Food only
 Many companies like imupro and others
 Food Intolerance
 Big subject
 Still ambiguous but very promising
 Related to many unexplained symptoms like fatigue , urticarial reactions ,…. But
needs more investigations
 Very beneficial for children

53. The Features of Immunotherapy in UAE
 Fungus play more role
 It is unusual to have Alder or Birch allergy , Although it is existing –search about
the trees around you because the trees in UAE is very carefully selected to adapt in
the humid hot climate , and it is not easy to correlate with specific family
 Consult experts in agriculture and contact with your patient to get the photo of the
trees around him.
 Think cleverly regarding the insurance issues , and try to select the cheap
companies as it should cover for 2 years at least

54. What about Humidity
 Higher humidity in the home creates an environment for two of the
most common and undesirable triggers for asthma and allergy –
dust mites and mould.
Dust mites
 Dust mites like moderate temperatures and high humidity (usually above 70 percent). They are
found in bedding, flooring, window coverings and furniture. Their poo is the main culprit and is
small enough to become airborne when stirred up.
Mould
 Mould needs long periods of humidity to grow. Houses in tropical areas or with rising damp may
be more at risk. Poor ventilation may mean a bathroom or built-in robe can produce mould, even if
not in humid areas.

55. So how can I control the humidity in my
home?
 Refrigerated air conditioners may reduce absolute humidity when they are cooling and relative
humidity when they are heating.
 Dehumidifiers will extract water from the air and reduce humidity.
 Most forms of heating will lower relative humidity however it is a good idea to avoid unflued gas
heating and open fireplaces.
 Insulation helps keep your home warm in winter and cool in the summer.
 Humidifiers may be suitable for very dry climates.
 Except in very dry areas, an evaporative air-conditioner should not be used as it will increase
humidity.
 Ventilation and improved circulation of air can be a cheap and effective way of reducing humidity.
 Heat recovery ventilation can also reduce relative humidity.
 Extraction fans should be used in bathrooms and laundries as hot showers and dryers can
dramatically increase relative humidity – these areas are often prone to mould growth.

56. There is sufficient evidence to support the overall
effectiveness and safety of both subcutaneous
immunotherapy (SCIT) and sublingual immunotherapy
(SLIT) for treating allergic rhinoconjunctivitis and asthma.
However, there is not enough evidence to determine if
either SCIT or SLIT is superior.
SCIT and SLIT are usually safe, although local reactions are
commonly reported regardless of the mode of delivery.
Overview of Conclusions (1 of 2)
Lin SY, Erekosima N, Suarez-Cuervo C, et al. AHRQ Comparative Effectiveness Review No. 111. Available at
http://www.effectivehealthcare.ahrq.gov/allergy-asthma-immunotherapy.cfm.

57.  Serious, life-threatening reactions are rare, although they can
occur.
 Studies of sublingual immunotherapy (SLIT) mainly include
patients with allergic rhinitis and/or mild asthma.
 Safety outcomes should not be extrapolated to more severely
affected patients.
 Most of the studies in the review used a single allergen for
immunotherapy, and it may be difficult to extrapolate these
results to the use of multiple-allergen regimens, which are
commonly used in clinical practice in the United States.
 Due to the wide variety of reported regimens, the target SLIT
maintenance dose and duration of therapy are unclear.
Overview of Conclusions (2 of 2)
Lin SY, Erekosima N, Suarez-Cuervo C, et al. AHRQ Comparative Effectiveness Review No. 111. Available at
http://www.effectivehealthcare.ahrq.gov/allergy-asthma-immunotherapy.cfm.

58.  Additional studies are needed on:
 The efficacy and safety of multiple-allergen subcutaneous (SCIT) and
sublingual (SLIT) immunotherapy
 The effectiveness of single-allergen versus multiple-allergen SCIT and SLIT
for desensitization
 The efficacy and safety of SCIT and SLIT in specific subpopulations
(pregnant women, monosensitized vs. polysensitized patients, patients
with severe asthma, and urban vs. rural patients)
 Whether or not SCIT and SLIT can prevent or modify the atopic march in
pediatric patients at high risk for allergic rhinitis and asthma, as well as the
optimal age to initiate therapy
 Determining the target maintenance dose, dosing strategies, and the
necessary durations of treatment for SCIT and SLIT
 Direct comparisons of SCIT to SLIT in pediatric and adult patients
 Optimizing allergen standardization for subcutaneous and sublingual
regimens
Gaps in Knowledge
Lin SY, Erekosima N, Suarez-Cuervo C, et al. AHRQ Comparative Effectiveness Review No. 111. Available at
http://www.effectivehealthcare.ahrq.gov/allergy-asthma-immunotherapy.cfm.

59. The benefits and adverse effects of subcutaneous (SCIT) or
sublingual (SLIT) immunotherapy for them or their child
Any comorbid conditions that they or their child may have
that would affect their ability to take SCIT or SLIT
Other prescription or over-the-counter medications they are
taking during SCIT or SLIT treatment
What adverse effects to look for and when to call their doctor
How often they should be taking SCIT or SLIT
How long they can expect to take SCIT or SLIT
The costs of SCIT and SLIT
Shared Decision making:
What To Discuss With Your Patients
Lin SY, Erekosima N, Suarez-Cuervo C, et al. AHRQ Comparative Effectiveness Review No. 111. Available at
http://www.effectivehealthcare.ahrq.gov/allergy-asthma-immunotherapy.cfm.

60. Massages you should know
1- Please start it ,It is really very beneficial for the patient
2- Please again If you do not want to do it ,Do not say that is not useful
3-Please again and again ,If you want to start it get good knowledge, prepare all the
replies for the patient and make the patient benefit your target.
4-Be sure of the correlation between the history and the tests
5-Take care of the features of the country you are working in