Texas Allergy Experts
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RUSH Immunotherapy

SUMMARY: Allergy immunization often fails because people have difficulty maintaining the schedule in the first six months as we edge up the concentrations.   Since the relief is often a function of the dosage, discouragement is common which drastically affects the compliance.

The reason to consider RUSH immunization includes:

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1. To reduce costs

2.  To improve the safety profile

3. To improve the likely hood of completion of the program     

 

By removing the build-up phase , this procedure removes 25 co-pays  for the patient, and cuts seven months off  the total effort now capped at approximately 1.5 years.  This will reduce the total cost of treatment significantly for both the patient and the carrier.  It also helps us by speeding the profiling of patients since the relief – if it occurs-  will be rapid.   Non-responding patients are discontinued quicker, and responding patients are more likely to complete therapy and enjoy remission for an extended period with few drugs and an improved quality of life.   Office visits drop, antibiotic and antihistamine use is diminished if we can achieve a lasting remission,  and go a long way to making allergy immunization more cost effective.

 

Finally, RUSH may improve the long term safety of allergy injections since the dosage for maintenance is established  on the RUSH visit, making dosage errors very unlikely – particularly when the vaccines are being administered remotely by PCPs.    There are risks for reactions in this intense procedure, but these are anticipated and managed under constant observation.

 

While major allergic reactions are very rare – sore arms from the injection in the first day are VERY common.

 


Rush immunotherapy (RIT), first described in 1933,  is a technique of advancing an allergic patient to a maintenance dose of an extract in one working day using an injection every 30 minutes over a four hour period with a 1-2 hour observation period at the end. While RIT has been used in the past for time crucial treatments for insect sensitivity, it is now receiving renewed interest because a more rapid effect and reduction of total time and expense of treatment by approximately 40%.  Much of the financial relief occurs in association with less frequent injections in patients with high co-pays.  The major drawback to rapid maintenance and RIT has been an increased level of allergic reactions during the initial phase.  Improvements in safety issues gained by pre-medication on the first day has reduced the risk considerably.  Many physicians and patients believe the benefits involved in the treatments exceed the risks.



Comparason                                                                    TRADITIONAL         RUSH

Time to reduced medication and clinical relief

6-8 months

1-2 weeks

Interval of injections after maintenance

Constant weekly

variable

Total number of injections after maintenance

75

36-48

Length of treatment

24 months

16 months

Reaction rate in first six months:

7-12.5%

10.8% - 38%

Number of co pays to maintenance

24

1

The systemic reaction rate with conventional immunotherapy is 0.1% to 0.51% per injection or 7% to 12.5% per patient over six months  Systemic reaction rates with RIT are approximately 4.6%  - 38% over the first six months depending on the maintenance level chosen.


The profile of patients most likely to consider RUSH immunotherapy include those with:

1. high insurance “co-pays”

2. unpredictable schedules where weekly build up is impossible

3. need for speed of relief

 

People we are reluctant to suggest RUSH include those with:

 

1.       Unstable asthma

2.       Multiple large skin test reactions