Position Statement Specific allergen immunotherapy for asthma A Position Paper of the Thoracic Society of Australia and New Zealand and the Australasian Society of Clinical Immunology and Allergy emetic, arisen, Cries ‘ha ayo me pe say Soe se Soon ap id ‘Sr aos ee ape SIGE Soe eee in controversial. Despite th, the Thorne Society SSEENSAE Ny Daten Mane Sey saat Del at ney es See SRLS eS ea este TSMAN GR Seen eae ‘Aopy.allorgens and asthma Sure co an alergunflloving prior exposure, and mediated an mmane acon nwone IB. These iil p= ‘Atopy i ances tendency to IgE-bsed eesiviy ‘suing in producon of pei IE annibody ovironmental alleen, sacha hose dst ‘moulds or anal dance. Thi sen enclly preioposed people ser expos Sereaone of allegen gue smoke tn el inecone About 40% of he popalition i tei, and shout half of this proup deep cnaldeaesnging om al hin ‘exponare co allergens leads to a sgniican increase in the prsalene of na Ninety percent of enren and 88 of ads wid asthma ar wopic* Once sensation bat ‘scented, r-exponut oles aval factor fo nace ‘includes pharmacologial therapy and allergen avoidance Foreranipie aoiting dust mt allen an reduce sp toms spd the need for nection, Rationale for using immunotherapy fr asthma ‘Astuna a sfammtory dase cared bythe pee nein lt itrstion between tes cl, becuse ofthe sey of tokneswaich hve vale of communication and b= fear proper, Chemotins sta cull o {roi ofthe process econday cheng or ch ticaning of Satement hembra ans foros vent of aieway inflammation in mang cases of asta (Continued exposure o lg rr sy cen na ‘ey ad eon raion, monn, of ‘and cyzokine interacions by diverse mechanisms, bat donot {dives the inating evene in slegie atin, By wat ‘wigeer of asthma. Tenmunalogical changes have been described af serum IgE, followed by a fall, and arise in specific IgG (olcting aiboay"). Specie gO tes crete poorly ‘redaction in meiaror release from mast cells vr, al ‘ions in ymphoehe rubs, and» downgegulstion 91 ‘esponsvense rnotherpy "Tae are song theres! eguness why immonote spy ould be wed ear in che course of te disease, ble imsmanosherapy may sto inence the prose of fal dara” immunotherapy soa pr be repre 22 Sleatie oestabshed fre of proven ay = ommended by the Nationa Asta Campaign" As temic com Sen anal munothrapy as 0075linia ile ‘ett doe tnd wal ofmumenrany fr aha, (Cemparon af thea itn nv oly beat of ie Inheree problems of il avlvag sta (ouch ssa Garision of lncuon nd wstense cate), but rene A meta-napicn aes some oes icles fn has ese bee sped 20 eadomied contd tll of tnoterspy forthe in oth als an c= rn." Ts metr-naita found aly uel apo ‘eat fom iemaosherpy wit hoor det mite ant sith ‘ther alergen (ee Box) Teconladed ta auunoterspy iea trentmenc option in hshy wld pens (eued sis and Rute conti sae pbs inthe at ee ears provide erence to the mon important tal of Akhough sever outs of allergen detivery have been wed ‘uid in ders and sh ob elective Giving alesgen ‘uact sublingual isnot recommened ae sruiet hive [edt show lagen een Til th pin ich pollen orally appeared promising, but iarge doses were Fuel and there ms afighinchenceofide fects Par ‘her studies of orl immanetherapy ng mos pepe ‘aon ae underway. Iensasdminiraon of ples {strat reuted in an aonceptble lvl of tide ees but failed to produce significant clinica improvemest.™ “Mose alegen exacts ed in Austral for nance ‘akof serious anaphylaxis and providing sustained immune “Thetis no elie stendardsaton of Solgar formaty allergen exsace weed n Aurea Nast 408 coo (totraton of cre material ate not wae pues le lopel scsi The ceacentradons of the slow-eease (alun-precusted) pepantions ar epreeed a “pro !lcogen unis and not lope sty gues orpae Tatons of some allrens, including Dermasplagie: epee andasied tsar a WHO ra sed fre exemely potent’ ‘Theis we Ia anima should be ‘ested to pelt cents Advorso tects ‘be expected. It may persis for 24 hours or more and is not ‘care for concen. A sore wvere reason ove 90 min WA Vol167 ST November 1997 Position Statement Sreymotoms and clucton tt medeaton a ore bjeanarponienee sr innsataapy ome ‘ttn bysoramson ta) Howse Golars mies Sra epee STN EST ameter sm nication for rection inthe subses ‘systemic resetions “These include sneering, broschospiam, rica and in more severe