short ragweed pollen allergen extract

Contraindicated in:

Use Cautiously in:

Oral inflammation/wounds including oral surgery/dental extraction, oral lichan planus, mouth ulcers or thrush (discontinue temporarily);
Geri: Safe and effective use in elderly patients has not been established, not approved for this age group;
OB: Use during pregnancy only if clearly needed;
Lactation: Use cautiously if breastfeeding;
Pedi: Safe and effective use in children has not been established.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: ear pruritus, throat irritation

GI: oral paresthesia, oral prutitus, eosinophilic esophagitis, mouth edema, tongue pruritus

Resp: LARYGOPHARYNGEAL SWELLING, oropharyngeal pain

Misc: allergic reactions including anaphylaxis

Interactions ⬆ ⬇

Drug-drug:

Concurrent allergen immunotherapy may ↑ risk of adverse reactions.
Concurrent beta blockers may ↓ response to bronchodilators or parenteral epinephrine if required for severe allergic reactions to pollen extract.
Alpha blockers and beta blockersblunt the beneficial effects of epinephrine which may be required to treat anaphylaxis (↑ dose of epinephrine may be required).
Ergot alkaloids may reverse the pressor effects of epinephrine.
Effects of epinephrine may be ↑ by tricyclic antidepressants, levothyroxine, MAO inhibitors and some antihistamines including chlorpheniramine and diphenhyramine.
Cardiac glycosides may ↑ risk of adverse cardiovascular events with epineprine.

Availability ⬆ ⬇

Sublingual tablet (contains gelatin, mannitol and sodium hydroxide): 12 Amb a 1–Unit (Amb a 1–U)

Route/Dosage ⬆ ⬇

SL (Adults 18–65 yr): One tablet daily, started at least 12 wk prior to onset of ragweed pollen season, continued throughout season.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Small doses of antigen produce T-cell activation and downregulation of mucosal mast cells; additional effects include ↓ IgE production, ↑ specific immunoglobulin G4 (IgG4) production and changes in interleukin and eosinophil activity.

Therapeutic effects:

Decreased symptoms (rhinitis/conjunctivitis) and need for daily medication to control symptoms.

Classifications ⬆ ⬇

Therapeutic Classification: allergy, cold and cough remedies

Pharmacologic Classification: antigens, immunotherapy

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(decrease in symptoms/need for medications)

ROUTE	ONSET	PEAK	DURATION
SL	12 wk	unknown	maintained throughout pollen season

Patient/Family Teaching ⬆ ⬇

Instruct patient in correct method of taking Ragwitek; avoid swallowing tablet until dissolved. Avoid food or beverage for 5 min after dissolution of tablet. If dose is missed, omit and take next scheduled dose next day; do not double doses. If more than 1 dose is missed, notify health care professional before restarting. Explain to patient that therapy does not give immediate relief of allergy symptoms. Instruct patient to read Medication Guide before starting therapy and with each Rx refill in case of changes.
Instruct patient in how and when to use autoinjectable epinephrine and to seek immediate medical care if used.
Advise patient to stop therapy notify health care professional if signs and symptoms of allergic reactions, asthma attack, oral inflammation, or eosinophilic esophagitis occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.