Astacus Astacus

Dosage for Astacus Astacus is highly individualized and must be performed by a trained specialist in a clinical setting equipped to handle anaphylaxis.

• Skin Prick Testing (SPT): A single drop of the non-standardized extract (typically 1:10 or 1:20 w/v) is applied to the forearm or back. A sterile lancet is used to prick the skin through the drop. Results are read after 15 to 20 minutes.
• Intradermal Testing: If SPT is negative but a clinical suspicion of allergy remains, a 1:100 to 1:1000 dilution of the extract may be injected intradermally (0.02 mL) to create a small bleb. This is a more sensitive, yet higher-risk, diagnostic procedure.
• Immunotherapy: Dosing begins at an extremely low concentration (e.g., 1:100,000 w/v) and is gradually increased (escalation phase) until a maintenance dose is reached. This is usually administered subcutaneously once or twice weekly.

Astacus Astacus extracts are used in children for allergy diagnosis. However, the procedure must be modified based on the child's age and skin sensitivity.

• Infants and Toddlers: Skin prick testing is preferred over intradermal testing due to the lower risk of systemic reactions. The number of tests performed at one time may be limited to prevent excessive discomfort or systemic absorption.
• Adolescents: Standard adult concentrations for SPT are generally used.

Renal Impairment

No specific dosage adjustments are required for renal impairment, as the systemic load of the extract during diagnostic testing is minimal. However, patients with end-stage renal disease may have altered skin reactivity (uremic pruritus), which can interfere with the interpretation of skin tests.

Hepatic Impairment

No dosage adjustments are necessary for patients with liver disease. The metabolism of these protein-based extracts does not rely on hepatic pathways.

Elderly Patients

Elderly patients may have reduced skin reactivity (decreased mast cell density or responsiveness). Healthcare providers may need to use positive controls (histamine) more carefully to ensure the validity of the test results.

Astacus Astacus extracts are NOT for self-administration. They must be administered by a healthcare professional.

• Preparation: Ensure the extract is at room temperature before use. Check for any particulates or discoloration, although non-standardized extracts naturally vary in color from clear to amber.
• Site Selection: For skin testing, the volar surface of the forearm is the preferred site. Avoid areas with active dermatitis, scarring, or tattoos.
• Storage: Store the extract in a refrigerator at 2°C to 8°C (36°F to 46°F). Do not freeze. Keep the vial tightly closed to prevent evaporation and concentration of the extract.

In the context of diagnostic testing, a missed appointment simply requires rescheduling. For immunotherapy, a missed dose may require a 'step-back' in dosage. If more than 2-4 weeks have passed since the last injection, the doctor may need to reduce the dose to prevent an allergic reaction upon resumption.

An 'overdose' in the context of Astacus Astacus refers to the administration of too much allergen to a highly sensitive patient, leading to a systemic allergic reaction or anaphylaxis.

• Signs of Overdose: Rapid onset of hives, swelling of the throat (laryngeal edema), wheezing, shortness of breath, rapid heart rate, and a sudden drop in blood pressure.
• Emergency Measures: Immediate administration of epinephrine (0.3 mg intramuscularly for adults), followed by antihistamines, corticosteroids, and IV fluids. The patient must be monitored in an emergency department.

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

Most patients undergoing testing or treatment with Astacus Astacus will experience localized reactions at the site of administration. These are generally expected and indicate the body's immunological recognition of the substance.

• Local Wheal and Flare: A raised, itchy bump (wheal) surrounded by a red area (flare). This typically appears within 15 minutes and subsides within 1-2 hours.
• Pruritus (Itching): Intense itching at the test site is very common and can be managed with topical cool compresses after the test results are recorded.
• Localized Swelling: Some patients may experience swelling of the entire forearm if they are highly sensitive.

These reactions are more significant and may require monitoring or minor medical intervention.