cates, ancy Wah Appotnson nd cok ape, They must sways be vegded seriou though ‘hey sully occur within 30 mats of he neon they Spaced prepeene Resane dee Gom che UK eatinate slum-precpitted exracs appeared be much er The neice of anphylane wth Allyl (Bayes, Pyable, ‘saps endlorbronchosaa, 1 in 14998 cours of The Commins on the Safety of Medi athe Unies Kingdom, reported in 1986 ct in the 29 yeas een 1957 Batientr where the inieton or therpy wae sth. Highly pried sna potent agusousexracs were naive inmost of these dew and ae dente were reported ith the Alpyrl exact Subuegueat epors indicted 8 mich lower inedence of sgn nd deat in France athe US," where oe majraifrence in racic that est ‘ments adminseced by pein with experts in he re 1s Aura fe deaths from immunotherapy were repored to the Adverse Drug Redctons Advisory Com tives inthe 21 ees from 1972 to 1993. Four were in ‘There ie no inereate in the preilense of reset ssaoimmune diene or monoiooa gmmopeiee ie of loog term worsening of astm oocure with smmanatheraps.Position Statement Practical aspects of adminitering immunotherapy “These uieines reece specie allergen immunothersey forthe westmunt of ena in pases wt ial man fenatons andlor need for ement of ongoing brn) peed “The decscn to prescribe immanotherepy i based 00 appropriate patient selection, appopeste anges secon, td wheter portal bene outweigh seoceed ist the management ofboth osthns and imenanotherpy souls tate the decion. Suitably qualified prctsones neu ‘horse pss with ning snd expert alley oF ‘neal mmancogalerge with tinged expertise in ahms It he responsi of the sperving cone. "ant to) dei wheter a patent need abe westd in 8 homial and() ense tar the medial pratont ging ‘nformad consent scearsing to catrenty sccered rien most he cbuined fom patents before starting Fnumocccerey sitative procedures, and in a secing where the folowing Feousitation equipment is mediately abe: een: ne 11000 fer emaras se (adenine he og of to immune), ope, anata bg abd mea es ‘so, tebuler and bronchodistor agbulze sion, heels and abi for venous sca ren fs Second appropestey waised health eae profesional Should be present Sug immunotherapy to sai ire scooeding to the degre of sestvty and cna reaction the injections. The principle of therapy et gt ih 8 Sonal dove an gradually increases oleate. Supervise schedule, Flexibility in dosage is eweetal and rigid adher- nce predeeenined doege schedle inappropie. ‘Bstnacts should be sored sn a rafigeator at 4°, leap med withthe pants enter) and ceplaced inthe epertr mena erase Before icin tbe friract shold be examined visu and dared i ts ppeaance hs changed. The content ofthe bole should ‘etmied well to roe vaio in dvoge When changing ts anew bath of unstndardad ett (acs a Alea ‘he far dose sould be reduced by 255 fo tae seco oF Each patent should have his or her own individal vial of Tavs in some Sates fetid mull ee of al or Brey patient should be aszessed clinically on sack ‘ceasion before an injection te pion wth pari hae srercrreariloestresctent the neon at ‘Spiromety or peak lo mete readings mast be thse ‘ore njertian ant sfmore tan 20k Bow the Best eet ‘corded eaing orca pases, he neon should not be fea The esdngs shoul berepeted 30 ines ser be ‘ie dring he period of obseraon a fall of 10% er ‘more an indixton fr reduceg the dae the eat ee. ing the dore and having it checked bya second health peo- fesiooa Tnjesns are gen subeutmecuy asta te bang the sue ovejing he wep mele group. Aer ‘coucing te eee and belo strung econ be ple shoul ety coe a eee ‘There i no consensus about che optimal oe that pwient mus remain under obseraation However, we ee. fire Rasesons may be delayed sh lsm-pecpated rpunions tt they te cry mint, Beers docharge sent shoul be sxamined fed te ne of he oe Fencon, ene tha thet ate be sgn of sen eee ‘Son, adie epeae poe a pen ow sess, Paes ‘user engage i strenuous sys exercise or take et ‘ths orenunas frst hours ae he econ. Pate i mor has le a os x ‘Sthne and imoruothery ‘Teal eweling larger han 50 mum requis eduction a tonspe, Pres should be instructed to mesure he dan ‘sr of alc eacton sho snr nae ere ‘Some practioner "coter”therpybygting opi ‘se shrines eds the lel revetons The pe ‘Seema tke dete judge te ees of ery, th locally