RATIONALE: Cluster Immunotherapy (CIT) is a modification of traditional immunotherapy that minimizes time to maintenance. This study compares time to maintenance, compliance, and reaction rate between CIT and traditional immunotherapy.METHODS: From November 2004 to July 2005, patients were offered traditional or CIT. CIT required nine office visits and 22 injections. The control group followed a traditional schedule with 22 visits and 22 injections.RESULTS: The CIT group had 25 females and 23 males with mean age 33 (range 7-61 years). Primary diagnoses were allergic rhinitis and/or asthma. At study termination, 27 (56%) of CIT patients achieved main-tenance doses with 475 visits and 1558 injections. Mean time to main-tenance was 42 days, range 19-98 and median 34. Five patients converted to traditional immunotherapy, two transferred care, and one stopped immunotherapy. Eleven large local reactions (LLR) and five systemic reactions (SR) occurred. The SR were mild, delayed, and urticarial, and were managed with oral antihistamines. The rate of LLR was 11/475 (2%) and SR was 5/475 (1%). This compared to the traditional group (N=24) with 408 visits and mean time to maintenance of 136 days. Eleven (24%) traditionals achieved maintenance. There were no LLR and only one SR (0.2%). Five traditional patients dropped out.CONCLUSIONS: Twice as many CIT patients achieved maintenance quicker. CIT had no drop outs compared to five in traditional. CIT reaction rate was higher but the reactions were mild. Co-seasonal benefit was appreciated with CIT. Patients saved money in co-pays with fewer visits. RATIONALE: Cluster Immunotherapy (CIT) is a modification of traditional immunotherapy that minimizes time to maintenance. This study compares time to maintenance, compliance, and reaction rate between CIT and traditional immunotherapy. METHODS: From November 2004 to July 2005, patients were offered traditional or CIT. CIT required nine office visits and 22 injections. The control group followed a traditional schedule with 22 visits and 22 injections. RESULTS: The CIT group had 25 females and 23 males with mean age 33 (range 7-61 years). Primary diagnoses were allergic rhinitis and/or asthma. At study termination, 27 (56%) of CIT patients achieved main-tenance doses with 475 visits and 1558 injections. Mean time to main-tenance was 42 days, range 19-98 and median 34. Five patients converted to traditional immunotherapy, two transferred care, and one stopped immunotherapy. Eleven large local reactions (LLR) and five systemic reactions (SR) occurred. The SR were mild, delayed, and urticarial, and were managed with oral antihistamines. The rate of LLR was 11/475 (2%) and SR was 5/475 (1%). This compared to the traditional group (N=24) with 408 visits and mean time to maintenance of 136 days. Eleven (24%) traditionals achieved maintenance. There were no LLR and only one SR (0.2%). Five traditional patients dropped out. CONCLUSIONS: Twice as many CIT patients achieved maintenance quicker. CIT had no drop outs compared to five in traditional. CIT reaction rate was higher but the reactions were mild. Co-seasonal benefit was appreciated with CIT. Patients saved money in co-pays with fewer visits.

Objective: This study explored the safety and efficacy of cetirizine for treatment of allergic rhinitis and asthma.Methods: Daily treatment for 6 weeks with cetirizine 10 mg (93 patients) was compared with placebo treatment(93 patients) in a randomized, double-blind parallel study of patients with allergic rhinitis and asthma. This multicenter study was started just-before onset of the fall pollen season. Rhinitis and asthma symptoms were assessed twice daily; spirometry was performed weekly.Results: Placebo-treated patients experienced a worsening of rhinitis symptoms from baseline throughout the study, whereas cetirizine-treated patients had a significant improvement in rhinitis symptoms at week I, which was maintained after onset of the pollen season. Asthma symptoms in the cetirizine group improved from baseline at week 1; symptoms were significantly better than in the placebo group for 5 of 6 weeks of the study. Pulmonary function did not worsen in patients taking cetirizine or placebo; there were no differences between treatments as determined by spirometry. Albuterol use was less frequent in the cetirizine-treated patients for every week of the study but differences did not reach significance. Pseudoephedrine use was similar in both groups. More cetirizine-treated patients (90%) completed the trial than did placebo-treated patients (74%). Both treatments were well tolerated.Conclusion: Cetirizine 10 mg daily is safe;and effective in relieving both upper and lower respiratory tract symptoms in patients with seasonal allergic rhinitis and concomitant asthma.

The Colorado Asthma Ski Day, an annual cross-country and alpine skiing event, encourages children with asthma to participate fully in outdoor winter sports. Since cold air and exercise can trigger bronchospasm, we examined the peak expiratory flow rates of 80 children who attended Asthma Ski Day 1992 or Asthma Ski Day 1993 to establish a safety profile for this event. Peak expiratory flow rates were measured prior to skiing, at lunchtime, and at the end of the day's activities. We asked the children to pretreat with their regular medications, as prescribed by their physicians, to use their bronchodilator inhalers p.r.n., and to report to our medical station if an episode of acute asthma occurred. The average age of the participants was 9.5 years, and the average baseline daytime peak flow rate was 100.03% of predicted. The average percent change in peak flow rates during the day was an increase of 5.00%. Our results demonstrate that with medical supervision, peak expiratory flow rate monitoring, and properly administered medications, peak flow rates can be stabilized and even improve during cold-weather exercise to an extent that safety concerns need not restrict children with asthma from engaging in exercise or cold-weather sports. The Colorado Asthma Ski Day can serve as a model event for other organizations that want to promote outdoor activities for children with asthma.