RUSH IMMUNOTHERAPY
What is Rush Immunotherapy (RIT)?
- Rush immunotherapy is a method for rapidly desensitizing patients to inhalant allergens. RIT involves giving a person multiple allergy injections over several hours in one day, achieving a near-maintenance dose in a very short amount of time.
- The procedure involves six allergy injections, with incremental increases in dose, are given in a span of 3 hours following the completion of RIT.
- After RIT, a person comes into the allergist’s office once a week for the next several weeks, until they reach the maintenance dose (typically about 3 months). RIT patients are able to reach maintenance dose and achieve benefit from allergy shots much faster.
Some Benefits of Rush Immunotherapy
- More rapid clinical improvement with fewer visits for injections
- Allows the patient to achieve maintenance dose more rapidly
- Allows the patient to reach monthly maintenance injections quicker
Some drawbacks or risks of Rush Immunotherapy
- Anaphylaxis (severe allergic reaction) which we help reduce with a specially designed regimen that you take before the procedure
- Premedication with corticosteroids and antihistamines has been shown to decrease the incidence of systemic reactions with RIT significantly
- If there is a systemic reaction, it is treated appropriately and RIT is stopped.
- May not be covered by all insurance companies
- Still requires patient to continue medication during build up phase
- Higher risk of reactions compared to traditional immunotherapy
Reactions to Rush Immunotherapy
- Local reactions (swelling, itching, or tenderness at the injection sites)
- Systemic reaction, which may include:
- Hives, itchy eyes, nose or throat, runny nose, nasal congestion, sneezing
- Tightness in chest and or throat, coughing and or wheezing
- Nausea and vomiting, abdominal cramps
- Lightheadedness or faintness and sometimes shock
What to do before your visit:
Premedication 2 days prior, 1 day prior and the morning of the procedure (provided in our office):
- Prednisone: 60mg once a day (Three 20mg tablets)
- Histamine (H1) Blocker: Claritin 10mg, Zyrtec 10mg, or Allegra 10mg once a day
- Histamine (H2) Blocker: Ranitidine (Zantac) 300mg once a day
- Montelukast (Singulair) 10 mg once a day
- Take all (6) pills at the same time each day if possible
Medication Time:
| Time recommended | Day 1 – 2 days before Premedication Time | Day 2 – 1 day before Premedication Time | Day 3 – Day of RIT Premedication Time |
| 8:00 AM |
How long will it take:
- The RIT protocol takes 3 hours and then you must be observed for 2 more hours.
- Expect to be in the office for 5-6 hours.
What to bring on the day of the visit:
- Books, activities, light blanket
- Wear a half sleeve or sleeveless shirt
- Have a light breakfast the morning of the procedure
- We will provide lunch after your last injection while you are waiting for the completion of the RIT
What we will do the day of the visit
- Make sure your asthma, if present, is under good control.
- Obtain baseline spirometry - FEV1 above 70%.
- No B-blockers, ACEI, or evidence of cardiovascular disease.
- Ensure we have Informed consent in chart.
What happens after RIT:
- For most patients, the final dose received during RIT will be repeated for the first post-RIT injection the week after.
- For patients who experienced a systemic reaction during RIT, the first post-RIT dose will be lowered.
- Following RIT, the regular IT schedule will be followed going forward.
- Generally if you tolerate the whole protocol you will continue on weekly injections for another 6-8 weeks, then we can proceed to every other week shots for 6 weeks, followed by every 3 week shots for 6 weeks then monthly
