Artemisia Vulgaris Pollen

Dosage for Artemisia Vulgaris Pollen is highly individualized and must be determined by an allergist based on the patient's sensitivity levels.

Diagnostic Dosing

• Skin Prick Test: A single drop of the extract (usually 1:10 or 1:20 w/v) is applied to the skin, which is then pricked. A positive result is a wheal ≥3mm larger than the negative control.
• Intradermal Test: If the prick test is negative but suspicion remains high, 0.02 mL of a 1:1000 or 1:500 w/v dilution may be injected into the dermis.

Immunotherapy Dosing

• Build-up Phase: Starts with a very low dose (e.g., 0.05 mL of a 1:100,000 dilution) and increases weekly or bi-weekly until the maintenance dose is reached. This typically takes 3 to 6 months.
• Maintenance Phase: Once the "top dose" is reached (often 0.5 mL of a 1:100 or 1:20 w/v concentration), injections are spaced out to every 2 to 4 weeks for several years.

Artemisia Vulgaris Pollen is generally considered safe for children over the age of 5. Dosing follows the same build-up and maintenance principles as adults, though smaller volume increments may be used in highly sensitive children. Use in children under 5 is rare and requires careful risk-benefit analysis due to the difficulty of children communicating early symptoms of a systemic reaction.

Renal Impairment

No specific dose adjustments are required for renal impairment, as the extract is not primarily cleared by the kidneys in its active form. However, patients with severe renal disease may be at higher risk if they require epinephrine for a reaction.

Hepatic Impairment

No dosage adjustments are necessary for patients with liver disease.

Elderly Patients

Caution is advised in elderly patients (over 65) due to the higher prevalence of underlying cardiovascular disease, which may make them less able to tolerate a systemic reaction or the treatment required (epinephrine).

1. 1Administration: This medication must ONLY be administered by a healthcare professional in a clinical setting equipped with emergency resuscitation equipment.
2. 2Injection Site: Subcutaneous injection in the posterior aspect of the upper arm.
3. 3Observation: Patients MUST remain in the clinic for at least 30 minutes following every injection to monitor for anaphylaxis.
4. 4Storage: Vials must be stored in a refrigerator at 2°C to 8°C (36°F to 46°F). Do not freeze.

If a dose is missed during the build-up phase, the next dose may need to be reduced or the previous dose repeated, depending on the time elapsed. If a maintenance dose is missed by more than 2 weeks, the physician will typically reduce the dose for the next injection to ensure safety. Never attempt to "double up" on doses at home.

An overdose occurs if too much allergen is injected or if the injection is accidentally given intravenously.

• Signs: Rapid onset of hives, swelling of the throat, wheezing, low blood pressure, and loss of consciousness.
• Emergency Measures: Immediate administration of epinephrine (adrenaline), oxygen, IV fluids, and potentially corticosteroids or antihistamines. Seek emergency medical care immediately if symptoms occur after leaving the clinic.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or frequency without medical guidance. The success of immunotherapy depends on strict adherence to the schedule.

Most patients undergoing treatment with Artemisia Vulgaris Pollen will experience local reactions.

• Injection Site Redness (Erythema): A pink or red area around the injection site, usually appearing within minutes and resolving within a few hours.
• Local Swelling (Wheal): A raised, itchy bump at the injection site. If the swelling is larger than the size of a half-dollar (approx. 3 cm), your doctor may adjust your next dose.
• Pruritus (Itching): Intense itching at the site of administration.

• Delayed Local Reactions: Swelling or redness that appears 6 to 24 hours after the injection. While uncomfortable, these are usually not dangerous.
• Fatigue: Some patients report feeling unusually tired for several hours after an immunotherapy session.
• Increased Allergy Symptoms: A temporary flare-up of hay fever symptoms, such as sneezing, nasal congestion, or itchy eyes.

• Generalized Urticaria: Hives appearing on parts of the body far from the injection site.
• Angioedema: Deep tissue swelling, often around the eyes, lips, or extremities.
• Mild Wheezing: A whistling sound when breathing, indicating slight airway constriction.

> Warning: Stop receiving Artemisia Vulgaris Pollen and call your doctor immediately or seek emergency care if you experience any of the following:

1. 1Anaphylaxis: A life-threatening systemic allergic reaction. Symptoms include a sudden drop in blood pressure, rapid or weak pulse, and fainting.
2. 2Laryngeal Edema: Swelling of the throat or tongue that makes it difficult to swallow or breathe.
3. 3Severe Bronchospasm: Intense chest tightness and difficulty catching your breath, especially in patients with a history of asthma.
4. 4Cyanosis: A bluish tint to the lips or fingernails, indicating a lack of oxygen.

There are no known long-term toxicities associated with Artemisia Vulgaris Pollen extracts. The primary long-term effect is the intended modification of the immune system. However, repeated injections over several years can occasionally cause localized "lumps" (subcutaneous nodules) or scarring at the injection site if the location is not rotated properly.

