Anthoxanthum Odoratum Pollen

The dosage for Anthoxanthum Odoratum Pollen is highly individualized and depends on whether the patient is receiving Sublingual Immunotherapy (SLIT) or Subcutaneous Immunotherapy (SCIT).

For Sublingual Immunotherapy (SLIT), the typical adult dose (often as part of a 5-grass extract) involves a titration phase followed by a maintenance phase. The maintenance dose is usually 300 IR (Index of Reactivity) taken once daily. Treatment typically begins 4 months before the expected start of the grass pollen season and continues throughout the season.

For Subcutaneous Immunotherapy (SCIT), dosing is measured in Bioequivalent Allergy Units (BAU). A common starting dose is 0.05 mL of a 1:10,000 w/v dilution, gradually increasing weekly or bi-weekly until a maintenance dose (e.g., 0.5 mL of a 10,000 BAU/mL concentration) is reached. The exact schedule is determined by the physician based on the patient's sensitivity and reaction to the injections.

Anthoxanthum Odoratum Pollen extracts are generally approved for use in children aged 5 years and older. The dosing for children is typically the same as the adult dose for sublingual tablets (e.g., 300 IR daily for the 5-grass extract). For subcutaneous injections, pediatric dosing is carefully titrated by an allergist, often starting at even lower concentrations to ensure safety. It is not currently approved for children under the age of 5 due to limited safety data and the difficulty of administering sublingual medication or monitoring for anaphylaxis in very young children.

Renal Impairment

No specific dosage adjustments are required for patients with renal impairment, as the proteins are not cleared by the kidneys in a manner that would lead to systemic toxicity.

Hepatic Impairment

No dosage adjustments are necessary for hepatic impairment, as the extract does not undergo hepatic metabolism via the CYP450 system.

Elderly Patients

Clinical trials have included limited numbers of patients over age 65. Healthcare providers should use caution and consider the patient's overall health and ability to tolerate potential systemic reactions or use an epinephrine auto-injector.

For Sublingual Tablets:

• Take the tablet once daily, preferably in the morning.
• Place the tablet under the tongue and allow it to dissolve completely (usually takes about one minute).
• Do not swallow for at least one minute.
• Avoid eating or drinking for 5 minutes after the tablet has dissolved.
• Wash your hands after handling the tablet.
• The first dose must be administered in a healthcare setting under medical supervision for at least 30 minutes to monitor for severe allergic reactions.

For Subcutaneous Injections:

• These must be administered by a healthcare professional in a clinic equipped to treat anaphylaxis.
• Patients must remain in the clinic for at least 30 minutes following the injection.

If a dose of the sublingual tablet is missed, skip the missed dose and take the next dose at the regularly scheduled time. Do not double the dose. If more than one or two doses are missed, contact your healthcare provider, as you may need to restart the titration or discontinue the treatment. For injections, if an appointment is missed, contact your allergist to adjust the schedule; missing multiple injections usually requires a reduction in the next dose to prevent reactions.

Signs of overdose (taking more than the prescribed sublingual dose) include severe local reactions (swelling of the tongue or mouth) or systemic allergic reactions. In the event of an overdose, seek emergency medical attention immediately. Treatment is supportive and may involve the administration of antihistamines or epinephrine if anaphylaxis occurs.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance.

Because Anthoxanthum Odoratum Pollen is an allergen extract, the most common side effects are localized allergic reactions at the site of administration. For sublingual administration, these include:

• Oral Pruritus: Intense itching of the mouth or tongue. This usually begins within minutes of administration and may last for 30 to 60 minutes.
• Throat Irritation: A 'scratchy' or 'tight' feeling in the throat.
• Edema of the Mouth: Swelling of the lips, tongue, or sublingual mucosa.
• Ear Pruritus: Itching inside the ears.
• Paresthesia: Tingling or 'pins and needles' sensation in the mouth.

These symptoms are typically most severe during the first week of treatment and tend to diminish as the body becomes desensitized.

• Gastrointestinal Distress: Nausea, abdominal pain, or diarrhea. This is thought to occur if the allergen is swallowed too quickly.
• Nasal Congestion: Sneezing or a runny nose shortly after taking the dose.
• Urticaria: Hives or itchy skin rashes away from the site of administration.
• Cough: A dry, persistent cough.

