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Allergen subcutaneous immunotherapy is a long lasting treatment which can modify the natural history of allergic respiratory diseases. Recommended administration is required for a minimum of three years. During this long term therapy the daily management is based on two crucial points, discussed in this review, such as the prevention and the treatment of side effects and the improvement and follow-up of patient adherence. This review specifically focuses on subcutaneous immunotherapy.

Background: Patients with aspirin-sensitive respiratory and cutaneous diseases experience cross reactions to all nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclo-oxigenase (COX) enzymes. As are now available drugs which selectively inhibit COX-2, questions are raised whether cross-reactivity occurs between aspirin and these COX 2 inhibitors., Objective: The aim of this study was to evaluate the tolerability of three COX-2 inhibitors (meloxicam, celecoxib and rofecoxib) in subjects with previous pseudoallergic respiratory and cutaneous reactions to NSAIDs., Methods: 76 subjects with documented previous cutaneous and respiratory pseudoallergic reactions to aspirin and/or other NSAIDs underwent a single blind challenge with celecoxib, meloxicam and rofecoxib., Results: All subjects with previous respiratory reactions tolerated all drugs. Three subjects with multiple-drug induced urticaria complained of a generalized reaction after challenge (Two due to celecoxib and one due to meloxicam). Among the group of patients with NSAIDs-induced urticaria five complained of a relapse of the disease due to rofecoxib (one subject), celecoxib (two subjects and meloxicam (two subjects)., Conclusions: According to these results the cross-reactivity between aspirin and these COX-2 inhibitors does not occur in subjects with previous respiratory pseudoallergic reactions. A good safety profile was also demonstrated in patients with cutaneous reactions, being few reactions observed. However for this reason a controlled oral challenge with these drugs is useful for the proper management of patients sensitive to classic NSAIDs.

Background: Efficacy and safety of local nasal immunotherapy has been demonstrated by many placebo-controlled clinical trials. The treatment schedule consists of an induction phase at increasing dosages followed by a maintenance phase. Aim of present study has been to evaluate a new simplified treatment schedule at constant dosage., Methods and Results: 26 grass-allergic rhinitic patients have been treated according to the new constant dosage schedule, while 15 patients in a control group were treated with conventional incremental dosage schedule. A commercial preparation of allergens incorporated into powder (Allerkin). The total cumulative dosage administered with conventional schedule resulted higher than simplified constant schedule (5,025 vs 3,000 AU). To evaluate efficacy, symptom and rescue medication scores were recorded during the spring pollen season, and a subjective overall evaluation was asked to the patients at the end of the season. The analysis of scores showed that the two treatment schedules were equivalent as regards both efficacy and safety, being side effects light and restricted to the administration site (sneezing)., Conclusions: The use of a constant dosage schedules is suggested for the administration of local nasal immunotherapy, having as advantage a better simplicity. Avoidance of mistakes in dosages is considered important in a therapy which is self-administered by patients.

Honey and royal jelly are complex etherogeneous mixtures of flowers' nectar, sugars, proteins and bee's glandular secretions. The existence of a type I hypersensitivity to honey is still matter of debate, while an aetiological role of Compositae pollens in the clinical manifestations following honey ingestion has been envisaged. We describe two cases of severe systemic reactions (anaphylaxis and generalized urticaria/angioedema) due to honey and royal jelly ingestion in patients sensitized to compositae (mugwort). Both patients had a skin and RAST positivity to mugwort and a positive prick-by-prick to the offending foods. Moreover, in one of the two patients the RAST-inhibition assay showed the strong cross-reactivity between the proteins of honey and mugwort and the SDS-PAGE analysis showed that the major proteic bands from honey and mugwort extracts are largely superimposable. Both the clinical data and the laboratory analysis support the hypothesis of a strict link between sensitization to compositae and adverse reactions to honey and jelly.

Over the last few years, many studies have been carried out in order to individualize which nonsteroidal anti-inflammatory drug (NSAID) can be tolerated in aspirin sensitivity. Imidazole salicylate (IS) is a new NSAID that inhibits Tromboxane A2 synthesis, without interferring with cyclo-oxygenase pathway, whose inhibition was demonstrated to cause asthma and/or urticaria/angioedema in aspirin-sensitive patients. We enrolled 67 subjects with documented intolerance to aspirin, pyrazolones or NSAIDs, clinically manifested as urticaria/angioedema (68%), asthma, and/or rhinitis (32%). A challenge with IS was carried out in every patient in single-blind fashion, reaching a cumulative dosage of 1000 mg in the fourth session. No appearance of urticaria or bronchospastic reactions was registered in any subject, confirming the safe use of IS in aspirin-sensitive patients.