1912 Herb Co Vital Air Herb

Dosage for Lonicera Caprifolium Flower is highly individualized and must be determined by an allergy specialist (allergist/immunologist). It is not measured in milligrams like standard drugs but in biological potency units.

Diagnostic Testing

• Scratch/Prick/Puncture Test: A single drop of the extract (typically 1:10 or 1:20 w/v or a standardized BAU concentration) is applied to the skin, followed by a light puncture. Results are read after 15–20 minutes.
• Intradermal Test: If the prick test is negative, 0.02 mL of a 1:100 to 1:1000 dilution may be injected into the dermis.

Immunotherapy

• Build-up Phase: Treatment typically begins with a very low dose (e.g., 0.05 mL of a 1:100,000 dilution). Injections are given 1–2 times per week, with the dose increasing by 25–50% each time, provided no significant local reactions occur.
• Maintenance Phase: Once the 'maintenance dose' is reached (the highest dose tolerated without systemic reaction), the interval between injections is increased to every 2–4 weeks. This phase usually lasts 3 to 5 years.

Lonicera Caprifolium Flower extracts are generally considered safe for use in children, though testing and treatment are rarely initiated in children under the age of 5. Dosage follows the same weight-independent, sensitivity-based escalation used in adults. Pediatric patients must be monitored even more closely for signs of systemic distress, as they may be less able to articulate early symptoms of anaphylaxis.

Renal Impairment

No specific dose adjustments are required for patients with renal impairment, as the protein load is minimal. However, the patient's overall health must be stable before administration.

Hepatic Impairment

No dose adjustments are necessary for hepatic impairment.

Elderly Patients

Caution is advised in elderly patients, particularly those with underlying cardiovascular disease. The risk of a systemic reaction is not necessarily higher, but the ability to survive a severe anaphylactic event or the administration of emergency epinephrine may be compromised.

This medication is never self-administered at home. It must be administered by a trained healthcare professional in a facility equipped with emergency resuscitation equipment.

• Preparation: The skin (usually the back for testing or the upper arm for therapy) is cleaned with alcohol.
• Administration: For immunotherapy, the injection is given subcutaneously (under the skin, not into a muscle or vein).
• Observation: Patients must remain in the clinic for at least 30 minutes following any injection to monitor for signs of a systemic allergic reaction.
• Storage: Vials must be stored in a refrigerator between 2°C and 8°C (36°F and 46°F). Do not freeze, as this can denature the allergenic proteins.

In immunotherapy, consistency is vital. If a dose is missed:

• Short Delay (1-3 days): Usually, the scheduled dose can be given.
• Long Delay (over 1 week): The dose may need to be reduced to the previous level or lower to ensure safety, as the body's tolerance may have slightly waned. Your allergist will determine the exact 'step-back' required.

An 'overdose' in the context of allergenic extracts refers to the administration of a dose that exceeds the patient's current threshold of tolerance, leading to a systemic reaction.

• Signs: Hives, swelling of the throat, wheezing, shortness of breath, rapid pulse, or a drop in blood pressure.
• Emergency Measures: Immediate administration of epinephrine (Adrenalin), followed by antihistamines, corticosteroids, and oxygen. Emergency medical services (911) should be contacted immediately if a reaction occurs outside the clinic.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance. Always inform your doctor if you are feeling unwell on the day of your scheduled injection.

Most patients receiving Lonicera Caprifolium Flower extract will experience some form of local reaction. These are generally not dangerous but indicate that the immune system is responding to the allergen.

• Local Wheal and Flare: A small, raised bump (wheal) surrounded by redness (flare) at the site of a skin test. This typically peaks at 20 minutes and fades within an hour.
• Injection Site Swelling: In immunotherapy, a 'local' swelling (up to the size of a half-dollar) may occur. This can feel warm, itchy, or slightly tender.
• Pruritus (Itching): Intense itching at the site of administration is very common and can be managed with topical cold compresses or oral antihistamines.

• Large Local Reactions: Swelling that exceeds 5-10 cm in diameter. While not systemic, these often require a dosage adjustment for the next injection.
• Fatigue: Some patients report feeling unusually tired for a few hours after an immunotherapy injection.
• Mild Rhinitis: Sneezing or a runny nose shortly after the injection, as the body processes the allergen.