and systema and to modify dorage according [Rima so Hock he nil manifestations ofan saptacte acto, Use of ts practice a mater of fuagerent but {propglacc drug reused we must be consent. Apyal preparaions are administered every 1-2 weeks until Smamtentoce dose reached. Maitenace ijecions se ‘Miminiserea every 2-4 wees Icsbould be sesmpaied edols ae not econmende, peru when aquest frac, which we becoming more sendy vase A> ‘la ee use. The dation of therapy x opal anagenet snmmanotheap teri cidence tte eae ai ‘anes niectons wil provide long ern potstion asst ‘llegy and practice vais, Dust mite fection see often ompoed fo 23 yar if sre i a esponse sd prse= Saal immunotherapy with ges plea epeated fr 2-3 MIA Vel167 $7 November 1972 Document sesianon tothe lise reerant scrolegen (by sine or aileron ts) 4. Fura exposre othe leg shouldbe unavoidable 4. Atcha smpcoms ould be sable, Howeres the Contraindceion foe therapy, but mold determine ‘tether the jecine soul be sa fn oral (Gee consandeaons and prcsl spec), 5 Significant seric upper aenay or ocr disse scengtens he ndcnon. Cn exerence improves he management af atin. The efisey Contradiction for immunotherapy ‘elaivecontraneations 1, Ifthe FEV, (ored expiratory volume in on second) Isls ha 70% of preted then amotherapy ssthma and immunotherapy has erablsbed thot the ote Benet ove anit and the amine ‘eon eavroment ables aca apes) (ering exert), pea ow ering ore {han 20% ors broncbodsoreponse fees than 20% are lav cninceaon obo tang Ashi should nor be given immunodherepy out showin 5. Immunotecapy she not be nated in patients ‘wh romanane eave or allenany,abough stoi wath en inceased rak of termepeneis. Absolute containdiations 1. Concomisadisinieaton of lockers nd immunotherapy r abetuey cosines because pet taking blocks ae at ncaa ik ef (oot hatte we of lockers conte i, ‘ronal sam, Position Statement lege sin as hee exiabed ba mo ehe jet fhe epor, ‘An eee alleen exc shouldbe aaah "Etccy has been enabled fr grasp caged pollen North Armes), hese dt mite, poten ‘therapeutic al with « commercially available Paints or prenguardans ould beable ge Informed cone Othe, ss angle, ators, sch wailing of ‘he puter 6 cominae with indefaie dra heyy fe he quai of Me dsred by the pate walle be given because ofthe rik othe feus ofa systemic Should bronchospasm wan murat dose cer the therapy sal be respended pending ‘whsther te isk of continuing withthe testers Fond hints ith ese may noel of skin lieve ding mmunowerspy and shoal be sppeo- Print inormed Agia redo a darage ‘Wie immunotherapy fo ihn appears obe more chen with seasonal fever and mild coeistent ‘sth, clncns shuld consider srely whether Indiesion othe neater). Lack of adequate eaciaton fis and equipment Previous anapylsti ecton wo innnoheapyPosition Statement ie ae a Obituary Karl George Ball luBB5, FACOG, FRACOG at George Ball was born ot Petr Borough, South” Avera, cn 12 ecember 1924s die i Ada u's November 1994, Hed meine st the Universiy of Adee, gredetng 1046, Ate aabor prod sete pasta, Ihe walned a obretes and gynaecology athe (Queen Vitora Hosptial, Adee snd then t ‘he Royal Hobere Hew With fre sis a Rada nrmary (Oxford, Unie Kington) the stained membership of the Ropl Colle Obgeicans and Gyeaeologie in 1954 ‘Royal Adelaide Hospital and the Queen Viezoria Hospital In 1969 che Quoen Vicia changed ism a purl tet ‘Karl was a bighly respected clinician, who counted among wives. He was forward-thinking ond compassionate man, being and quality of she was with thew paysel beat ‘nis rerun om Oxford vse space tat eas‘ acon ofthe eoneratne Ale Toad estaclment ith a nee pes Seeving ie starar gu, tt eather 4 reas ‘hinded iberal (Setotely “si with a eh ot Hewes = oanding meer ‘ot FamlyPaoning South Australians fequently ie Presdeat snd. Chritman for he moderaeasion of Sruth Auatlen "is sow manner ofspeec concaid aa cit sand ila tttec. What he Icke la speed dairy debate and teaching he more tne up for wit ir lary of thous ad ieee lows ‘ecnjoyed baseball (bad represented South Aucralt hile an undergrads) and gland ws intreed fhe "Kat is rorvied by hi thre one roof whom ce md el practidenars— Devi, = rditon oncology Mel bourne, and Andiew, » medial olfcer wit the World “Heats Organza in Geseva~~and by oor ranches