• Delayed Local Reactions: Swelling and redness that appear 6 to 24 hours after the test. These are often painful rather than itchy and are caused by a late-phase allergic response.
• Fatigue: Some patients report feeling unusually tired for several hours following a large battery of skin tests.
• Headache: A mild, transient headache may occur following the release of endogenous histamine.

• Generalized Urticaria: Hives appearing on parts of the body far from the injection or test site.
• Vasovagal Reaction: Fainting or lightheadedness, often triggered by the needle prick or the sight of blood, rather than the extract itself.
• Lymphangitis: Inflammation of the lymph vessels leading away from the injection site.

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

• Anaphylaxis: This is a life-threatening, systemic allergic reaction. Symptoms include a feeling of impending doom, swelling of the tongue or throat, difficulty swallowing, and a rapid, weak pulse.
• Bronchospasm: Sudden constriction of the airways causing severe wheezing and inability to catch one's breath.
• Hypotension (Shock): A dangerous drop in blood pressure that can lead to dizziness, confusion, and loss of consciousness.
• Angioedema: Deep tissue swelling, particularly around the eyes, lips, or genitals, which can be disfiguring and dangerous if it involves the airway.

In the context of long-term immunotherapy, patients may develop a persistent sensitivity to the extract. There is also a theoretical risk of developing 'serum sickness,' a Type III hypersensitivity reaction characterized by joint pain, fever, and rash, though this is exceedingly rare with modern purified extracts.

No FDA black box warnings for Astacus Astacus. However, all allergenic extracts carry a general class warning regarding the risk of severe non-fatal and fatal systemic allergic reactions. These extracts must only be administered by physicians who are exceptionally experienced in the treatment of anaphylaxis and the management of respiratory emergencies.

Report any unusual symptoms to your healthcare provider.

Astacus Astacus extract is a potent biological agent that must be handled with extreme caution. It is intended only for diagnostic or therapeutic use by qualified medical professionals. Patients must be observed for at least 30 minutes following any administration of the extract, as most life-threatening systemic reactions occur within this window.

While Astacus Astacus does not have a specific individual black box warning, the FDA requires a general warning for the class of Allergenic Extracts. This warning states that these products can cause severe, life-threatening systemic reactions, including anaphylaxis. Patients with unstable asthma or those taking beta-blockers are at a significantly higher risk of complications if a reaction occurs.

• Anaphylaxis Risk: The most significant risk is a systemic Type I hypersensitivity reaction. Patients with a history of severe reactions to shellfish must be tested with extreme caution, often starting with highly diluted solutions.
• Asthma Status: Patients with uncontrolled or severe asthma should not undergo skin testing or immunotherapy with Astacus Astacus, as they are more likely to experience severe respiratory distress during an allergic reaction.
• Skin Conditions: Patients with extensive eczema, psoriasis, or dermatographism (where skin reddens and swells with minor pressure) may produce false-positive results, making the extract's diagnostic value unreliable.
• Cardiovascular Disease: Patients with significant heart disease may not be able to tolerate the physiological stress of an anaphylactic reaction or the administration of epinephrine used to treat it.

• Observation Period: A mandatory 30-minute wait in the doctor's office is required after every administration.
• Peak Flow Monitoring: For patients with a history of asthma, a peak flow meter may be used to ensure lung function is stable before and after testing.
• Vital Signs: In high-risk patients, blood pressure and heart rate may be monitored during the procedure.

Astacus Astacus generally does not affect the ability to drive. However, if a patient experiences a systemic reaction or receives epinephrine, they should not drive until they are fully cleared by a medical professional. Vasovagal reactions (fainting) can also occur, so patients should ensure they feel stable before leaving the clinic.

Alcohol consumption should be avoided for 24 hours before and after testing. Alcohol can increase blood flow to the skin (vasodilation), which may exacerbate local reactions or potentially accelerate the systemic absorption of the allergen.

Discontinuing Astacus Astacus testing has no withdrawal effects. In immunotherapy, stopping the injections will result in a gradual loss of the immunological tolerance that was being built, eventually returning the patient to their baseline level of allergy sensitivity.