While non-standardized extracts may not always carry a formal "Black Box" in the same way as newer sublingual tablets, the FDA-approved labeling for all allergenic extracts includes a Severe Warning regarding Anaphylaxis:

• Risk of Systemic Reactions: This product can cause severe, life-threatening systemic reactions, including anaphylaxis.
• Setting: Must only be administered in a facility where emergency equipment and trained personnel are available.
• Asthma Risk: Patients with unstable or severe asthma are at a significantly higher risk for fatal reactions.
• Epinephrine: Patients should be evaluated for their ability to use an epinephrine auto-injector if a delayed reaction occurs.

Report any unusual symptoms, even if they seem mild, to your healthcare provider before your next scheduled injection.

Artemisia Vulgaris Pollen is a potent biological agent. Its use is restricted to individuals with a documented IgE-mediated allergy to Mugwort pollen. It is not effective for non-allergic (vasomotor) rhinitis. Safety depends entirely on the accuracy of the dose and the clinical environment in which it is administered.

No FDA black box warnings for Artemisia Vulgaris Pollen are currently mandated in the same format as pharmaceutical drugs; however, the class-wide warning for allergenic extracts is considered equivalent in severity. It emphasizes that anaphylaxis can occur even in patients who have previously tolerated the injections without issue.

• Anaphylaxis Risk: The risk is highest during the build-up phase and in patients with high levels of sensitivity. Any systemic symptom (itchy palms, throat clearing, hives) must be treated as a potential precursor to anaphylaxis.
• Asthma Status: Patients must be assessed for asthma control before every injection. If a patient is experiencing an asthma flare-up or has a peak flow meter reading significantly below their personal best, the injection MUST be postponed. Uncontrolled asthma is the primary risk factor for death from immunotherapy.
• Cardiovascular Health: Patients with significant heart disease may not tolerate the physiological stress of a systemic reaction or the side effects of epinephrine (tachycardia, hypertension).
• Infection/Illness: Injections should be deferred if the patient has a fever or a significant respiratory infection, as this can lower the threshold for a systemic reaction.

• Pre-Injection Assessment: Check for current allergy symptoms, asthma control, and any new medications (especially heart medications).
• Post-Injection Observation: A mandatory 30-minute wait time in the office is the standard of care.
• Lung Function: For asthmatic patients, periodic FEV1 or peak flow monitoring is recommended.

Generally, Artemisia Vulgaris Pollen does not cause sedation. However, if a patient experiences a systemic reaction or receives antihistamines/epinephrine for a reaction, they should not drive or operate machinery until they are fully recovered and cleared by a physician.

Alcohol should be avoided for several hours before and after an injection. Alcohol can cause vasodilation (widening of blood vessels), which may increase the rate of allergen absorption and potentially trigger or worsen a systemic reaction.

Immunotherapy is typically discontinued if:

1. 1The patient experiences a life-threatening reaction.
2. 2There is no clinical improvement after 12-24 months of maintenance therapy.
3. 3The patient becomes non-compliant with the schedule.

> Important: Discuss all your medical conditions, especially respiratory or heart problems, with your healthcare provider before starting Artemisia Vulgaris Pollen.

• Beta-Blockers (e.g., Propranolol, Atenolol, Metoprolol): These are often considered a relative or absolute contraindication for immunotherapy. Beta-blockers can make a systemic reaction more severe and, crucially, can block the effects of epinephrine, making it difficult to treat anaphylaxis if it occurs.

• ACE Inhibitors (e.g., Lisinopril, Enalapril): Some studies suggest that patients on ACE inhibitors may be at an increased risk for more severe systemic reactions to allergenic extracts.
• MAO Inhibitors (MAOIs) and Tricyclic Antidepressants: These medications can potentiate the effect of epinephrine, leading to dangerously high blood pressure if epinephrine must be administered for an allergy emergency.

• Antihistamines (e.g., Loratadine, Cetirizine): These can mask the early warning signs of a systemic reaction (like itching or hives), potentially delaying the diagnosis of anaphylaxis. However, they are often used to manage local reactions.
• Other Immunotherapy: If a patient is receiving multiple different allergenic extracts (e.g., Grass, Ragweed, and Mugwort), the risk of a cumulative systemic reaction is increased.

• Mugwort-Celery-Spice Syndrome: Patients sensitized to Artemisia Vulgaris Pollen may experience "Oral Allergy Syndrome" when eating celery, carrots, coriander, caraway, or fennel. While this is not a drug-food interaction in the metabolic sense, it is a clinical cross-reactivity that patients should be aware of.
• High-Fat Meals: No known effect on the pharmacology of the extract.

• St. John's Wort: No direct interaction, but patients should inform their doctor of all supplements.
• Echinacea: Some immunologists suggest avoiding immune-stimulating herbs during the build-up phase of immunotherapy, though data is limited.

• Skin Testing: The extract itself is used for testing. However, the use of antihistamines within 3-7 days of a skin test will cause a false-negative result.
• Serum IgE: Total and specific IgE levels may temporarily rise during the start of immunotherapy before eventually declining over years of treatment.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, especially those for blood pressure, heart rhythm, or depression.

