可用的标准化形式的草花粉有:百慕大草(Cynodon dactylon),果园草(Dactylis glomerata),多年生黑麦草(Lolium perenne),提摩西草(Phleum pratense),红顶草(Agrostis alba),肯塔基蓝草(Poa pratensis)。 ,草地羊茅(Festuca elatior)和甜春草(Anthoxanthum odoratum)。花粉提取物打算用于皮下注射以进行免疫治疗;皮内和点刺或穿刺进行诊断。花粉提取物是无菌溶液,其包含花粉的可提取物,0.5%的氯化钠,0.275%的碳酸氢钠和50%的甘油作为防腐剂。可用于皮内测试的无菌,稀释的标准草花粉提取物含有0.9%的氯化钠,按体积计不超过0.5%的甘油,0.03%的碳酸氢钠和0.4%的苯酚作为防腐剂。提取物的原料使用水凝或抽真空等技术收集。致敏提取物的原料中所含可检测异物的总量不超过1%(花粉纯度为99%)。注意:BAU / mL标准化草花粉不可与任何其他草花粉产品互换。
产品浓度:
1.生物等效过敏单位。这些变应原提取物根据与生物制品评估和研究中心(CBER),食品药品管理局(FDA)参考制剂的比较(通过ELISA竞争)以生物等效变态反应单位/ mL(BAU / mL)进行标记。2FDA参考提取物已根据CBER ID 50 EAL方法分配了生物等效过敏单位。5简而言之,使用皮内技术采用3倍提取物稀释液对高敏感性患者的参考制剂进行皮肤测试。根据引起红斑直径总计为50mm(D 50 )的稀释液,生物等效性过敏单位分配如下:
BAU /毫升 | 皮内平均 | 稀释度D 50 |
1000,000 | 1:5,000,000 | 13-14.9 |
10,000 | 1:500,000 | 11-12.9 |
1,000 | 1:50,000 | 9-10.9 |
通过将成分表中各组分的BAU / mL值相加得出标准草混合物的小瓶效价,该值表示每mL混合物中每种组分的效价。
2.专心。
一种。浓缩标签术语适用于变应原提取物定制混合物,其中组合的各个变应原的强度或强度指定有所不同。
例如 | 集中 |
50% | 短豚草1:20 w / v |
25% | 肯塔基蓝草100,000 BAU / mL |
25% | 标准螨D.farinae 10,000 AU / mL |
如果医师选择计算“浓缩”混合物中每种成分的实际强度,则可以使用以下公式:
浓缩混合物中的实际过敏原强度 | = | 过敏原制造实力 | X | 配方中的过敏原(按体积或份数计) |
b 。在包含标准草的混合料的产品标签的成分列表部分中,计算每种成分的效力以表示每1毫升混合物中每种成分的效力。瓶效用浓缩物或浓缩物的体积/体积稀释度表示。
红斑总和(mm) | 烟气总和(mm) | ||||
参考花粉 | ñ | 意思 | 范围 | 意思 | 范围 |
百慕大草-Cynodon dactylon | 15 | 90.3 | 43-123 | 15.7 | 7-31 |
肯塔基州蓝草(6月)-早熟禾 | 15 | 77.3 | 47-107 | 15.9 | 6-28 |
草甸羊茅-Festuca elatior | 15 | 81.1 | 57-115 | 11.9 | 7-22 |
果园草-Dactylis glomerata | 15 | 84.3 | 57-111 | 14.1 | 9-19 |
多年生黑麦草-黑麦草 | 15 | 92.3 | 73-135 | 17.5 | 6-36 |
红顶-Agrostis gigantea(alba) | 15 | 77.1 | 42-98 | 14.1 | 8-19 |
甜春草-花椒 | 15 | 81.2 | 28-123 | 15.7 | 8-30 |
蒂莫西-Phleum pratense | 15 | 88.3 | 51-109 | 16.9 | 8-40 |
参考花粉 | 意思 | BAU50 / mL范围 |
百慕大草-Cynodon dactylon | 0.02 | 0.4-0.0003 |
肯塔基州蓝草(6月)-早熟禾 | 0.02 | 0.1-0.004 |
草甸羊茅-Festuca elatior | 0.02 | 0.9-0.002 |
果园草-Dactylis glomerata | 0.02 | 1.9-0.002 |