• Eosinophilic Esophagitis (EoE): Inflammation of the esophagus characterized by difficulty swallowing (dysphagia) or chest pain. This is a serious immune-mediated condition that requires discontinuation of the drug.
• Laryngeal Edema: Swelling of the voice box, which can lead to difficulty breathing.
• Systemic Allergic Reactions: Generalized hives, swelling, or mild wheezing that does not progress to full anaphylaxis.

> Warning: Stop taking Anthoxanthum Odoratum Pollen and call your doctor immediately if you experience any of these.

• Anaphylaxis: A life-threatening systemic allergic reaction. Symptoms include a sudden drop in blood pressure, rapid or weak pulse, narrowing of the airways (wheezing), and fainting.
• Angioedema: Severe swelling under the skin, particularly around the eyes, lips, or throat, which can obstruct breathing.
• Severe Dyspnea: Significant shortness of breath or chest tightness.
• Syncope: Fainting or feeling like you are about to pass out, which may indicate a systemic drop in blood pressure.
• Difficulty Swallowing: This may be a sign of severe throat swelling or the development of EoE.

The long-term use of Anthoxanthum Odoratum Pollen is generally well-tolerated. The primary long-term effect is a sustained reduction in allergy symptoms even after the treatment is discontinued (usually after 3 years of therapy). However, patients should be monitored for the late development of Eosinophilic Esophagitis. There is no evidence that long-term use causes organ toxicity or increases the risk of malignancy.

Anthoxanthum Odoratum Pollen extracts (especially SLIT formulations like Oralair) carry an FDA Black Box Warning regarding the risk of severe allergic reactions.

Summary of Warning:

• Anthoxanthum Odoratum Pollen can cause life-threatening allergic reactions such as anaphylaxis and severe laryngopharyngeal edema.
• Do not administer to patients with severe, unstable, or uncontrolled asthma.
• Observe patients in the office for at least 30 minutes following the initial dose.
• Patients must be prescribed and trained in the use of an auto-injectable epinephrine device (e.g., EpiPen) to treat potential reactions at home.
• Treatment may not be suitable for patients who have conditions that may reduce their ability to survive a systemic allergic reaction or who are taking medications that can complicate the treatment of such a reaction (e.g., beta-blockers).

Report any unusual symptoms to your healthcare provider.

Anthoxanthum Odoratum Pollen is a potent immunotherapeutic agent. It is not a medication for the immediate relief of allergy symptoms (like an antihistamine) but is intended for long-term immune modification. Patients must be aware that every dose carries a small but real risk of a systemic allergic reaction. It is vital that the patient is capable of recognizing the early signs of anaphylaxis and is willing and able to use an epinephrine auto-injector if necessary.

As noted in the side effects section, the FDA has issued a Black Box Warning for sublingual grass pollen extracts. This warning emphasizes that the first dose must be supervised by a medical professional and that patients with uncontrolled asthma are at the highest risk for fatal respiratory complications. No FDA black box warnings exist for the non-standardized diagnostic extracts, but the risk of anaphylaxis remains inherent to all allergenic products.

• Allergic Reactions / Anaphylaxis Risk: This is the primary concern. Risk factors include a history of severe systemic reactions to immunotherapy or current illness (such as a cold or flu) which may lower the threshold for a reaction.
• Asthma: Patients with asthma must have their condition well-controlled before starting therapy. If a patient experiences an asthma exacerbation, immunotherapy should be temporarily withheld.
• Eosinophilic Esophagitis (EoE): Patients with a history of EoE or those who develop persistent gastrointestinal symptoms (heartburn, difficulty swallowing) should not use sublingual extracts.
• Oral Conditions: Treatment should be paused if the patient has oral surgery, tooth extraction, or open sores/wounds in the mouth, as this can increase the rate of systemic absorption and the risk of a reaction.

While routine blood work (like liver or kidney function tests) is not required, patients must be monitored for:

• Respiratory Function: Regular assessment of asthma control.
• Oral Health: Inspection for inflammation or lesions in the mouth.
• Adherence: Ensuring the patient is taking the dose correctly and not skipping doses, which can increase the risk of a reaction when treatment is resumed.

Anthoxanthum Odoratum Pollen does not typically cause drowsiness or cognitive impairment. However, if a patient experiences a systemic reaction or uses epinephrine, they should not drive and should seek emergency care.

There is no direct pharmacological interaction between alcohol and Anthoxanthum Odoratum Pollen. However, alcohol consumption can cause vasodilation and may theoretically increase the rate of allergen absorption or mask the early symptoms of an allergic reaction. It is generally advised to avoid alcohol shortly before and after taking the dose.

