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House Dust Mite, Dermatophagoides farinae

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Overview

What is House Dust Mite, Dermatophagoides farinae?

Mite extract is a sterile solution containing the extractables of mite whole bodies in 0.25% sodium chloride, 0.125% sodium bicarbonate, 50% glycerol by volume and 0.4% phenol as a preservative. The mites are grown on a medium of yeast and pork and are handled and cleaned in a manner to remove more than 99% of the food medium. The medium contains no material of human origin. This extract may be administered by the scratch, prick-puncture, or intradermal methods of skin testing for diagnostic purposes and subcutaneously for therapeutic purposes as directed under Dosage and Administration. Intradermal skin tests in patients who were puncture test positive (Sum E ≥ 40 mm) to either or extract were performed with extracts of the mite food medium obtained from the same supplier. The results, submitted to the FDA by several manufacturers, were as follows: By intradermal testing, there was 1 positive (Sum E ≥ 20 mm) in 44 individuals at an estimated 1% level of medium content (approximately the same as contained in the mite extract). At a ten-fold increase (estimated 10% medium content), 4 positives in 40 individuals were observed. Two of the individuals who were skin test positive to the mite extract and who also were skin test positive to the medium extract were also skin test positive to an extract of yeast (Saccharomyces sp.) when tested by the puncture method. The extract is standardized by comparing its relative potency by ELISA competition to a U.S. reference mite extract available from the Center for Biologics Evaluation and Research, U.S. Food and Drug Administration. The U.S. reference extract has been assigned a potency of 10,000 AU/mL based on quantitative skin testing.



What does House Dust Mite, Dermatophagoides farinae look like?



What are the available doses of House Dust Mite, Dermatophagoides farinae?

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What should I talk to my health care provider before I take House Dust Mite, Dermatophagoides farinae?

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How should I use House Dust Mite, Dermatophagoides farinae?

Standardized mite extract is indicated for use in the diagnosis of patients with a history of allergy to mites or house dust and for the treatment of patients with a history of mite allergy who have established sensitivity to mites by diagnostic skin testing. The use of mite extract for the above purposes should be made only by physicians with special familiarity and knowledge of allergy as described in a standard allergy textbook .

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. The product should be discarded if discoloration or particles are observed. The skin test concentration of 10,000 AU/mL in dropper vials is used for scratch or prick-puncture testing. Puncture tests performed with extract on 5 persons sensitive to mite showed a mean diameter wheal of 8.8 mm ± 1.8 mm and mean diameter erythema of 39.2 mm ± 5.3 mm. Puncture tests with extract on 10 persons sensitive to mite showed a mean diameter wheal of 7.8 mm ± 4.1 mm and mean erythema of 33.7 mm ± 12.0 mm. Extract for intradermal testing should be prepared by diluting the 10,000 AU/mL stock concentrate in bulk vials with sterile saline with or without human serum albumin. Intradermal skin tests (0.05 mL) in persons highly sensitive to mite showed the following results:

Intradermal extract should be used as follows:

Therapeutic

Preparing Dilutions


What interacts with House Dust Mite, Dermatophagoides farinae?

Injections of mite extract should not be administered in the presence of diseases characterized by a bleeding diathesis. Immunotherapy should not be started in patients until a specific diagnosis of Type I allergy to mite is made by a physician based on skin testing with this product. Other contraindications include: : Determined from previous anaphylaxis following skin testing, immunotherapy, or natural exposure. : Individuals with autoimmune disease maybe at risk, due to the possibility of routine immunizations exacerbating symptoms of the underlying disease. : Patients who have experienced a recent myocardial infarction may not be able to tolerate immunotherapy. The benefit-to-risk ratio must be carefully evaluated. : Children with nephrotic syndrome require careful consideration and probably should not receive immunotherapy due to a variety of seemingly unrelated events that may cause an exacerbation of nephrotic disease.



What are the warnings of House Dust Mite, Dermatophagoides farinae?

