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Our group has published 2 case series describing a rush subcutaneous immunotherapy (SCIT) schedule administered using a subcutaneous infusion pump [1,2], in which the maintenance dose was reached after 3 visits. This type of rush protocol with SCIT provides a rapid clinical response, improved adherence, and increased cost-effectiveness owing to the lower number of visits and doses [3-5]. The aim of this prospective, observational study was to shorten the protocol to a 1-day schedule (4 hours) while maintaining its real-world applicability and evaluate its safety, with and without premedication. We selected patients with rhinitis and/or asthma due to sensitization to cat and dog dander for which treatment with immunotherapy was indicated [6]. For a patient to be included, clinical symptoms had to be clearly related to exposure to cat or dog dander, and specific IgE to cat or dog extract had to be confirmed by skin prick test (ALK) and/or in serum (CAP Thermo Fisher). Randomization was achieved by recruiting consecutive patients, beginning with those who did not receive premedication followed by those who did, at an approximate ratio of 3:1. Patients or their guardians signed an informed consent document. The study was approved by the local ethics committee (FJD-ALG-15/01). Rhinitis and asthma were classified according to the ARIA and the GINA guidelines, respectively. Premedication consisted of oral administration of 10 mg of cetirizine 2 hours before the patient re-ceived SCIT. Maintenance vials of Alutard SQ cat and dog extracts (ALK) were used as appropriate. A portable subcutaneous infusion pump (Medis Infusa T) and infusion set (Accu-Chek TenderLink, Roche) were used to administer extracts. The pump was adjusted to deliver 1.2 mL over 4 hours, and all patients remained under observation for 2 hours after the infusion. One month later, 1 mL of the extract was administered with the infusion pump over 30 minutes, and 1 month later, patients received 1 mL of the extract subcutaneously using a 1-mL syringe. Adverse reactions (ARs: local, systemic, immediate, or delayed) were recorded according to the EAACI guidelines [7]. Delayed ARs were monitored by telephone In conclusion, peripheral eosinophil count correlates well with nasal eosinophil count and could reasonably be considered a biomarker for suspecting type 2 inflammation in the nose.

Safety of an Ultrarush (4 Hours) Subcutaneous Immunotherapy Schedule With Cat and Dog Extracts Using an Infusion Pump