There is no 'withdrawal syndrome' associated with stopping Anthoxanthum Odoratum Pollen. However, stopping the treatment prematurely (before the recommended 3-year course) may result in the return of allergy symptoms. If treatment is stopped for more than a few days, the patient must consult their doctor before restarting, as a dose reduction or re-titration may be necessary to ensure safety.

> Important: Discuss all your medical conditions with your healthcare provider before starting Anthoxanthum Odoratum Pollen.

• Unstable Asthma Medications: Anthoxanthum Odoratum Pollen should not be used in patients whose asthma is not adequately controlled by maintenance medications. The risk of a fatal bronchospasm during an allergic reaction is too high.
• Beta-Blockers (e.g., Propranolol, Atenolol): These medications are contraindicated because they can interfere with the effectiveness of epinephrine. If a patient on beta-blockers has an anaphylactic reaction to the pollen extract, the standard treatment (epinephrine) may be ineffective, leading to a medical emergency.

• MAO Inhibitors (MAOIs) and Tricyclic Antidepressants: These drugs can potentiate the effects of epinephrine, leading to severe hypertension or cardiac arrhythmias if epinephrine must be administered for an allergic reaction.
• Other Immunotherapy: Taking multiple types of immunotherapy (e.g., for dust mites and grass) simultaneously increases the cumulative allergen load and the risk of systemic reactions. These should only be combined under the strict supervision of an allergist.

• Antihistamines and Mast Cell Stabilizers: While often used to manage symptoms, these drugs can mask the early warning signs of a systemic reaction to the immunotherapy. Patients should inform their doctor if they are starting or stopping these medications.
• Corticosteroids: High-dose systemic steroids may suppress the immune response to the immunotherapy, potentially reducing its long-term efficacy.

There are no known direct food interactions with Anthoxanthum Odoratum Pollen. However, patients with Oral Allergy Syndrome (OAS) may experience cross-reactivity. For example, some people allergic to grass pollen also react to certain fruits (like melons or oranges). Eating these foods immediately after a dose may worsen oral itching or swelling.

There is limited data on herbal interactions. However, supplements that affect the immune system (such as Echinacea or Astragalus) should be used with caution, as they could theoretically interfere with the desensitization process. Always inform your doctor of any supplements you are taking.

• Skin Tests: Anthoxanthum Odoratum Pollen treatment will eventually decrease the wheal-and-flare response to grass pollen skin tests. This is an expected clinical outcome, not a 'false' result.
• IgE/IgG4 Testing: The treatment will cause an initial rise in IgE followed by a long-term increase in IgG4 levels. These changes are used by some clinicians to monitor the progress of the therapy.

For each major interaction, the mechanism usually involves either a pharmacodynamic interference with the body's response to the allergen or an interference with the emergency medications used to treat a reaction. The management strategy always involves a thorough risk-benefit analysis by the prescribing allergist.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking.

Anthoxanthum Odoratum Pollen must NEVER be used in the following circumstances:

• Severe or Uncontrolled Asthma: Patients with a Forced Expiratory Volume (FEV1) less than 80% of predicted or those with frequent exacerbations are at high risk for fatal respiratory arrest during a systemic reaction.
• History of Severe Systemic Allergic Reaction: Anyone who has had a previous life-threatening reaction to grass pollen extracts or any component of the formulation.
• Eosinophilic Esophagitis (EoE): Because sublingual immunotherapy can trigger or worsen EoE, a known history of this condition is an absolute contraindication for SLIT.
• Malignancy or Immunodeficiency: Patients with active cancer or severe primary/secondary immunodeficiency may not respond appropriately to treatment and face unknown risks.

Conditions requiring careful risk-benefit analysis include:

• Beta-Blocker Therapy: As mentioned, this makes treating anaphylaxis difficult.
• Severe Oral Inflammation: Conditions like lichen planus, oral candidiasis, or large dental ulcers increase the risk of rapid systemic allergen absorption.
• Autoimmune Diseases: While not strictly contraindicated, the use of immunotherapy in patients with active autoimmune disorders (like Lupus or Rheumatoid Arthritis) is controversial and requires specialist consultation.

Anthoxanthum Odoratum Pollen belongs to the Poaceae family. There is high cross-reactivity between Sweet Vernal Grass and other grasses such as:

• Timothy Grass (Phleum pratense)
• Kentucky Bluegrass (Poa pratensis)
• Perennial Rye Grass (Lolium perenne)
• Orchard Grass (Dactylis glomerata)

Patients allergic to one of these grasses are almost certainly allergic to the others. This cross-sensitivity is the basis for using multi-grass extracts for broad-spectrum grass allergy treatment.