Patients who receive pamidronate disodium should have serum creatinine assessed prior to each treatment. Patients treated with pamidronate disodium for bone metastases should have the dose withheld if renal function has deteriorated (see


What are the precautions of House Dust Mite, Dermatophagoides farinae?

GENERAL

INFORMATION FOR PATIENTS

CARCINOGENESIS, MUTAGENESIS, IMPAIRMENT OF FERTILITY

PREGNANCY CATEGORY C

PEDIATRIC USE

D. farinae

D. pteronyssinus

NURSING MOTHERS

DRUG INTERACTION

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What are the side effects of House Dust Mite, Dermatophagoides farinae?

Adverse systemic reactions usually occur within minutes and consist primarily of allergic symptoms such as generalized skin erythema, urticaria, pruritus, angioedema, rhinitis, wheezing, laryngeal edema and hypotension. Less commonly, nausea, emesis, abdominal cramps, diarrhea and uterine contractions may occur. Severe reactions may cause shock and loss of consciousness. Fatalities have occurred rarely . Systemic reactions occur with varying frequency in different clinics. To some extent, the reaction rate is related to the type and dose of administered extract and to the degree of sensitivity of the patient. Despite all precautions, occasional reactions are unavoidable. Reports from regulatory authorities in Sweden to the Center for Biologics Evaluation and Research (CBER) indicated that several deaths have been associated with the use of mite extracts. CBER was subsequently informed that these deaths may have been related to use by physicians or other health professionals untrained in the administration of potent allergens, rather than a product defect. It should be noted that anaphylaxis and deaths following the injection of mite and other extracts also have been reported by the British Committee on Safety in Medicine in the British Medical Journal, 293: 943, 1986. Local reactions consisting of erythema, itching, swelling, tenderness and sometimes pain may occur at the injection site. These reactions may appear within a few minutes to hours and persist for several days. Local cold applications and oral antihistamines may be effective treatment. For marked and prolonged local reactions, steroids may be helpful. The treatment of systemic allergic reactions is somewhat dependent upon the symptom complex. Epinephrine hydrochloride 1:1,000 aqueous, in an adult dose of 0.3 - 0.5 mL (or 0.01 mL per kg. for children) administered subcutaneously in the opposite arm is the immediate treatment of choice. A tourniquet should be placed above the site of the extract injection if the injection was done on the extremities. Antihistamines may offer relief of recurrent urticaria, associated skin reactions and gastrointestinal symptoms. Persistent wheezing may necessitate intravenous aminophylline treatment. For profound shock and hypotension, intravenous fluids, vasopressors and oxygen also may be needed. Maintenance of an open airway is critical if upper airway obstruction is present. Corticosteroids may provide benefit if symptoms are prolonged or recurrent.


What should I look out for while using House Dust Mite, Dermatophagoides farinae?

Injections of mite extract should not be administered in the presence of diseases characterized by a bleeding diathesis. Immunotherapy should not be started in patients until a specific diagnosis of Type I allergy to mite is made by a physician based on skin testing with this product. Other contraindications include: : Determined from previous anaphylaxis following skin testing, immunotherapy, or natural exposure. : Individuals with autoimmune disease maybe at risk, due to the possibility of routine immunizations exacerbating symptoms of the underlying disease. : Patients who have experienced a recent myocardial infarction may not be able to tolerate immunotherapy. The benefit-to-risk ratio must be carefully evaluated. : Children with nephrotic syndrome require careful consideration and probably should not receive immunotherapy due to a variety of seemingly unrelated events that may cause an exacerbation of nephrotic disease.