多年生黑麦草-黑麦草Perenne | 0.02 | 0.7-0.002 |
红顶-Agrostis gigantea(alba) | 0.02 | 0.8-0.004 |
甜春草-花椒 | 0.02 | 1.0-0.002 |
蒂莫西-Phleum pratense | 0.02 | 0.6-0.002 |
相对于CBER参考的Hollister-Stier实验室LLC的数量* | |||||
---|---|---|---|---|---|
花粉 | 测试的手数 | 少于 | 等于 | 比...更棒 | 计算的BAU / mL范围**(四舍五入至000) |
果园草 | 20 | 2 | 13 | 5 | 66,000-242,000 |
多年生黑麦草 | 17 | 5 | 12 | 0 | 25,000-127,000 |
甜春草 | 13 | 1个 | 12 | 0 | 73,000-110,000 |
肯塔基蓝草 | 21 | 8 | 12 | 1个 | 32,000-145,000 |
红顶 | 20 | 5 | 6 | 9 | 13,000-402,000 |
草地羊茅 | 21 | 0 | 1个 | 20 | 128,000-948,000 |
百慕大草 | 22 | 3 | 13 | 6 | 6,000-28,000 |
提摩太 | 19 | 11 | 6 | 2 | 43,000-176,000 |
尚无免疫疗法的绝对禁忌症。有关怀孕风险,请参阅预防措施。
患有心血管疾病或肺部疾病(例如症状不稳定,类固醇依赖型哮喘)的患者,和/或正在接受心血管药物(例如β受体阻滞剂)的患者,发生严重不良反应的风险更高。这些患者对正常的过敏治疗方案也可能较难治。仅当治疗的益处大于风险时,才应对患者进行治疗。1
有出血倾向的患者应避免任何注射,包括免疫疗法。
由于对常规免疫可能加重自身免疫疾病的可能性存在意见分歧,因此,只有在接触过敏原的风险大于加重自身免疫过程的风险的情况下,才应谨慎对待患有自身免疫疾病的患者进行免疫治疗。
哮喘症状和体征的出现似乎是过敏注射后严重反应的指示。通过测量峰值流量或采取其他措施来评估气道阻塞情况,可为使用过敏注射的可取性提供有用的指标。1、30、31、32、33
浓缩的提取物在使用前必须先进行稀释:有关标准甘油化过敏原提取物稀释的详细说明,请参见“剂量和管理”部分。
用白蛋白盐和苯酚(0.4%)稀释的过敏原提取物可能比用不含稳定剂的稀释剂稀释的提取物更有效。从非稳定的稀释剂切换到稳定的稀释剂时,应考虑将较弱的初始稀释液用于皮内测试和免疫疗法。
应使用无菌溶液,小瓶,注射器等,并在稀释时遵守无菌预防措施。
为避免交叉污染,请勿使用同一根针从多于一种提取物的小瓶中提取物质,或先提取后再稀释。
应使用以0.01毫升为单位的无菌结核菌素注射器,以从适当的稀释度中测量每个剂量。注射过敏原提取物时应始终使用无菌技术。
每个患者都应使用单独的无菌注射器,以防止肝炎和其他传染原从一个人传播到另一个人。
每次新注射之前,应检查患者对先前注射的反应。医师应遵循保守的剂量时间表,直到建立可用于监测剂量增加的局部反应模式为止。
很少会遇到患者,对微小剂量的过敏原会产生全身反应,并且经过几个月的治疗后并未表现出对注射的耐受性增加。如果小剂量持续发生全身反应或过度局部反应,应停止免疫治疗。
每次注射后至少应在办公室观察患者30分钟。最严重的反应将在这段时间内发生,应采取迅速的治疗措施。有关此类治疗措施,请参见不良反应部分。
应指导患者识别对免疫疗法特别是对休克症状的不良反应。应该让患者了解30分钟观察期的重要性,如果离开后出现症状,应警告患者立即返回办公室。
尚未对动物用致敏提取物进行长期研究,以确定其致癌性,致突变性或生育能力受损的潜力。
怀孕类别C。致敏提取物。尚未对过敏原提取物进行动物繁殖研究。还未知的是,向孕妇服用时,过敏原提取物是否会引起胎儿伤害或会影响生殖能力。仅在明确需要的情况下,才应将过敏原提取物给予孕妇。对于已经获得维持剂量的过敏原而没有副作用的妇女,怀孕的发生并不意味着停止免疫治疗。
目前尚无关于母乳中过敏原提取物成分的分泌或其对哺乳婴儿影响的研究。由于许多药物是从人乳中排泄的,因此,对护理妇女服用过敏原提取物时应格外小心。