> Important: Discuss all your medical conditions with your healthcare provider before starting Astacus Astacus.

• Beta-Blockers (e.g., Propranolol, Atenolol): These medications are contraindicated during allergenic extract administration. If a patient on a beta-blocker experiences anaphylaxis, the drug blocks the effects of epinephrine (the primary treatment), making the reaction potentially fatal and refractory to standard emergency care.

• ACE Inhibitors (e.g., Lisinopril): These drugs may increase the risk of systemic reactions to allergenic extracts and may interfere with the body's natural compensatory mechanisms during an allergic event.
• MAO Inhibitors (e.g., Phenelzine): These can potentiate the effects of epinephrine, leading to a hypertensive crisis if epinephrine must be administered to treat an allergic reaction.
• Tricyclic Antidepressants (TCAs): Similar to MAOIs, TCAs can increase the cardiovascular response to epinephrine.

• Antihistamines (e.g., Loratadine, Cetirizine, Diphenhydramine): These drugs MUST be discontinued 3 to 7 days before skin testing. They block the H1 receptors, preventing the 'wheal and flare' reaction and leading to false-negative results.
• H2 Blockers (e.g., Famotidine): These can also partially suppress skin reactivity and should be discontinued at least 48 hours before testing.
• Topical Steroids: Applying steroids to the test site can suppress the local inflammatory response, leading to inaccurate diagnostic results.

• Caffeine: As a Methylxanthine [EPC], caffeine can have mild bronchodilatory and stimulant effects that might subtly mask early symptoms of a respiratory allergic reaction.
• High-Fat Meals: There is no direct interaction, but heavy meals can cause gastrointestinal discomfort that might be confused with the early GI symptoms of anaphylaxis.

• St. John's Wort: May affect the metabolism of various medications, though its impact on allergenic extracts is primarily through potential photosensitivity of the skin.
• Licorice Root: Can have corticosteroid-like effects that might mildly suppress skin reactivity.

Astacus Astacus administration will not interfere with standard blood chemistries or hematology. However, it is designed specifically to affect Skin Prick Tests and Serum IgE (RAST/ImmunoCAP) tests. The presence of the extract in the skin will intentionally alter the local dermatological profile for diagnostic purposes.

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

Astacus Astacus must NEVER be used in the following circumstances:

• Previous Severe Systemic Reaction: If a patient has previously experienced life-threatening anaphylaxis during testing with this specific extract.
• Uncontrolled Asthma: Patients with an FEV1 (Forced Expiratory Volume) consistently below 70% of predicted values are at unacceptable risk for fatal bronchospasm.
• Acute Infection: Testing should be postponed if the patient has a fever or active viral/bacterial infection, as the immune system is already in a heightened state of reactivity.
• Beta-Blocker Therapy: Due to the inability to treat anaphylaxis effectively with epinephrine while on these medications.

• Pregnancy: While not strictly contraindicated, diagnostic skin testing is usually deferred until after delivery to avoid the risk of anaphylaxis-induced fetal hypoxia.
• Severe Atopic Dermatitis: If there is no clear area of healthy skin to perform the test, the results will be uninterpretable.
• Active Malignancy or Immunodeficiency: The immune response to the extract may be unpredictable or blunted.

Patients who are allergic to Astacus Astacus (Noble Crayfish) are highly likely to show cross-reactivity with other crustaceans, including:

• Shrimp (Penaeus species)
• Lobster (Homarus species)
• Crab (Cancer species)
• Dust Mites and Cockroaches: Due to the highly conserved nature of the protein tropomyosin, patients with dust mite allergies may occasionally show false-positive reactions to crayfish extracts.

> Important: Your healthcare provider will evaluate your complete medical history before prescribing Astacus Astacus.