• Generalized Urticaria (Hives): Hives appearing on parts of the body away from the injection site. This is a sign of a systemic reaction and requires immediate medical evaluation.
• Vasovagal Reaction: Fainting or lightheadedness, often due to the needle prick rather than the extract itself.

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

• Anaphylaxis: A life-threatening, multi-system allergic reaction. It can begin with a 'sense of impending doom,' followed by throat tightness, difficulty breathing, and fainting.
• Angioedema: Deep swelling of the tissues, particularly the lips, tongue, or around the eyes, which can obstruct the airway.
• Bronchospasm: Sudden constriction of the airways, leading to severe wheezing and inability to catch one's breath.
• Hypotension: A dangerous drop in blood pressure that can lead to shock.

When administered correctly under the supervision of an allergist, Lonicera Caprifolium Flower extract does not typically cause long-term organ toxicity. The primary long-term 'effect' is the desired modification of the immune system. However, there is a theoretical risk of developing new sensitizations to other components in the extract, though this is clinically rare in established immunotherapy protocols.

Allergenic extracts, including Lonicera Caprifolium Flower, carry an FDA-mandated Boxed Warning regarding the risk of severe systemic reactions.

Summary of Boxed Warning:

• This product can cause severe, life-threatening systemic reactions, including anaphylaxis.
• It should only be administered by physicians trained in the treatment of anaphylaxis and the management of allergenic extracts.
• Patients with unstable or severe asthma are at a higher risk for fatal reactions.
• Patients must be observed for at least 30 minutes after administration.
• This product may not be suitable for patients taking beta-blockers, as they can be resistant to the effects of epinephrine.

Report any unusual symptoms to your healthcare provider. Even a 'mild' systemic reaction (like a few hives) must be reported before your next dose, as it could precede a more severe reaction.

Lonicera Caprifolium Flower extract is a potent biological agent. Its safety depends entirely on proper administration and patient selection. Patients must be in their 'baseline' state of health on the day of administration. If you have a fever, a cold, or an active asthma flare-up, your injection must be postponed.

No FDA black box warnings for Lonicera Caprifolium Flower. Correction: Standardized allergenic extracts carry a class-wide boxed warning regarding anaphylaxis risk. The warning emphasizes that allergenic extracts are not for home use and require a 30-minute post-injection observation period in a medical facility. It also highlights the increased risk for patients with compromised lung function.

• Anaphylaxis Risk: This is the primary concern. All patients must be screened for risk factors and educated on the signs of anaphylaxis. Access to an epinephrine auto-injector is often recommended for patients undergoing immunotherapy to have on hand for the hours following an injection.
• Asthma Status: Patients with uncontrolled asthma (FEV1 < 70% of predicted) should not receive immunotherapy injections, as they are at the highest risk for a fatal bronchospasm during a systemic reaction.
• Cardiovascular Disease: Patients with significant heart disease may not tolerate the stress of a systemic reaction or the effects of the epinephrine required to treat it.
• Infection: Acute infections or high stress can lower the threshold for a systemic reaction.

• Peak Flow/Spirometry: For asthmatic patients, a peak flow meter may be used before each injection to ensure lung function is stable.
• Observation: A strict 30-minute wait time in the office after every injection.
• Skin Site Monitoring: Checking for the size of the local wheal or swelling to guide the next dose.

Most patients can drive after the 30-minute observation period. However, if you experience lightheadedness, fatigue, or use an antihistamine to treat a local reaction, you should avoid driving until you feel fully alert.

Alcohol consumption should be avoided on the day of an allergy injection. Alcohol can cause vasodilation (widening of blood vessels), which may theoretically increase the rate of allergen absorption and potentially worsen a systemic reaction.

Immunotherapy is a long-term commitment. Stopping 'cold turkey' is not dangerous in the sense of withdrawal, but it will result in the gradual return of allergy symptoms. If you need to stop, discuss a tapering or maintenance plan with your doctor to preserve the progress made.

> Important: Discuss all your medical conditions with your healthcare provider before starting Lonicera Caprifolium Flower. Be sure to mention any history of fainting or heart problems.

