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Novel Formulations: Allergoids and Adjuvants ÎAllergoids are modified allergen extracts processed in a way that reduces the extract's allergenicity while preserving its antigenicity. (B) ÎAdjuvants might enhance the effectiveness of allergen immunotherapy by shifting the immune response toward TH1 production. The two adjuvants most extensively studied with allergen immunotherapy are an immunostimulatory oligonucleotide sequence of DNA containing a CpG motif (CpG) and 3-deacylated monophospholipid A (MPL). Clinical trials with these adjuvants, in combination with ragweed (CPG and MPL) and grasses (MPL), demonstrate significant improvement in allergic rhinitis symptoms with 4 to 6 injections administered preseasonally. Neither of these adjuvants is available as FDA- approved allergen extracts. (NR) ÎAn allergen immunotherapy extract must be considered different if there is any change. There is potentially an increased risk of a systemic reaction if the immunotherapy extract is changed because of the possible variability in the composition and potency of allergen extracts. If the allergen immunotherapy extract is changed, the patient might need to be retested for specific IgE sensitivity and started on an immunotherapy formulation and schedule that is based on this re- evaluation.(D) 23

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