Accelerated Immunotherapy Schedules and Premedication

Subcutaneous immunotherapy is divided into 2 phases: a buildup and a maintenance phase. With conventional immunotherapy schedules, the buildup phase generally involves 1 to 2 injections per week with a single injection given each visit. The duration of the buildup phase varies but typically ranges from 3 to 8 months. Accelerated immunotherapy buildup schedules allow the patient to achieve the benefits of immunotherapy more rapidly, because the maintenance dose is reached in a shorter time period. It has the advantage of a reduced number of office visits, saving the patient time and increasing convenience. Rush and cluster immunotherapy schedules are the 2 most common accelerated schedules used in the United States. A cluster immunotherapy schedule involves the patient receiving several allergen injections (generally 2–4) sequentially in a single day of treatment on nonconsecutive days. The maintenance dose is generally reached in 4 to 8 weeks. In rush immunotherapy (RIT) protocols, higher doses are administered at intervals of 15 to 60 minutes in a period of 1 to 3 days until the maintenance dose is achieved.