由于儿科人群的剂量与成人相同,21较大剂量的溶液可能会产生过度的不适感。因此,为了获得所需的总剂量,可能需要将每次剂量的剂量分成多次注射。
免疫疗法对老年患者的反应与年轻患者相同。老年患者可能更倾向于使用可阻断肾上腺素作用的药物,该药物可用于治疗严重的反应,或者由于先前存在的心血管疾病,他们可能对肾上腺素的心血管副作用更为敏感4。
接受非选择性β受体阻滞剂的患者可能对诊断或治疗的过敏原反应性更高,并且可能对通常用于治疗过敏反应的肾上腺素剂量没有反应[19]。
某些药物可能会减轻过敏原和组胺在不同时间段引起的皮肤测试性风疹和红斑反应。常规抗组胺药应在皮肤测试前至少5天停用。长效抗组胺药应在皮肤测试前至少3周停用。23皮肤测试前应在皮肤测试部位至少2至3周停用局部类固醇。23,24应停用多环平等三环类抗抑郁药皮肤测试前至少7天。25局部局部麻醉药可能会抑制眩光反应,应在皮肤测试部位避免使用26。
1.局部反应
注射部位有些红斑,肿胀或瘙痒很常见,程度因患者而异。除非这些反应持续至少24小时,否则不应将其视为重要反应。直径超过4-5厘米的局部反应(红斑或肿胀)不仅不舒服,而且还表明如果增加剂量,则可能发生全身反应。在这种情况下,应将剂量减少至不引起反应的最后水平,并在谨慎再次增加剂量之前,先将其维持两次或三次治疗的水平。
大型持续性局部反应可通过局部冷敷,湿敷料和/或使用口服抗组胺药治疗。应将其视为可能发生的严重全身反应的警告,并指示需要暂时减少剂量。
预计注射后立即轻度燃烧。这通常需要10到20秒。
2.系统反应
仔细注意剂量和给药方式后,全身性反应很少发生,但不能过分强调,在敏感个体中,任何注射都可能导致过敏性休克。因此,至关重要的是,给予过敏原提取物的医师应了解并做好治疗严重反应的准备。
其他可能发生的严重程度不同的全身性反应是喉头水肿,昏厥,苍白,心动过缓,低血压,血管性水肿,咳嗽,喘息,结膜炎,鼻炎和荨麻疹。过敏性提取物用于测试和治疗的不良反应频率数据表明风险低。1,2,22
如果确实发生全身或过敏反应,则在注射部位上方应用止血带,然后向另一只手臂肌肉内或皮下注射1:1000肾上腺素盐酸盐。至少每10分钟松开止血带一次。不要用止血带阻塞动脉血流。
乙丙胺剂量
成人剂量:应注射0.3至0.5 mL。如有必要,请重复5到10分钟。
小儿剂量:通常的初始剂量为每千克体重0.01 mg(mL)或每平方米体表面积0.3 mg(mL)。 2岁以下婴儿的建议剂量为0.05至0.1mL; 2至6岁儿童,0.15毫升;和6到12岁的儿童0.2毫升。单次儿科剂量不应超过0.3 mg(mL)。根据病情的严重程度和患者的反应,剂量可每20分钟重复一次。
给予肾上腺素后,应使用静脉输液和可能的血管活性药物治疗严重休克或血管舒缩。应当确保呼吸道通畅。氧气应通过面罩给予。给予足够的肾上腺素和循环支持后,必要时可使用静脉注射抗组胺药,吸入支气管扩张药,茶碱和/或皮质类固醇。如果对上述措施无反应的严重全身或过敏反应,必须立即提供紧急复苏措施和接受使用培训的人员
[参考过敏与临床免疫学杂志,77(2):p。 271-273,1986]。
上述所有措施很少需要;止血带和肾上腺素通常会迅速产生反应。但是,医师应事先为所有突发事件做好准备。及时采取紧急治疗措施至关重要。
严重的全身反应要求下一次给药至少减少50%,然后谨慎增加。重复的全身反应,即使是轻微的全身反应,也足以阻止进一步尝试增加引起反应的剂量。
3.不良事件报告
请致电1(800)992-1120向Hollister-Stier实验室LLC客户技术服务部门报告所有不良事件。通过FDA MEDWATCH计划,可以使用针对卫生专业人员的自愿性不良事件报告系统。可以通过致电1(800)FDA-1088从FDA获得预印表格(FDA表格3500)。填写完整的表格应邮寄至MEDWATCH,5600 Fisher Lane,Rockville,MD 20852-9787或传真至:1(800)FDA-0178
参见不良反应部分。
1.一般
当制备用于免疫治疗的浓缩物稀释液时,可以使用含有白蛋白(人)[白蛋白盐和苯酚(0.4%)的无菌水性稀释剂]或50%甘油的稀释剂。对于皮内测试稀释液,建议使用白蛋白盐和苯酚(0.4%)。
应使用无菌稀释剂,小瓶,注射器等精确,无菌地稀释。通过摇动或旋动,彻底,轻柔地混合。
在溶液和容器允许的情况下,给药前应目视检查肠胃外药品是否存在颗粒物和变色。