1. 1Severe, Uncontrolled Asthma: Patients with an FEV1 consistently below 70% of predicted value or those with frequent exacerbations are at an unacceptable risk for fatal anaphylaxis.
2. 2History of Severe Anaphylaxis to Immunotherapy: If a patient has previously had a near-fatal reaction to Mugwort extract, further treatment is typically contraindicated.
3. 3Recent Myocardial Infarction (Heart Attack) or Unstable Angina: The risk of a reaction and the subsequent need for epinephrine poses too great a risk to the cardiovascular system.
4. 4Beta-Blocker Therapy: In many clinical guidelines, the use of beta-blockers is an absolute contraindication due to the interference with emergency treatment.

1. 1Autoimmune Disorders: Patients with active systemic lupus erythematosus (SLE) or rheumatoid arthritis may experience a flare-up of their condition, though this is debated.
2. 2Malignancy: Patients with active cancer are generally not started on immunotherapy.
3. 3Severe Atopic Dermatitis: Extensive skin disease may make it difficult to perform and interpret diagnostic skin tests.
4. 4Pregnancy (Initiation): Immunotherapy should not be started during pregnancy due to the risk of anaphylaxis-induced fetal hypoxia.

Patients allergic to Artemisia Vulgaris Pollen often show cross-reactivity with other members of the Asteraceae (Compositae) family, including:

• Ragweed (Ambrosia)
• Dandelion
• Chrysanthemums
• Sunflowers

> Important: Your healthcare provider will evaluate your complete medical history, including your current lung function and heart health, before prescribing Artemisia Vulgaris Pollen.

Pregnancy Category C. There are no adequate and well-controlled studies of Artemisia Vulgaris Pollen in pregnant women.

• Risk Summary: The primary risk is not the extract itself, but the potential for maternal anaphylaxis, which can cause uterine contractions and fetal hypoxia (lack of oxygen).
• Clinical Practice: Allergists generally do not start new immunotherapy during pregnancy. However, if a woman is already on a stable maintenance dose and is tolerating it well, the treatment may be continued at that dose (or reduced) throughout pregnancy.

It is not known whether allergenic extract components are excreted in human milk. Because these are large proteins that are likely digested in the infant's gut, the risk to a nursing infant is considered very low. Breastfeeding is not a contraindication to receiving Artemisia Vulgaris Pollen injections.

• Approved Age: Generally safe and effective for children aged 5 years and older.
• Considerations: Children must be able to cooperate with the injection process and communicate symptoms of a reaction. The efficacy of immunotherapy in children is high and may prevent the development of new sensitivities or the progression from rhinitis to asthma.

Patients over 65 require a thorough cardiovascular evaluation. The risk-benefit ratio may be less favorable in this group due to the potential for underlying coronary artery disease and the use of medications like beta-blockers or ACE inhibitors.

No dosage adjustment is required. The metabolic breakdown of the proteins in the extract does not rely on renal function. However, overall health status should be stable.

No dosage adjustment is required. The liver is not the primary site of action or clearance for these allergenic proteins.

> Important: Special populations, particularly pregnant women and the elderly, require individualized medical assessment and frequent monitoring during allergy treatment.

Artemisia Vulgaris Pollen extract acts as an immunomodulator. Its primary molecular targets are the IgE receptors on mast cells and basophils (for diagnosis) and the T-cell receptor/cytokine signaling pathways (for therapy). The major allergen, Art v 1, is a defensin-like protein that is highly immunogenic. During immunotherapy, the repeated exposure to these proteins induces a shift from a Th2 (allergic) response to a Th1/T-reg (tolerant) response, increasing the production of IL-10 and IgG4 antibodies.

• Onset of Action (Diagnosis): 15-20 minutes for a skin wheal.
• Onset of Action (Therapy): Symptom relief typically begins after reaching the maintenance dose, usually 6-12 months into treatment.
• Duration of Effect: If a full 3-5 year course is completed, the desensitization effect can last for several years or even decades after discontinuation.

| Parameter | Value |

|---|---|

| Bioavailability | N/A (Subcutaneous/Local) |

| Protein Binding | Primarily to IgE and IgG4 |

| Half-life | Minutes to hours (as proteins) |

| Tmax | 30-60 minutes (systemic absorption) |

| Metabolism | Proteolysis (Tissue/Blood) |

| Excretion | Renal (as peptide fragments) |

• Composition: A complex mixture of proteins, glycoproteins, and polysaccharides.
• Major Allergens: Art v 1 (Defensin-like), Art v 2, Art v 3 (LTP - Lipid Transfer Protein), Art v 4 (Profilin).
• Solubility: Soluble in aqueous buffers (e.g., phenolated saline or albumin saline).

Artemisia Vulgaris Pollen is classified as a Non-Standardized Pollen Allergenic Extract. It is grouped with other weed pollens like Ragweed and Pigweed. Unlike "Standardized" extracts (like Grass or Cat), its potency is not measured by a federally mandated bioassay, but rather by the manufacturer's internal standards (PNU or w/v).