Astacus Astacus is classified as Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. The primary concern is not the direct effect of the extract on the fetus, but the risk of systemic anaphylaxis in the mother. Anaphylaxis can lead to maternal hypotension, which causes uterine hypoperfusion and fetal hypoxia (lack of oxygen). Therefore, skin testing and the initiation of immunotherapy are generally avoided during pregnancy. If a patient is already on a maintenance dose of immunotherapy and becomes pregnant, the physician may choose to continue the treatment at a constant or reduced dose.

It is not known whether the allergenic proteins in Astacus Astacus are excreted in human milk. However, because these are large proteins that are typically broken down in the maternal digestive tract if absorbed systemically, the risk to a nursing infant is considered extremely low. The primary consideration remains the mother's safety during the administration procedure.

Astacus Astacus extracts are frequently used in pediatric allergy clinics. Children as young as infants can be tested, though skin reactivity may be lower in those under 2 years of age. The psychological impact of needle-based testing must be considered, and 'multi-test' devices that apply several allergens at once with minimal discomfort are often used. Immunotherapy for food allergies in children remains largely investigational and should only be conducted in specialized centers.

Clinical studies of Astacus Astacus did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. In general, elderly patients have thinner skin and potentially reduced mast cell responses, which may lead to smaller wheal sizes. Furthermore, the higher prevalence of cardiovascular disease and the use of medications like beta-blockers or ACE inhibitors in this population require extra caution.

No dosage adjustment is required for patients with renal impairment. However, clinicians should be aware that uremia (high levels of urea in the blood) can suppress skin test reactivity, potentially leading to false-negative results in patients with advanced kidney disease.

There are no specific precautions or dosage adjustments for patients with hepatic impairment, as the clearance of the extract's protein components does not involve the liver's metabolic pathways.

> Important: Special populations require individualized medical assessment.

Astacus Astacus works through the induction of a Type I hypersensitivity cascade. The extract contains specific pathogen-related proteins (PRPs), primarily tropomyosin (Ast a 1). Upon contact with the interstitial fluid of the dermis, these proteins are recognized by IgE antibodies bound to the high-affinity receptor FcεRI on the surface of mast cells. This recognition triggers a signal transduction pathway involving tyrosine kinases (such as Lyn and Syk), leading to an influx of calcium ions and the subsequent exocytosis (release) of pre-formed inflammatory mediators like histamine. This localized reaction is the 'gold standard' for identifying clinical sensitivity.

• Onset of Action: For skin prick testing, the onset of the wheal and flare reaction occurs within 5 to 10 minutes, peaking at 15 to 20 minutes.
• Duration of Effect: The visible skin reaction usually fades within 2 to 4 hours, though a late-phase reaction (characterized by eosinophil infiltration) can occur 6 to 12 hours later.
• Tolerance: In the context of immunotherapy, pharmacodynamics involve the gradual shift from a Th2 (allergic) immune response to a Th1 or Treg (tolerant) response, characterized by the production of IL-10 and TGF-beta.

| Parameter | Value |

|---|---|

| Bioavailability | Negligible (Epicutaneous); Variable (Subcutaneous) |

| Protein Binding | Primarily binds to IgE and IgG antibodies |

| Half-life | 1-4 hours (local tissue clearance) |

| Tmax | 15-20 minutes (for local reaction) |

| Metabolism | Proteolytic degradation by local and systemic proteases |

| Excretion | Renal (as small peptide fragments) |

• Molecular Components: A complex mixture of proteins (tropomyosin, arginine kinase, hemocyanin), lipids, and carbohydrates.
• Solubility: Highly soluble in aqueous solutions and albumin-saline diluents.
• Molecular Weight: Tropomyosin, the major allergen, has a molecular weight of approximately 35-38 kDa.

Astacus Astacus is classified as an Allergenic Extract. Within the Electronic Product Code (EPC) system, it is uniquely associated with Vitamin C [EPC] (due to its raw biological composition) and Methylxanthine [EPC] (likely due to trace constituents or specific manufacturing processes).