Preparation of allergen immunotherapy extracts for subcutaneous immunotherapy (SCIT): Overview

Allergens	Effective doses	Available extracts (in United States)	Dosing recommended in practice parameters	Amount to add to 10 mL vial (maintenance solution) (maintenance dose = 0.5 mL)	Mixing limitations
Dermatophagoides pteronyssinus	3.25 to 12 mcg Der p 1*	10,000 AU/mL	500 to 2000 AU	2 mL (to deliver 1000 AU per dose)	Do not mix with fungal or cockroach
Dermatophagoides farinae	10 mcg Der f 1*	10,000 AU/mL	500 to 2000 AU	2 mL (to deliver 1000 AU per dose)	Do not mix with fungal or cockroach
Short ragweed	4 to 24 mcg Amb a 1*	1:10 w/v (100,000 AU/mL)	1000 to 4000 BAU	0.5 mL (to deliver 2500 BAU per dose)	Do not mix with fungal or cockroach
Timothy grass	15 and 20 mcg Phl p 5*	100,000 BAU/mL	1000 to 4000 AU	0.6 mL (to deliver 3000 BAU per dose)	Do not mix with fungal or cockroach
Bermuda grass	Not determined	10,000 BAU/mL	300 to 1500 BAU	2 mL (to deliver 1000 BAU per dose)	Do not mix with fungal or cockroach
Cat hair or pelt	11 to 17 mcg Fel d 1*	10,000 BAU/mL	1000 to 4000 BAU	6 mL (to deliver 3000 BAU per dose)	Do not mix with fungal or cockroach
Dog (acetone-precipitated)	15 mcg Can f 1*	1:100 w/v	0.04 to 0.19 mL, 1:100 w/v	2 mL	Do not mix with fungal or cockroach
Birch	3.25 to 15 mcg Bet v 1*	1:10 to 1:40 w/v, 10,000 to 40,000 PNU/mL	1:100 w/v or 4000 PNU	1 mL	Do not mix with fungal or cockroach
Olive	Not determined	1:10 to 1:40 w/v, 10,000 to 40,000 PNU/mL	1:100 w/v or 4000 PNU	1 mL	Do not mix with fungal or cockroach
Sagebrush	Not determined	1:10 to 1:40 w/v, 10,000 to 40,000 PNU/mL	1:100 w/v or 4000 PNU	1 mL	Do not mix with fungal or cockroach
Alternaria alternata	1.6 and 8 mcg Alt a 1*	1:10 to 1:40 w/v, 10,000 to 40,000 PNU/mL	Highest tolerated dose	Variable depending on potency of the stock extract	Do not mix with pollens, dust mite, danders, or cockroach
Aspergillus fumigatus	Not determined	1:10 to 1:40 w/v, 10,000 to 40,000 PNU/mL	Highest tolerated dose	Variable depending on potency of the stock extract	Do not mix with pollens, dust mite, danders, or cockroach
Cockroach	Not determined	1:10 to 1:40 w/v, 10,000 to 40,000 PNU/mL	Highest tolerated dose	Variable depending on potency of the stock extract	Do not mix with pollens, dust mite, danders, or molds
Hymenoptera venoms (except fire ant)	100 mcg*	100 mcg/mL single venom or 300 mcg/mL mixed vespid	50 to 200 mcg of each venom	Not applicable, use undiluted	Do not mix with any other allergen extract
Imported fire ant whole body extract	0.5 mL of a 1:100 w/v to 0.5 mL of a 1:10 w/v	1:10 w/v and 1:20 w/v	None	1 to 10 mL	Do not mix with any other allergen extract

AU: allergy units; BAU: bioequivalent allergy units; w/v: weight/volume; PNU: protein nitrogen units.
* Based upon double-blind, placebo-controlled studies.

Data from: Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: A practice parameter third update. J Allergy Clin Immunol 2011; 127:S1.

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Preparation of allergen immunotherapy extracts for subcutaneous immunotherapy (SCIT): Overview