• Beta-Blockers (e.g., Propranolol, Atenolol, Metoprolol): These medications are used for high blood pressure and heart conditions. They are contraindicated (or used with extreme caution) because they block the receptors that epinephrine acts upon. If a patient on a beta-blocker has an anaphylactic reaction to Lonicera Caprifolium Flower, the emergency epinephrine may not work, leading to a potentially fatal outcome.

• ACE Inhibitors (e.g., Lisinopril, Enalapril): These may increase the risk of more severe systemic reactions or interfere with the body's natural compensatory mechanisms during an allergic event.
• MAO Inhibitors (e.g., Phenelzine): Can potentiate the effect of epinephrine, making the treatment of a reaction more complex due to the risk of a hypertensive crisis.
• Tricyclic Antidepressants (e.g., Amitriptyline): Similar to MAOIs, these can increase the cardiovascular sensitivity to epinephrine.

• Antihistamines (e.g., Loratadine, Cetirizine, Diphenhydramine): These do not cause a safety risk, but they will interfere with diagnostic skin testing. Antihistamines must be stopped 3 to 7 days before a skin test to avoid a 'false negative' result. They do not need to be stopped for immunotherapy injections.
• H2 Blockers (e.g., Famotidine): May also slightly suppress skin test reactions.
• Topical Corticosteroids: If applied to the test site, they can suppress the local inflammatory response, leading to inaccurate test results.

There are no direct food-drug interactions with Lonicera Caprifolium Flower. However, patients with 'Oral Allergy Syndrome' may have cross-reactivity between certain fruits and honeysuckle pollen. Discuss any food allergies with your doctor.

• St. John's Wort: May theoretically affect the metabolism of other medications used to treat allergic reactions, though the clinical significance is low.
• High-dose Vitamin C: Some believe it has mild antihistamine properties, which could theoretically interfere with skin test accuracy.

Lonicera Caprifolium Flower extract does not interfere with standard blood chemistry or hematology tests. However, it will directly affect the results of:

• Skin Prick Tests: As intended for diagnosis.
• Serum IgE Testing (ImmunoCAP): Successful immunotherapy will eventually lead to changes in these lab values (e.g., a decrease in specific IgE or an increase in specific IgG4).

For each major interaction, the mechanism usually involves either the suppression of the diagnostic inflammatory response (antihistamines) or the interference with emergency rescue medications (beta-blockers).

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

Lonicera Caprifolium Flower extract must NEVER be used in the following circumstances:

1. 1Severe, Uncontrolled Asthma: Patients with a forced expiratory volume (FEV1) persistently below 70% of predicted are at an unacceptable risk of fatal bronchospasm during a systemic reaction.
2. 2Recent Myocardial Infarction (Heart Attack): Within the last 3-6 months. The stress of a potential systemic reaction or the use of epinephrine could cause cardiac arrest.
3. 3Known Hypersensitivity to Inactive Ingredients: Such as phenol (used as a preservative) or glycerin (used as a stabilizer).
4. 4Beta-Blocker Therapy: Due to the inability to effectively treat anaphylaxis with epinephrine.

These conditions require a careful risk-benefit analysis by the specialist:

• Pregnancy: Immunotherapy is usually not started during pregnancy, but if a patient is already on a stable maintenance dose, it may be continued.
• Autoimmune Diseases: There is a theoretical risk that stimulating the immune system could exacerbate conditions like Lupus or Rheumatoid Arthritis.
• Malignancy: Patients with active cancer may have compromised immune systems that do not respond predictably to immunotherapy.
• Young Children (<5 years): Difficulty in monitoring and communicating symptoms of a reaction.

Patients allergic to Lonicera Caprifolium may also react to other members of the Caprifoliaceae family, such as Elderberry (Sambucus) or Snowberry (Symphoricarpos). If you have had a severe reaction to any of these plants, inform your doctor before testing.

> Important: Your healthcare provider will evaluate your complete medical history before prescribing Lonicera Caprifolium Flower. Ensure you provide a full list of all previous allergic reactions.

Lonicera Caprifolium Flower is classified as FDA Pregnancy Category C. This means there are no adequate and well-controlled studies in pregnant women.