2.诊断
穿刺或穿刺测试:为识别高度敏感的个体,为安全起见,建议在开始皮内测试之前,先使用10,000 BAU / mL的提取物进行穿刺或穿刺测试。如果此测试为阴性,则可以使用100,000 BAU / mL提取物进行第二次点刺/穿刺测试。通过将一滴提取物放在皮肤上并以轻微的提起动作刺穿该滴剂进入皮肤来进行点刺测试。穿刺测试是通过将一滴提取物浓缩物放在皮肤上,然后用细针(例如Prick Lancetter)刺穿皮肤而进行的。穿刺后十五分钟,测量风团和红斑的直径,并按表3确定患者的敏感度等级。可以使用推荐的浓缩提取物稀释液对皮内敏感性较低的人群(0至1+级)进行皮内测试。 (请参阅皮内测试说明)。
皮内测试:刺或穿刺测试阴性的患者应以100 BAU / mL的皮内测试。如果该测试为阴性,则可以使用1,000 BAU / mL提取物进行第二次皮内测试。阴性对照的甘油浓度应与皮内测试溶液中的甘油浓度相当,但不得超过5%。
建议仅在通过点刺或穿刺试验进行筛查后才使用皮内技术对患者进行检查。
用于皮内测试的提取物应通过将多剂量小瓶中提供的储备浓缩液与无菌白蛋白盐水和苯酚(0.4%)稀释来制备(请参见下面免疫治疗部分的表4)。
要使用皮内强度稀释液,应使用带有27号短针的1 mL结核菌素注射器。将针头以30°角皮内插入,向下倾斜,然后注入0.02至0.05 mL的提取物。注射后十五分钟,测量风团和红斑反应的直径,并通过下表确定患者的敏感性等级。皮肤测试根据在10至20分钟时出现的风疹和红斑反应进行分级。可以通过实际测量两种反应的程度来记录风团和红斑的大小。请参阅表3确定皮肤测试灵敏度等级。还显示了相应的∑E(红斑的最大直径和中点正交直径的总和)。
类 | 吸气口径 | 红斑直径 | 对应的∑E |
---|---|---|---|
0 | <5毫米 | <5毫米 | <10毫米 |
± | 5-10毫米 | 5-10毫米 | 10-20毫米 |
1+ | 5-10毫米 | 11-20毫米 | 20-40毫米 |
2+ | 5-10毫米 | 21-30毫米 | 40-60毫米 |
3+ | 10-15毫米的 | 31-40毫米 | 60-80毫米 |
4+ | > 15毫米b | > 40毫米 | > 80毫米 |
3.免疫疗法
过敏原提取物应使用具有0.01 mL刻度的无菌注射器和25-27号X 1/2“至5/8”针头给药。皮下注射。最常见的注射部位是上臂或大腿的侧面。皮内或肌内注射可能产生较大的局部反应,这可能非常痛苦。
致敏提取物的剂量是高度个体化的事情,并根据患者的敏感性程度,他的临床反应以及在注射方案早期阶段对给药提取物的耐受性而变化。起始剂量应基于用于免疫疗法的提取物的皮肤试验。要制备用于皮内和治疗用途的稀释液,请通过将1.0 mL浓缩液添加到9.0 mL含酚(0.4%)的无菌白蛋白盐水中来进行1:10稀释。随后的系列稀释以类似方式进行。 (请参阅表4。)要确定起始剂量,请使用最稀的提取物制剂开始皮内测试。注入0.02 mL,15分钟后读取反应。随着提取物浓度的增加,继续进行皮内测试,直到发生11-20 mm的红斑∑E(20-40 mm)和/或5 mm的风团反应。然后以0.03 mL的剂量将此浓度用作免疫疗法的起始剂量,并每次增加0.03 mL至高达0.12 mL的增量,直至达到0.3 mL,此时可使用浓度为强10倍的稀释液。 ,从0.03 mL开始。以这种方式进行,直到达到耐受剂量或症状得到控制。建议的维持剂量为浓缩液的0.2 mL。有时,需要较大剂量来缓解症状。大于0.2 mL的剂量需要特别注意。两次给药之间的间隔通常为3至7天。
10,000 BAU / mL和100,000 BAU / mL的效力可用于治疗。这两种选择可通过提供定量给料的灵活性来促进安全切换。对于以前未经治疗的患者,应使用由10,000 BAU / mL浓缩液制成的稀释液开始治疗。 If tolerated and symptoms justify a higher dosage, then use of dilutions made from the 100,000 BAU/mL concentrate is warranted. Proceed with caution when using 100,000 BAU/mL in higher doses.
