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Ambrosia artemisiifolia
Overview
What is Short Ragweed?
INGREDIENTS
Ambrosia elatior
Ambrosia elatior
Ambrosia trifida
STANDARDIZATION
The weight by volume value shown on the label is a measurement of extract concentration, rather than extract potency. Weight by volume designations may be used to identify dilutions of extract for skin testing and immunotherapy, and are useful from a practical standpoint in identifying the relative strength of a given extract. However, studies have shown that the antigen E content varies in extracts with the same weight by volume concentration
.
- Expiration dating is based on the antigen E content of the extract. Extracts containing 50% glycerol by volume have longer dating periods due to the protective effects of glycerol on antigen E
. The expiration period of aqueous concentrate and saline dilutions of glycerinated concentrate is approximately one-half that of glycerinated extract containing comparable antigen E content.
Ragweed extract should be kept at 2°C to 8°C during use and office storage to retain potency. Higher temperatures have an adverse affect on antigen E.
What does Short Ragweed look like?
What are the available doses of Short Ragweed?
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What should I talk to my health care provider before I take Short Ragweed?
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How should I use Short Ragweed?
Studies have shown that properly performed an interpreted skin tests with ragweed pollen extract are useful in the diagnosis of allergy to ragweed pollen
. Immunotherapy with the appropriate dosage of short ragweed pollen extract is effective in reducing symptoms of hay fever and asthma resulting from exposure to short ragweed pollen (9, 10, 11), and it is believed to be effective with extract of giant ragweed, although carefully controlled studies are unavailable. However, clinical observations and known cross reactivity between short and giant ragweed pollens have led to the practice of using a mixture of the two species for skin testing and treatment
.
This form of treatment is recommended for patients who cannot avoid exposure to pollen and who do not obtain satisfactory relief of symptoms from other medications, such as antihistamines. Immunologic changes resulting from treatment with short ragweed pollen extract are believed to include:
DIAGNOSIS.
PROCEDURES
Prick Test
Intradermal Test
INTERPRETATION OF RESULTS
Scratch and Prick Test
Intradermal Test
IMMUNOTHERAPY
Patients who have received allergenic extract for maintenance therapy should not be given the same dose from a fresh vial of extract.
SUGGESTED DOSAGE SCHEDULE FOR RAGWEED EXTRACT BASED ON ANTIGEN E CONCENTRATION (units per ml
Note: Do not exceed a dose of 0.2 ml if the extract being administered contains 50% glycerol by volume
Studies
have shown that the accumulated pre-seasonal dose of short ragweed pollen extract should be in the range of 250 to 1000 units of antigen E to effectively reduce ragweed-related symptoms
. This dosage of antigen E is contained in 2.5 ml to 10.0 ml of extract containing 100 antigen E units/ml. Treatment with a maximum tolerated dose is recommended for both short ragweed pollen extract and mixed short-giant ragweed extract.
The maintenance dose of ragweed pollen extract is defined as the highest tolerated dose that is consistently well tolerated without undue pain or swelling and which provides maximum relief to symptoms. The interval between maintenance injections should not exceed 4 weeks, since tolerance to the extract may be lost at longer intervals. If the interval exceeds 4 weeks, the dosage should be reduced by one-half for every additional two week period. A reduction in the maintenance dose also may be necessary during the ragweed season, due to the overdosing effects of inhaled allergen combined with injected allergen. As a rule, it is advisable to reduce the dosage by one-half during ragweed pollination and to increase the frequency of injections as needed to provide adequate relief symptoms. The dosage of ragweed pollen extract given to children is the same as the adult dose except for slight modifications due to body size and weight. A child's dose of 0.2 ml is considered comparable to an adult dose of 0.5 ml of the same dilution. Maintenance injection should be continued for a period of two to three years or longer, depending upon patient tolerance and clinical response.
What interacts with Short Ragweed?
There are no absolute contraindications to the use of ragweed pollen extract in the diagnosis and treatment of ragweed allergy. When used in accordance with accepted principles of skin testing and immunotherapy, the extract is considered safe and effective. Relative contraindications include (1) extreme sensitivity to the extract as demonstrated by previous anaphylaxis following skin testing or subcutaneous injection, (2) recent myocardial infarction, and (3) pregnancy (see Precautions #4). The benefit to risk ration must be evaluated in each of the above situations. Ragweed pollen extract should not be administered to persons who are not sensitive to ragweed pollen
What are the warnings of Short Ragweed?