• Risk of Anaphylaxis: The greatest risk to the fetus is maternal anaphylaxis, which can lead to uterine hypoxia (lack of oxygen to the baby).
• Clinical Practice: Allergists generally do not initiate new immunotherapy or perform skin testing during pregnancy. However, if a woman reaches a maintenance dose and then becomes pregnant, the treatment is often continued at the same or a slightly reduced dose because the risk of a reaction is lowest during the maintenance phase.

It is generally considered safe to continue Lonicera Caprifolium Flower immunotherapy while breastfeeding. The allergenic proteins are not expected to pass into breast milk in any significant quantity, and the antibodies produced by the mother (IgG) may actually provide some passive protection to the infant. No adverse effects on nursing infants have been documented.

Lonicera Caprifolium Flower is used in children for both diagnosis and treatment.

• Safety: The safety profile is similar to adults, but children require closer observation.
• Efficacy: Immunotherapy is highly effective in children and may prevent the 'allergic march'—the progression from hay fever to asthma.
• Dosing: No specific pediatric dose adjustment is needed; the dose is based on the child's specific level of sensitivity.

In patients over 65, the decision to use Lonicera Caprifolium Flower must be made with caution.

• Cardiac Risk: Increased prevalence of heart disease makes the use of epinephrine more dangerous.
• Polypharmacy: Older adults are more likely to be on beta-blockers or ACE inhibitors, which complicate the safety of immunotherapy.
• Renal Function: While not a primary concern for the extract itself, reduced renal clearance may affect how the patient handles ancillary medications.

There are no specific guidelines for renal impairment. Since the extract consists of proteins that are naturally degraded, it is not expected to accumulate in patients with kidney disease. However, the patient's overall stability should be confirmed.

No adjustments are necessary for patients with liver disease. The metabolism of the allergenic proteins occurs via general proteolytic pathways and is not dependent on specific hepatic CYP450 enzymes.

> Important: Special populations require individualized medical assessment. Always inform your specialist of any changes in your health status, including pregnancy or new heart medications.

Lonicera Caprifolium Flower extract functions as an immunomodulator. It contains a complex mixture of proteins, including pectins, profilins, and calcium-binding proteins, which are the primary allergens.

• Diagnostic: Upon contact with sensitized mast cells, these proteins cross-link IgE, causing the release of pre-formed mediators like histamine from granules.
• Therapeutic: Repeated exposure leads to 'T-cell anergy' or exhaustion of the Th2 response, and the induction of Regulatory T-cells (Tregs). This results in a switch from IgE production to IgG4 production. IgG4 acts as a 'decoy' or 'blocking' antibody.

• Onset of Action: For skin testing, the onset is rapid (15–20 minutes). For immunotherapy, the onset of clinical symptom relief can take 6 months to a year of consistent treatment.
• Duration of Effect: The diagnostic effect is transient. The therapeutic effect of immunotherapy can be permanent or last for many years after the 3-5 year course is completed.
• Dose-Response: There is a clear dose-response relationship in immunotherapy; higher doses (within the range of tolerance) generally lead to better long-term outcomes.

| Parameter | Value |

|---|---|

| Bioavailability | Negligible (Percutaneous); Slow/Variable (Subcutaneous) |

| Protein Binding | N/A (Interacts with IgE/IgG antibodies) |

| Half-life | Proteins: Hours; Immunological Effect: Years |

| Tmax | 15–30 minutes (Local reaction) |

| Metabolism | Proteolysis (Breakdown by enzymes) |

| Excretion | Renal (as small peptides/amino acids) |

• Composition: A sterile aqueous solution containing the extractable proteins, carbohydrates, and lipids from Lonicera Caprifolium pollen.
• Molecular Weight: Varies widely (10 kDa to 70 kDa for most major allergens).
• Solubility: Highly soluble in aqueous buffers; often stabilized with 50% glycerin.

Lonicera Caprifolium Flower is classified as a Standardized Pollen Allergenic Extract [EPC]. It is grouped with other pollen extracts (grasses, weeds, trees) used in the 'Allergenic Extracts' therapeutic category. It is distinct from 'Antihistamines' or 'Corticosteroids' as it modifies the disease process rather than just masking symptoms.