When converting a patient who is currently receiving non-Standardized Grass Pollen extracts, it is recommended that skin testing be performed to compare the potency of the new and old extracts. If you choose not to skin test as recommended, but to continue therapy, the maximum first dose of the new allergenic product should not exceed 10% (1/10) of the previous dose.
This is offered as a suggested schedule for average patients and will be satisfactory in most cases. However, the degree of sensitivity varies in many patients. The size of the dose should be adjusted and should be regulated by the patient's tolerance and reaction. The size of the dose should be decreased if the previous injection resulted in marked local or the slightest general reaction. Another dose should never be given until all local reactions resulting from the previous dose have disappeared.
In some patients, the dosage may be increased more rapidly than called for in the schedule. In seasonal allergies, treatment should be started and the interval between doses regulated so that at least the first twenty doses will have been administered by the time symptoms are expected. Thus, the shorter the interval between the start of immunotherapy and the expected onset of symptoms, the shorter the interval between each dose. Some patients may even tolerate daily doses. A maintenance dose, the largest dose tolerated by the patient that relieves symptoms without producing undesirable local or general reactions, is recommended for most patients. The upper limits of dosage have not been established; however, doses larger than 0.2 mL of the glycerin concentrate may be painful due to the glycerin content. The dosage of allergenic extract does not vary significantly with the respiratory allergic disease under treatment. The size of this dose and the interval between doses will vary and can be adjusted as necessary. Should symptoms develop before the next injection is scheduled, the interval between doses should be decreased. Should allergic symptoms or local reactions develop shortly after the dose is administered, the size of the dose should be decreased. In seasonal allergies, it is often advisable to decrease the dose to one-half or one-quarter of the maximum dose previously attained if the patient has any seasonal symptoms.
The interval between maintenance doses can be increased gradually from one week to 10 days, to two weeks, to three weeks, or even to four weeks if tolerated. Repeat the doses at a given interval three or four times to check for untoward reactions before further increasing the interval. Protection is lost rapidly if the interval between doses is more than four weeks. (See WARNINGS Section.)
The usual duration of treatment has not been established. A period of two or three years of injection therapy constitutes an average minimum course of treatment.
表4 TEN-FOLD DILUTION SERIES Standardized Extracts Labeled 100,000 BAU/mL | ||||
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稀释 | Extract | + Diluent | = | BAU/mL Concentration |
0 | Concentrate | +0 mL | = | 100,000 |
1个 | 1 mL Concentrate | +9 mL | = | 10,000 |
2 | 1 mL dilution #1 | +9 mL | = | 1,000 |
3 | 1 mL dilution #2 | +9 mL | = | 100 |
4 | 1 mL dilution #3 | +9 mL | = | 10 |
5 | 1 mL dilution #4 | +9 mL | = | 1.0 |
6 | 1 mL dilution #5 | +9 mL | = | 0.10 |
7 | 1 mL dilution #6 | +9 mL | = | 0.010 |
The dose for the pediatric population is the same as for adults. (请参阅注意事项。)
The dose for elderly patients is the same as for adult patients under 65.4
The expiration date of pollen extract in 50% glycerin is listed on the container label. The extract should be stored at 2°- 8°C. Dilutions containing less than 50% glycerin are less stable and, if loss of potency is suspected, should be checked by skin testing with equal units of a freshly prepared dilution on known pollen allergic individuals. The expiration date of the intradermal tests is listed on container labels. Store at 2°- 8°C.