> Important: Your healthcare provider will evaluate your complete medical history before prescribing Anthoxanthum Odoratum Pollen.

Anthoxanthum Odoratum Pollen is generally classified as Pregnancy Category B or C (depending on the specific manufacturer). There is no evidence of teratogenicity (birth defects) in animal studies. However, the primary risk during pregnancy is not the drug itself, but the risk of a systemic allergic reaction (anaphylaxis) in the mother, which can cause fetal hypoxia (lack of oxygen).

Clinical Recommendation: It is generally advised NOT to start new immunotherapy during pregnancy. If a woman is already on a maintenance dose and tolerating it well, the healthcare provider may choose to continue the treatment, but increasing the dose during pregnancy is typically avoided.

It is unknown whether the allergenic proteins or their metabolites are excreted in human milk. However, because these are proteins that are digested in the gastrointestinal tract, it is highly unlikely that they would affect a nursing infant. The risk-benefit profile usually favors continuing treatment if it is necessary for the mother's respiratory health.

Anthoxanthum Odoratum Pollen is approved for children as young as 5 years old. Clinical trials have demonstrated that immunotherapy is effective in children and may even prevent the 'allergic march'—the progression from allergic rhinitis to asthma. Parents must be carefully trained to monitor their children for side effects and to use a pediatric epinephrine auto-injector. It is not approved for children under 5 years of age.

Patients over the age of 65 may have a higher prevalence of comorbid conditions (like heart disease) that could make a systemic allergic reaction more dangerous. Additionally, elderly patients are more likely to be taking medications like beta-blockers or ACE inhibitors. Dosing should be approached with caution, and the clinician must ensure the patient has the manual dexterity to use an epinephrine device.

No dose adjustment is required. The active proteins are localized to the immune system and are not cleared by the kidneys. There is no evidence of nephrotoxicity associated with allergenic extracts.

No dose adjustment is required. The extract does not undergo significant hepatic metabolism. Patients with liver disease can safely use this medication provided they are otherwise candidates for immunotherapy.

> Important: Special populations require individualized medical assessment.

Anthoxanthum Odoratum Pollen acts as a biological response modifier. Its molecular mechanism involves the induction of peripheral T-cell tolerance. Upon administration, the major allergens—specifically Anth o 1 (a beta-expansin) and Anth o 5 (a ribonuclease)—are processed by antigen-presenting cells (APCs). These APCs present the allergen peptides to naive T-cells in the presence of specific cytokines, favoring the differentiation of Regulatory T-cells (Tregs). These Tregs produce IL-10, which suppresses IgE production by B-cells and instead promotes the production of IgG4. IgG4 acts as a 'decoy' or 'blocking' antibody, preventing the allergen from binding to IgE on mast cells, thereby inhibiting the release of histamine and other inflammatory mediators.

The pharmacodynamic effect of Anthoxanthum Odoratum Pollen is slow-onset. While some immunological changes occur within weeks, the clinical reduction in symptoms usually requires 2-4 months of daily treatment. The duration of effect is significant; a completed 3-year course of treatment can provide relief for several years after discontinuation. There is no evidence of the development of pharmacological tolerance (tachyphylaxis); rather, the body becomes more 'tolerant' in an immunological sense.

| Parameter | Value |

|---|---|

| Bioavailability | Negligible systemic bioavailability as intact proteins |

| Protein Binding | N/A (Active ingredients are themselves proteins) |

| Half-life | Local residency in mucosa: hours; Immunological effect: months |

| Tmax | N/A (Local action) |

| Metabolism | Proteolysis by cellular enzymes |

| Excretion | Cellular degradation and recycling of amino acids |

Anthoxanthum Odoratum Pollen extract is a complex biological mixture. It contains various proteins, glycoproteins, and polysaccharides. The primary allergenic proteins are Anth o 1 (approx. 30-35 kDa) and Anth o 5 (approx. 25-30 kDa). The extract is typically standardized based on its biological potency, measured in Bioequivalent Allergy Units (BAU) or Index of Reactivity (IR), rather than a simple molecular weight or formula.

This agent is a member of the Standardized Pollen Allergenic Extract [EPC] class. It is closely related to other grass pollen extracts like Timothy Grass (Phleum pratense) and is often found in combination products used for '5-grass' sublingual therapy.