Cluster Therapy

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What is Cluster Immunotherapy (CIT)?

•Cluster immunotherapy is a method for rapidly desensitizing patients to inhalant allergens. CIT involves giving a person multiple allergy injections over several hours over several days, achieving a near-maintenance dose in a very short amount of time.
•The procedure involves 2-3 allergy injections, with incremental increases in dose, which are given in a span of 1-2 hours.
•After CIT, a person comes into the allergists office once a week for the next several weeks. Then we will start spacing out the frequency of your injections according to our immunotherapy (IT) protocol.

Some Benefits of Cluster 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 Cluster Immunotherapy

•Anaphylaxis (severe allergic reaction) which we help reduce with a specially designed regimen that you take before the procedure
•Premedication with anti-leukotrienes (montelukast) and antihistamines has been shown to decrease the incidence of systemic reactions with CIT significantly
•Premedication with anti-leukotrienes (montelukast) and antihistamines has been shown to decrease the incidence of systemic reactions with CIT significantly
•May not be covered by all insurance companies, thus cost may be higher
•Still requires you to continue medication during the build-up phase
•Higher risk of allergic reactions compared to traditional immunotherapy

Reactions to Cluster 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 possibly shock

What to do before your visit:

Premedication 1 day prior and the morning of the procedure.

•Histamine (H1) Blocker: Options include Claritin 10 mg, or Zyrtec 10 mg, or Allegra 180 mg once a day

•Montelukast (Singulair) 10 mg once a day

•Take both pills at the same time each day if possible

Medication Time:

Time recommended Day 1  Day before CIT Premedication Time Day 2 Day OF CIT Premedication Time
8:00 AM    

How long will it take:

•The CIT protocol takes 1 - 2 hours in the clinic.

•There is a 30 min wait in between injections and a 1 hour wait after the last injection.

•You can do CIT up to 2 times a week, with 48 hours in between each CIT

What to bring on the day of the visit:

•Books, activities, laptop, etc.

•Wear a half sleeve or sleeveless shirt

•Have a light breakfast the morning of the procedure

•Have a light snack before the procedure

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 CIT:

•For most patients, the final dose received during CIT will be repeated for the first post-CIT injection the week after.

•For patients who experienced a systemic reaction during CIT, the first post-CIT dose will be lowered.

•Following CIT, 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