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Practical recommendations for mixing allergy immunotherapy extracts.

Daigle BJ, Rekkerth DJ - Allergy Rhinol (Providence) (2015)

Bottom Line: Some components in allergen extracts are cross-reactive, meaning that treatment with an extract from one species may confer partial protection against a triggering allergen from another species.Therefore, knowledge of allergen extract cross-reactivities and incompatibilities guides the preparation of subcutaneous immunotherapy prescriptions.In a clinical setting, an understanding of what can and can not be mixed is one critical element in improving treatment outcomes.

View Article: PubMed Central - PubMed

Affiliation: Eastern Maine Otolaryngology, Bangor, Maine, USA.

ABSTRACT
Critical aspects of formulating allergy immunotherapy vaccines include the selection, total number, and proportions of each allergen component in therapeutic mixtures. The immunotherapy prescription, determined by a medical provider, details the dosing and schedule for treatment as well as the specific composition of the treatment vials. Allergen extracts are composed of many components such as proteins, glycoproteins, and proteases. Some components in allergen extracts are cross-reactive, meaning that treatment with an extract from one species may confer partial protection against a triggering allergen from another species. Conversely, some allergen extracts are incompatible with other extracts when combined in a mixture for treatment, resulting in lowered therapeutic potential for the patient. Therefore, knowledge of allergen extract cross-reactivities and incompatibilities guides the preparation of subcutaneous immunotherapy prescriptions. In a clinical setting, an understanding of what can and can not be mixed is one critical element in improving treatment outcomes.

No MeSH data available.


Mixing recommendations for subcutaneous allergen extract immunotherapy: extract compatibilities after storage for 1–3 months at 2–8°C in (A) 0–10% glycerin, (B) 25% glycerin, or (C) 50% glycerin. In this two-way chart, the combination is designated as unstable if either of the components have reduced potency on storage. Mixtures are designated as compatible (green), partially unstable (yellow), or not recommended (red) according to research presented by Cox et al.1, Esch19, Grier et al.,33 and Esch and Grier.34 © GREER 2015. Reprinted with permission from GREER Laboratories, Inc, Lenoir, NC.
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Figure 1: Mixing recommendations for subcutaneous allergen extract immunotherapy: extract compatibilities after storage for 1–3 months at 2–8°C in (A) 0–10% glycerin, (B) 25% glycerin, or (C) 50% glycerin. In this two-way chart, the combination is designated as unstable if either of the components have reduced potency on storage. Mixtures are designated as compatible (green), partially unstable (yellow), or not recommended (red) according to research presented by Cox et al.1, Esch19, Grier et al.,33 and Esch and Grier.34 © GREER 2015. Reprinted with permission from GREER Laboratories, Inc, Lenoir, NC.

Mentions: The allergenic products with the highest protease activity are insect and fungal (mold) extracts. As an example, studies have shown that the potencies of representative grass and tree pollens, as well as cat, dog, ragweed, and other weed extracts, are reduced when these extracts are mixed with mold or fungal extracts (Alternaria, Aspergillus, and Penicillium).1,5,29–31 Certain mixtures of fungi and insects are also incompatible. For example, Alternaria extract did not retain potency when mixed with insect extracts and German cockroach extract did not retain potency when mixed with fungal extracts.31 Dust mite extracts manufactured in the United States can be successfully mixed with grass pollens because they are more highly purified than European dust-mite extracts but may be unstable when mixed with molds.19,28 Recommendations on considering incompatibility when mixing treatment vials are based on ongoing research and summarized in Fig. 1.1,19,28–33


Practical recommendations for mixing allergy immunotherapy extracts.

Daigle BJ, Rekkerth DJ - Allergy Rhinol (Providence) (2015)

Mixing recommendations for subcutaneous allergen extract immunotherapy: extract compatibilities after storage for 1–3 months at 2–8°C in (A) 0–10% glycerin, (B) 25% glycerin, or (C) 50% glycerin. In this two-way chart, the combination is designated as unstable if either of the components have reduced potency on storage. Mixtures are designated as compatible (green), partially unstable (yellow), or not recommended (red) according to research presented by Cox et al.1, Esch19, Grier et al.,33 and Esch and Grier.34 © GREER 2015. Reprinted with permission from GREER Laboratories, Inc, Lenoir, NC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388870&req=5

Figure 1: Mixing recommendations for subcutaneous allergen extract immunotherapy: extract compatibilities after storage for 1–3 months at 2–8°C in (A) 0–10% glycerin, (B) 25% glycerin, or (C) 50% glycerin. In this two-way chart, the combination is designated as unstable if either of the components have reduced potency on storage. Mixtures are designated as compatible (green), partially unstable (yellow), or not recommended (red) according to research presented by Cox et al.1, Esch19, Grier et al.,33 and Esch and Grier.34 © GREER 2015. Reprinted with permission from GREER Laboratories, Inc, Lenoir, NC.
Mentions: The allergenic products with the highest protease activity are insect and fungal (mold) extracts. As an example, studies have shown that the potencies of representative grass and tree pollens, as well as cat, dog, ragweed, and other weed extracts, are reduced when these extracts are mixed with mold or fungal extracts (Alternaria, Aspergillus, and Penicillium).1,5,29–31 Certain mixtures of fungi and insects are also incompatible. For example, Alternaria extract did not retain potency when mixed with insect extracts and German cockroach extract did not retain potency when mixed with fungal extracts.31 Dust mite extracts manufactured in the United States can be successfully mixed with grass pollens because they are more highly purified than European dust-mite extracts but may be unstable when mixed with molds.19,28 Recommendations on considering incompatibility when mixing treatment vials are based on ongoing research and summarized in Fig. 1.1,19,28–33

Bottom Line: Some components in allergen extracts are cross-reactive, meaning that treatment with an extract from one species may confer partial protection against a triggering allergen from another species.Therefore, knowledge of allergen extract cross-reactivities and incompatibilities guides the preparation of subcutaneous immunotherapy prescriptions.In a clinical setting, an understanding of what can and can not be mixed is one critical element in improving treatment outcomes.

View Article: PubMed Central - PubMed

Affiliation: Eastern Maine Otolaryngology, Bangor, Maine, USA.

ABSTRACT
Critical aspects of formulating allergy immunotherapy vaccines include the selection, total number, and proportions of each allergen component in therapeutic mixtures. The immunotherapy prescription, determined by a medical provider, details the dosing and schedule for treatment as well as the specific composition of the treatment vials. Allergen extracts are composed of many components such as proteins, glycoproteins, and proteases. Some components in allergen extracts are cross-reactive, meaning that treatment with an extract from one species may confer partial protection against a triggering allergen from another species. Conversely, some allergen extracts are incompatible with other extracts when combined in a mixture for treatment, resulting in lowered therapeutic potential for the patient. Therefore, knowledge of allergen extract cross-reactivities and incompatibilities guides the preparation of subcutaneous immunotherapy prescriptions. In a clinical setting, an understanding of what can and can not be mixed is one critical element in improving treatment outcomes.

No MeSH data available.