Concentrated extract must be diluted with sterile diluent prior to first use on a patient for treatment or intradermal testing. All concentrates of allergenic extract are manufactured to assure high potency and therefore have the ability to cause serious local and systemic reactions, including death in sensitive patients . Patients should be informed of this risk and precautions should be discussed prior to initiating immunotherapy (see PRECAUTIONS below). Allergenic extract should be temporarily withheld from patients or the dose adjusted downward if any of the following conditions exist: 1) severe symptoms of rhinitis and/or asthma; 2) infection or flu accompanied by fever; 3) exposure to excessive amounts of clinically relevant allergen prior to a scheduled injection. The dosage must be reduced when starting a patient on fresh standardized mite extract or when transferring a patient from non-standardized or modified extract to standardized extract, even though the labeled strength of the old and new vials may be the same. This is necessary due to a loss of extract potency during storage in the physician's office. The mite allergen content of old and new extract may be compared and adjusted by dosage reduction and/or dilution before the new extract is administered. The amount of new extract given should not exceed 25% of the last dose given from the old vial, assuming both extracts contain comparable amounts of mite allergen. Any evidence of a local or generalized reaction requires a reduction in dosage during the initial stages of immunotherapy, as well as during maintenance therapy. Beta-blocking drugs may make patients refractory to the usual dose of epinephrine, in the event epinephrine is required to treat an adverse allergic reaction.


What might happen if I take too much House Dust Mite, Dermatophagoides farinae?

A strong local reaction to the injection of extract may be treated with oral antihistamines and the local application of a cold compress. The dosage must be reduced and additional extract must not be given until all evidence of the reaction has disappeared. A systemic reaction following the injection of extract must be treated immediately with Epinephrine hydrochloride 1:1,000 aqueous (see Adverse Reactions, paragraph 4 above).


How should I store and handle House Dust Mite, Dermatophagoides farinae?

Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP] .Extract of and containing 5,000 and 10,000 Allergy Units per mL is supplied in 50% glycerol v/v in 10 mL, 30 mL and 50 mL vials. Extract containing 10,000 Allergy Units per mL is supplied in 50% glycerol v/v in dropper vials for scratch or prick-puncture testing. An equal v/v mixture of the two mites is offered in 10, 30 and 50 mL vial sizes at a concentration of 2,500 AU/mL or 5,000 AU/mL for each mite. See DESCRIPTION above for the complete list of the active and inactive ingredients of this product. Extract of and may be diluted in sterile buffered saline containing 0.4% phenol or in sterile buffered saline containing human serum albumin and 0.4% phenol.


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Clinical Information

Chemical Structure

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Clinical Pharmacology

The mechanism for the pharmacologic action of allergenic extracts used diagnostically is based on the liberation of histamine and other substances when the allergen reacts with IgE antibody attached to mast cells. The mechanism of the therapeutic effect is not well understood and further research is required to substantiate current hypotheses. Mites belonging to the genus Dermatophagoides are found in approximately 80% of house dust samples throughout the world. is common in much of the United States, although is predominant in certain coastal regions and both species are commonly found in homes . The diagnosis of mite allergy is established by the allergy history and skin test reactivity . Immunotherapy with mite extract has been studied by several investigators. It is generally believed that hyposensitization with this product is helpful in reducing symptoms associated with house dust allergy .

Non-Clinical Toxicology
Injections of mite extract should not be administered in the presence of diseases characterized by a bleeding diathesis. Immunotherapy should not be started in patients until a specific diagnosis of Type I allergy to mite is made by a physician based on skin testing with this product. Other contraindications include: : Determined from previous anaphylaxis following skin testing, immunotherapy, or natural exposure. : Individuals with autoimmune disease maybe at risk, due to the possibility of routine immunizations exacerbating symptoms of the underlying disease. : Patients who have experienced a recent myocardial infarction may not be able to tolerate immunotherapy. The benefit-to-risk ratio must be carefully evaluated. : Children with nephrotic syndrome require careful consideration and probably should not receive immunotherapy due to a variety of seemingly unrelated events that may cause an exacerbation of nephrotic disease.