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What are the precautions of Short Ragweed?
- Extract must be stored at 2°C to 8°C to retain potency. Storage at this temperature should be observed as closely as possible, since higher temperatures adversely affect the antigen E content of the product. Extract should not be left at room temperature for the purpose of making dilutions or mixing with other allergenic materials, unless precautions are taken to maintain the recommended temperature using special cooling trays or other suitable methods.
- Extract should be administered with autoclaved or sterile disposable syringes, needles and testing devices to prevent the transmission of homologous serum hepatitis and other infectious agents from person to person.
- Extract may cause local or generalized reactions. Physicians who administer the product should be familiar with the principles and practice of allergy and should have epinephrine HCL 1:1,000, as well as other emergency medication and equipment available to treat anaphylaxis. Persons receiving extract by skin test or by subcutaneous injection for treatment must be instructed to remain in the physician's office for 20 minutes following testing or immunotherapy, and to return immediately to the office if any signs of a generalized allergic reaction occur, including hives, symptoms of hay fever, and/ or asthma.
- PREGNANCY CATEGORY C. ragweed pollen extract. Animal reproduction studies have not been conducted with ragweed pollen extract. It is also not known whether ragweed pollen extract can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Ragweed pollen extract should be given to a pregnant woman only if clearly needed.
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What are the side effects of Short Ragweed?
LOCAL REACTIONS.
A second reaction at or near the dose which caused the first local response indicates that a maximum tolerated amount of extract has been reached and no further increases in dosage should be attempted. Maintenance therapy should be continued thereafter at the highest possible non-reacting dose.
Systemic (generalized) reactions may range from a mild exaggeration of the patient's allergic symptoms to hives, anaphylactic shock, or even death from anaphylaxis. Systemic reactions may occur when a previous local reaction has not been heeded, or when the extract is accidentally injected intravenously. The reaction usually occurs 5 to 20 minutes after injection. Symptoms may include sneezing, coughing, itching, shortness of breath, abdominal cramps, vomiting, diarrhea, tachycardia, hypotension, and respiratory failure in severe cases. The reaction is usually stopped by the subcutaneous injection of epinephrine HCL 1:1,000 (See Overdosage below). The oral administration of antihistamines and the placement of a tourniquet proximal to the injection site are helpful adjuncts. In the event that additional measures are required, it may be necessary to treat the patient for bronchospasm with intravenous aminophylline, intravenous fluids and corticosteroids; for hypotension with vasopressors, volume repletion, isoproterenol and corticosteroids; for laryngeal obstruction with oxygen and tracheostomy and for cardiac arrest with cardiopulmonary resuscitation and other appropriate measures.
- Additional injections should not be given until all evidence of the reaction has disappeared.
- The dosage should be reduced three levels, e.g., from 0.4 cc to 0.5 cc or the equivalent, and held at that level for two or three treatments.
What should I look out for while using Short Ragweed?
There are no absolute contraindications to the use of ragweed pollen extract in the diagnosis and treatment of ragweed allergy. When used in accordance with accepted principles of skin testing and immunotherapy, the extract is considered safe and effective. Relative contraindications include (1) extreme sensitivity to the extract as demonstrated by previous anaphylaxis following skin testing or subcutaneous injection, (2) recent myocardial infarction, and (3) pregnancy (see Precautions #4). The benefit to risk ration must be evaluated in each of the above situations. Ragweed pollen extract should not be administered to persons who are not sensitive to ragweed pollen
Physicians who elect to administer ragweed pollen extract should be familiar with the clinical use of allergenic extracts and have the necessary emergency equipment and medication available to treat systemic allergic reactions.
What might happen if I take too much Short Ragweed?
A local reaction characterized by erythema and edema that persists for several hours or longer, or a recurrence of allergic symptoms following an injection requires that the dosage be reduced. Additional extract should not be given until all evidence of a previous reaction has disappeared.
Severe generalized symptoms or anaphylaxis following an injection must be treated immediately with epinephrine HCL 1:1000 as follows: Usual Dosage - Children under 12 years 0.1 to 0.2 cc; persons over 12 years 0.3 to 0.5 cc, repeated as necessary every 10 to 15 minutes. Intravenous antihistamines and hydro-cortisone also may be used, but only after sufficient epinephrine has been give. (see Adverse Reaction Systemic).