A number of factors beyond our control could reduce the efficacy of this product or even result in an ill effect following its use. These include storage and handling of the product after it leaves our hands, diagnosis, dosage, method of administration and biological differences in individual patients. Because of these factors, it is important that this product be stored properly and that the directions be followed carefully during use. No warranty, express or implied, including any warranty of merchantability or fitness, is made. Representatives of the Company are not authorized to vary the terms or the contents of any printed labeling, including the package insert, for this product except by printed notice from the Company's headquarters. The prescriber and user of this product must accept the terms hereof.
1. Lockey, Richard F., Linda M. Benedict, Paul C. Turkeltaub, Samuel C. Bukantz. Fatalities from immunotherapy (IT) and skin testing (ST). J. Allergy Clin. Immunol., 79 (4): 660-677, 1987.
2. US Food and Drug Administration (FDA), Center for Biologics Evaluation and Research (CBER). ELISA competition assay (Enzyme-linked Immunosorbent Assay). Methods of Allergenic Products Testing Laboratory. October 1993. CBER Docket No. 94N.0012.
3. US Food and Drug Administration, Center for Biologics Evaluation and Research, Data on file.
4. Peebles, Ray Stokes, Jr., B. Bochner, Howard J. Zeitz, ed. Anaphylaxis in the elderly. Immunology and Allergy Clinics of North America. 13 (3): 627-646, August 1993.
5. Turkeltaub, P., S. Rastogi. Quantitative intradermal test procedure for evaluation of subject sensitivity to standardized allergenic extracts and for assignment of bioequivalent allergy units to reference preparations using the ID50EAL method, Allergenic Products Testing Laboratory, Center for Biologics Evaluation and Research (CBER), FDA. Revised November 1994.
6. Lowell, FC, W. Franklin. A “double-blind” study of treatment with aqueous allergenic extracts in cases of allergic rhinitis. J. Allergy, 34 (2): 165-182, 1983.
7. Lowell, FC, W. Franklin.豚草花粉症注射疗法的有效性和特异性的双盲研究。 N. Eng. J. Med., 273 (13): 675-679, 1965.
8. Zavazal, V., A. Stajner. Immunologic changes during specific treatment of the atopic state.二。 Acta. Allergol., 25 (1): 11-17, 1970.
9. Reisman, RE, JI Wypych, EE Arbesman. Relationship of immunotherapy, seasonal pollen exposure and clinical response to serum concentrations of total IgE and ragweed-specific IgE. Int. Arch. Allergy Appl. Immunol., 48 (6): 721-730, 1975.
10. Taylor, WW, JL Ohman, FC Lowell. Immunotherapy in cat-induced asthma; double-blind trial with evaluation of bronchial responses to cat allergen and histamine. J. Allergy and Clin. Immunol., 61 (5): 283-287, 1978.
11. Smith, AP Hyposensitization with Dermatophagoides pteronyssinus antigen: trial in asthma induced by house dust. Br。中J., 4: 204-206, 1971.
12. Chapman, MD, TAE Platts-Mills, M. Gabriel, HK Ng, WGL Allen, LE Hill, AJ Nunn. Antibody response following prolonged hyposensitization with Dermatophagoides pteronyssinus extract. Int. Arch. Allergy Appl. Immunol., 61: 431-440, 1980.
13. Norman, PS Postgraduate Course Presentation. An overview of immunotherapy, implications for the future. J. Allergy Clin. Immunol., 65 (2): 87-96, 1980.
14. Norman, PS, WL Winkenwerder. Maintenance immunotherapy in ragweed hay fever. J. Allergy, 74: 273-282, 1971.
15. Norman, PS, WL Winkenwerder, LM Lichtenstein. Immunotherapy of hay fever with ragweed antigen E; comparisons with whole pollen extract and placebos. J. Allergy, 42: 93-108, 1968.
16. Sheldon, JM, RG Lovell, KP Matthews. A Manual of Clinical Allergy. Second Edition. WB Saunders, Philadelphia, 1967, pp. 107-112.