Concentrated extract must be diluted with sterile diluent prior to first use on a patient for treatment or intradermal testing. All concentrates of allergenic extract are manufactured to assure high potency and therefore have the ability to cause serious local and systemic reactions, including death in sensitive patients . Patients should be informed of this risk and precautions should be discussed prior to initiating immunotherapy (see PRECAUTIONS below). Allergenic extract should be temporarily withheld from patients or the dose adjusted downward if any of the following conditions exist: 1) severe symptoms of rhinitis and/or asthma; 2) infection or flu accompanied by fever; 3) exposure to excessive amounts of clinically relevant allergen prior to a scheduled injection. The dosage must be reduced when starting a patient on fresh standardized mite extract or when transferring a patient from non-standardized or modified extract to standardized extract, even though the labeled strength of the old and new vials may be the same. This is necessary due to a loss of extract potency during storage in the physician's office. The mite allergen content of old and new extract may be compared and adjusted by dosage reduction and/or dilution before the new extract is administered. The amount of new extract given should not exceed 25% of the last dose given from the old vial, assuming both extracts contain comparable amounts of mite allergen. Any evidence of a local or generalized reaction requires a reduction in dosage during the initial stages of immunotherapy, as well as during maintenance therapy. Beta-blocking drugs may make patients refractory to the usual dose of epinephrine, in the event epinephrine is required to treat an adverse allergic reaction.

Drug Interactions:

Uricosuric drugs, such as probenecid and sulfinpyrazone, can inhibit renal tubular secretion of nitrofurantoin. The resulting increase in nitrofurantoin serum levels may increase toxicity, and the decreased urinary levels could lessen its efficacy as a urinary tract antibacterial.

GENERAL

INFORMATION FOR PATIENTS

CARCINOGENESIS, MUTAGENESIS, IMPAIRMENT OF FERTILITY

PREGNANCY CATEGORY C

PEDIATRIC USE

D. farinae

D. pteronyssinus

NURSING MOTHERS

DRUG INTERACTION

6

7

Adverse systemic reactions usually occur within minutes and consist primarily of allergic symptoms such as generalized skin erythema, urticaria, pruritus, angioedema, rhinitis, wheezing, laryngeal edema and hypotension. Less commonly, nausea, emesis, abdominal cramps, diarrhea and uterine contractions may occur. Severe reactions may cause shock and loss of consciousness. Fatalities have occurred rarely . Systemic reactions occur with varying frequency in different clinics. To some extent, the reaction rate is related to the type and dose of administered extract and to the degree of sensitivity of the patient. Despite all precautions, occasional reactions are unavoidable. Reports from regulatory authorities in Sweden to the Center for Biologics Evaluation and Research (CBER) indicated that several deaths have been associated with the use of mite extracts. CBER was subsequently informed that these deaths may have been related to use by physicians or other health professionals untrained in the administration of potent allergens, rather than a product defect. It should be noted that anaphylaxis and deaths following the injection of mite and other extracts also have been reported by the British Committee on Safety in Medicine in the British Medical Journal, 293: 943, 1986. Local reactions consisting of erythema, itching, swelling, tenderness and sometimes pain may occur at the injection site. These reactions may appear within a few minutes to hours and persist for several days. Local cold applications and oral antihistamines may be effective treatment. For marked and prolonged local reactions, steroids may be helpful. The treatment of systemic allergic reactions is somewhat dependent upon the symptom complex. Epinephrine hydrochloride 1:1,000 aqueous, in an adult dose of 0.3 - 0.5 mL (or 0.01 mL per kg. for children) administered subcutaneously in the opposite arm is the immediate treatment of choice. A tourniquet should be placed above the site of the extract injection if the injection was done on the extremities. Antihistamines may offer relief of recurrent urticaria, associated skin reactions and gastrointestinal symptoms. Persistent wheezing may necessitate intravenous aminophylline treatment. For profound shock and hypotension, intravenous fluids, vasopressors and oxygen also may be needed. Maintenance of an open airway is critical if upper airway obstruction is present. Corticosteroids may provide benefit if symptoms are prolonged or recurrent.

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72
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Interactions

Interactions

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