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Venom IT - Rapid Desensitization
Venom IT - Rapid Desensitization
Rapid Desensitization (Modified Rush Protocol) Bob Erskine Associate Scientific Director
Polistes (Wasp)
1
November 2010
2010
ALK Overview
Stinging Insects
The Culprits Insects from the order Hymenoptera
Yellow Jackets (Vespula sp.) Hornets (Dolichovespula sp.) Wasps (Polistes sp.)
2010
ALK Overview
Venom Immunotherapy
History Prior to 1978
Whole Body Extracts used for immunotherapy Entire insects were dried, ground, extracted Felt to be effective
1978
Entomologist at Penn State U. developed methods to remove venom sacs from insects, collect venom. Breakthrough study published by Hunt et al.
Compared WBE, Purified Venom, Placebo. Conducted sting challenges WBE was no better than Placebo ~40% efficacy Purified Venom provided >95% efficacy Purified Venom supplied by Vespa Laboratories (now part of ASM)
2010
ALK Overview
Venom Immunotherapy
Current Single Species (YJ, YH, WFH, Wasp, or HB)
Extracts supplied for 100 g/mL venom protein at highest dose Maintenance = 1.0cc = 100ug total protein
Wasp Extract
5 Common Species
Yellowjacket Extract
6 Common Species
2010
ALK Overview
Venom Immunotherapy
Current Build-up
Traditional = start dilute, advance weekly over several months Cluster = multiple doses per week to reach maintenance sooner Rush = rapid advancement over 1 to 3 days (hospital setting advised)
Treatment duration
Maintenance advised every 4-6 weeks Treatment continues indefinitely for many patients
2010
ALK Overview
How Supplied
Treatment Kit (6 single-dose vials)
Multi-dose Vial (10-dose vial)
2010
ALK Overview
Extract Preparation
Reconstitute Freeze-Dried Venom Human Serum Albumin is required diluent
Saline, 0.4 % phenol, 0.03% serum albumin
Concentrate 100 g/mL protein 300 ug/mL (Mixed Vespid) Prepare Dilution Series 10 g/mL 1 g/mL 0.1 g/mL 0.01 g/mL 0.001 ug/mL (if neccesary)
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0.2 mL
0.2 mL
0.2 mL
0.2 mL
100 g/mL
10 g/mL
1.0 g/mL
0.1 g/mL
0.01 g/mL
2010
ALK Overview
Key differences
First dose at lower starting concentration Multiple doses per visit Achieve maintenance at week 9
10
2010
ALK Overview
Visit #1
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
3 injections
0.1 g/mL 30 minute wait after each dose
1.0 g/mL
10 g/mL
100 g/mL
11
2010
ALK Overview
Visit #2
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
0.1 g/mL
1.0 g/mL
3 injections
30 minute wait after each dose
10 g/mL
100 g/mL
12
2010
ALK Overview
Visit #3
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
0.1 g/mL
1.0 g/mL
3 injections
10 g/mL 30 minute wait after each dose
100 g/mL
13
2010
ALK Overview
Visit #4
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
0.1 g/mL
1.0 g/mL
10 g/mL
2 injections
100 g/mL 30 minute wait after each dose
14
2010
ALK Overview
Visit #5
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
0.1 g/mL
1.0 g/mL
10 g/mL
2 injections
100 g/mL 30 minute wait after each dose
15
2010
ALK Overview
Visit #6
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
0.1 g/mL
1.0 g/mL
10 g/mL
2 injections
100 g/mL 30 minute wait after each dose
16
2010
ALK Overview
Visit #7
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
0.1 g/mL
1.0 g/mL
10 g/mL
2 injections
100 g/mL 30 minute wait after each dose
17
2010
ALK Overview
Visit #8
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
0.1 g/mL
1.0 g/mL
10 g/mL
2 injections
100 g/mL 30 minute wait after each dose
18
2010
ALK Overview
Visit #9
ALK Pharmalgen Package Insert
Cluster Protocol 9 weeks to maintenance
0.01 g/mL
0.1 g/mL
1.0 g/mL
10 g/mL
1 injection
100 g/mL 30 minute wait after dose
19
2010
ALK Overview
Venom Expiration
ALK Pharmalgen Package Insert
20
2010
ALK Overview
10
More Information
Review Articles
J Allergy Clin Immunol. 2011 Apr;127(4):852-4 e23.
http://allergyparameters.org/file_depot/0-10000000/3000040000/30326/folder/73825/2011_StingingInsect.pdf
21 2010
ALK Overview
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