Rush Therapy Specialist

What is rush immunotherapy (RIT)?

When you get standard allergy shots, also called immunotherapy, the treatment proceeds slowly to gradually build up your resistance to the allergens that trigger your symptoms. Rush immunotherapy, or RIT, accelerates the process. The goal is to increase your tolerance and reach a maintenance dose quickly, so more allergy shots are given in a shorter amount of time.

Like standard therapy, RIT involves getting multiple shots, with each one containing a higher dose of the allergen. During rush therapy, a shot is administered every 15-60 minutes for 1-3 days, until you reach a maintenance dose. Even though you’ll follow a maintenance schedule, you’ll need shots less frequently than standard allergy immunotherapy.  

Which allergies can be treated using rush immunotherapy?

Rush immunotherapy may be recommended for patients who are sensitive to inhalant allergens, which includes anything you breathe in that causes an allergic reaction. Some of the most common inhaled allergens are dust (dust mites), mold, pet dander, and pollens from grasses, trees, and weeds. Allergic asthma is also triggered by inhaling the same allergens.

You may be a good candidate for RIT if you have a severe allergy to insect venom and need rapid protection from future insect stings, whether from bees, wasps, ants, or another type of insect. While the doctors at North Texas Allergy & Asthma Associates may consider rush immunotherapy for other types of allergies, some patients can’t have this type of treatment due to interactions with medications or health concerns, so the doctors will carefully screen your medical history.

Is rush immunotherapy safe?

RIT has been performed many times, so it has an established reputation for being safe and effective. Since you get large doses of allergen in a short period of time, there’s a risk of having an allergic reaction, but the doctors and staff take every precaution to ensure your wellbeing. In the days right before rush immunotherapy begins, you’ll receive medications such as antihistamines that prevent or minimize allergic reactions.

You’ll stay in the office throughout treatment so we can closely monitor your health and take immediate action if you have an allergic response. That means you’ll need to be prepared to spend the day in our office, but that’s a trade-off many patients are willing to make in return for needing fewer allergy shots in the future.

What are 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

What are 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

Are there any common 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: 50mg once a day ( One 50mg tablet)
• 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:

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 snacks during RIT but you are welcome to bring food with you.

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