Immunotherapy after anaphylaxis should only be considered if the probable cause of anaphylaxis can be identified, such as accidental intravenous injection or failure to reduce the dosage after a previous local reaction or during periods of high external exposure to ragweed pollen.
How should I store and handle Short Ragweed?
Prior to Dispensing: Store refrigerated at 2°C to 8°C (36°F to 46°F) for and the . Do not freeze. Do not use beyond the expiration date on the label. Store at room temperature up to 25°C (77°F) for the .Short ragweed pollen extract and mixed short-giant ragweed pollen extract in concentrated form (w/v 1:20) are supplied in 1 ml dropper vials for scratch or prick testing and in 10 ml, and 50 ml vials for bulk use. Dilutions other than 1:20 w/v may be custom ordered.
Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
Non-Clinical Toxicology
There are no absolute contraindications to the use of ragweed pollen extract in the diagnosis and treatment of ragweed allergy. When used in accordance with accepted principles of skin testing and immunotherapy, the extract is considered safe and effective. Relative contraindications include (1) extreme sensitivity to the extract as demonstrated by previous anaphylaxis following skin testing or subcutaneous injection, (2) recent myocardial infarction, and (3) pregnancy (see Precautions #4). The benefit to risk ration must be evaluated in each of the above situations. Ragweed pollen extract should not be administered to persons who are not sensitive to ragweed pollenPhysicians who elect to administer ragweed pollen extract should be familiar with the clinical use of allergenic extracts and have the necessary emergency equipment and medication available to treat systemic allergic reactions.
Catecholamine-depleting drugs (e.g., reserpine) may have an additive effect when given with beta-blocking agents. Patients treated with atenolol plus a catecholamine depletor should therefore be closely observed for evidence of hypotension and/or marked bradycardia which may produce vertigo, syncope, or postural hypotension.
Calcium channel blockers may also have an additive effect when given with atenolol (see ).
Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects. Disopyramide has been associated with severe bradycardia, asystole and heart failure when administered with beta blockers.
Amiodarone is an antiarrhythmic agent with negative chronotropic properties that may be additive to those seen with beta blockers.
Beta blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the two drugs are coadministered, the beta blocker should be withdrawn several days before the gradual withdrawal of clonidine. If replacing clonidine by beta-blocker therapy, the introduction of beta blockers should be delayed for several days after clonidine administration has stopped.
Concomitant use of prostaglandin synthase inhibiting drugs, e.g., indomethacin, may decrease the hypotensive effects of beta blockers.
Information on concurrent usage of atenolol and aspirin is limited. Data from several studies, i.e., TIMI-II, ISIS-2, currently do not suggest any clinical interaction between aspirin and beta blockers in the acute myocardial infarction setting.
While taking beta blockers, patients with a history of anaphylactic reaction to a variety of allergens may have a more severe reaction on repeated challenge, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.
Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.
LOCAL REACTIONS.
A second reaction at or near the dose which caused the first local response indicates that a maximum tolerated amount of extract has been reached and no further increases in dosage should be attempted. Maintenance therapy should be continued thereafter at the highest possible non-reacting dose. Systemic (generalized) reactions may range from a mild exaggeration of the patient's allergic symptoms to hives, anaphylactic shock, or even death from anaphylaxis. Systemic reactions may occur when a previous local reaction has not been heeded, or when the extract is accidentally injected intravenously. The reaction usually occurs 5 to 20 minutes after injection. Symptoms may include sneezing, coughing, itching, shortness of breath, abdominal cramps, vomiting, diarrhea, tachycardia, hypotension, and respiratory failure in severe cases. The reaction is usually stopped by the subcutaneous injection of epinephrine HCL 1:1,000 (See Overdosage below). The oral administration of antihistamines and the placement of a tourniquet proximal to the injection site are helpful adjuncts. In the event that additional measures are required, it may be necessary to treat the patient for bronchospasm with intravenous aminophylline, intravenous fluids and corticosteroids; for hypotension with vasopressors, volume repletion, isoproterenol and corticosteroids; for laryngeal obstruction with oxygen and tracheostomy and for cardiac arrest with cardiopulmonary resuscitation and other appropriate measures.
Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
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