17. Sherman, WB Hypersensitivity mechanism and management. WB Sanders, Philadelphia, 1968, pp. 169-172.
18. Swineford, O. Asthma and Hay Fever. Charles C. Thomas, Springfield, IL, 1971, pp. 148-155.
19. Jacobs, RL, GW Rake, Jr., et al. Potentiated anaphylaxis in patients with drug-induced beta-adrenergic blockade. J. Allergy and Clin. Immunol., 68 (2): 125-127, August 1981.
20. Patterson, Roy, et al. Allergy Principles and Practice, 2nd ed. E. Middleton, Jr., CE Reed, EF Ellis, Ed., CV Mosby Co., 1983, St. Louis, MO, 1983, Chapter 52.
21. Levy, DA, LM Lichtenstein, EO Goldstein, and K. Ishizaka.伴随花粉过敏治疗的免疫和细胞变化。 J. Clinical Investigation, 50:360, 1971.
22. Turkeltaub, Paul C., MD, and Peter J. Gergen, MD. The risk of adverse reactions from percutaneous prick-puncture allergen skin testing, venipuncture, and body measurements: data from the Second National Health and Nutrition Examination Survey, 1976-80 (NHANES II). J. Allergy Clin. Immunol. 84(6): 886-890, Dec. 1989.
23. Pipkorn, Ulf. Pharmacological influence of anti-allergic medication on In Vivo allergen testing. Allergy. 43: 81-86, 1988.
24. Andersson, M. and U. Pipkorn. Inhibition of the dermal immediate allergic reaction through prolonged treatment with topical glucocorticosteroids. J. Allergy Clin. Immunol. 79 (2): 345-349, Feb. 1987.
25. Rao, Kamineni S., et al. Duration of suppressive effect of tricyclic anti-depressants on histamine induced wheal and flare reactions on human skin. J. Allergy Clin. Immunol. 82: 752-757, November 1988.
26. Pipkorn, Ulf, and M. Andersson. Topical dermal anesthesia inhibits the flare but not the wheal response to allergen and histamine in the skin prick test. Clinical Allergy. 17: 307-311, 1987.
27. Pauli, G., JC Bessot, R. Thierry and A. Lamensons. Correlation between skin, inhalation tests and specific IgE in a study of 120 subjects to house dust and D. pteronyssinus.临床Allergy. 7:337, 1977.
28. Murray, AB, AC Ferguson and BJ Morrison. Diagnosis of house dust mite allergy in asthamatic children. What constitutes positive history? J. Allergy Clin. Immunol. 71: 21, 1983.
29. Metzger, WJ, E. Turner and R. Patterson. The safety of immunotherapy during pregnancy. J. Allergy Clin. Immunol. 61 (4): 268-272, 1978.
30. Reid, MJ, RF Lockey, PC Turkletaub, TAE Platts-Mills. Survey of fatalities from skin testing and immunotherapy. J. Allergy Clin. Immunol. 92 (1): 6-15, July 1993.
31. Reid, MJ, G. Gurka. Deaths associated with skin testing and immunotherapy. J. Allergy Clin. Immunol. 97(1) Part 3:231, Abstract 195, January 1996.
32. Thompson, RA et al, report of a WHO/IUIS working group. The current status of allergen immunotherapy (hyposensitization). Allergy. 44: 369-379, 1989.
33. Malling, H.-J., B. Weeke, et al, The European Academy of Allergology and Clinical Immunology. Position Papers. Allergy. 48 (Supplement 14): 9-82, 1993.
Standardized Grass Pollen, BERMUDA GRASS Standardized Grass Pollen, bermuda grass injection, solution | |||||||||||||||||||
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Standardized Grass Pollen, BLUEGRASS, KENTUCKY (JUNE) Standardized Grass Pollen, bluegrass, kentucky (june) injection, solution | |||||||||||||||||||
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Standardized Grass Pollen, BLUEGRASS, KENTUCKY (JUNE) Standardized Grass Pollen, bluegrass, kentucky (june) injection, solution | ||||||||||||
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药物状态美国日本医生Gregory Aaen MD经验:11-20年 Brian Aalbers DO经验:11-20年 Glen Scott DO经验:21年以上 Cecile Becker MD经验:11-20年 Shruti Badhwar DO经验:11-20年 渡邊剛经验:21年以上 渡邊剛经验:21年以上 百村伸一 教授经验:21年以上 村上和成 教授经验:21年以上 中山秀章 教授经验:21年以上 临床试验
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