Abies Nigra

Picea Mariana Resin is a non-standardized plant allergenic extract used primarily for the diagnosis and treatment of specific tree pollen allergies. It belongs to the class of allergenic extracts used in skin testing and immunotherapy.

Dosage for Picea Mariana Resin is not 'one size fits all.' It is highly individualized based on the patient's level of sensitivity, which is determined through initial skin testing.

• Diagnostic Testing (Prick Method): Usually, one drop of a 1:10 or 1:20 w/v extract is applied to the skin, followed by a light puncture.
• Immunotherapy (Induction Phase): Treatment typically begins with a very dilute solution (e.g., 1:100,000 w/v). Doses are increased weekly or bi-weekly until a 'maintenance dose' is reached.
• Maintenance Phase: Once the maintenance dose is reached (often 0.5 mL of a 1:100 or 1:20 w/v solution), the interval between injections is increased to every 2 to 4 weeks.

Picea Mariana Resin is used in children, but the dosage must be approached with extreme caution.

• Children under 5: Immunotherapy is generally avoided unless the allergic disease is severe, as younger children may have difficulty communicating the early signs of a systemic reaction.
• Children 5 and older: Dosing follows the adult escalation protocol but may be adjusted based on the child's body weight and the severity of their allergic symptoms. There is no specific 'pediatric dose' other than the individualized sensitivity-based dose.

Renal Impairment

No specific dose adjustments are provided in the manufacturer's labeling for renal impairment; however, clinicians should monitor patients closely as the clearance of degraded proteins may be slowed.

Hepatic Impairment

Hepatic impairment does not typically affect the dosing of allergenic extracts, as they are not metabolized by the liver's cytochrome P450 system.

Elderly Patients

Elderly patients may have a higher risk of cardiovascular complications if a systemic reaction occurs. Dosage should be increased more cautiously, and the patient's underlying heart health must be evaluated before starting immunotherapy.

This medication is NEVER self-administered at home. It must be given in a clinical setting.

• Preparation: The area (usually the forearm for testing or the upper arm for immunotherapy) is cleaned with alcohol.
• Administration: For immunotherapy, the injection is given subcutaneously (under the skin). It should not be given into a blood vessel.
• Observation: After receiving an injection, the patient MUST remain in the doctor's office for at least 30 minutes. This is the period when life-threatening anaphylaxis is most likely to occur.
• Storage: Vials must be stored in a refrigerator between 2°C and 8°C (36°F to 46°F). Freezing will destroy the potency of the proteins.

In immunotherapy, timing is critical.

• If a dose is missed by a few days, the same dose may often be given.
• If a dose is missed by more than one week, the allergist may need to REDUCE the dose to ensure safety, as the body's tolerance may have slightly decreased.
• If several weeks are missed, the escalation process may need to be restarted from a much lower concentration.

An overdose of Picea Mariana Resin occurs if too much extract is injected or if the concentration is increased too rapidly.

• Signs: Massive swelling at the injection site, hives (urticaria), wheezing, swelling of the throat, and a drop in blood pressure.
• Emergency Measures: Immediate administration of epinephrine (Adrenalin), oxygen, intravenous fluids, and antihistamines. Patients should be transported to an emergency department immediately.

> 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 Picea Mariana Resin extracts will experience some form of local reaction. These are generally considered normal and indicate that the immune system is responding to the allergen.

• Local Redness (Erythema): The area around the injection site may become red and warm. This usually appears within minutes and fades within a few hours.
• Local Swelling (Wheal): A small, raised bump at the injection site is common. If the bump is smaller than the size of a nickel, it is usually not a cause for concern.
• Itching (Pruritus): Intense itching at the site of the skin test or injection is very common. This is caused by the local release of histamine.

Picea Mariana Resin must be used with extreme caution. Because it is a biological extract, its potency can vary between lots. Patients must be stable and healthy at the time of injection. If you are experiencing an asthma flare-up or have a fever, your injection should be postponed.

No FDA black box warnings specifically for 'Picea Mariana Resin' as a standalone entity, but it falls under the mandatory class-wide warnings for Allergenic Extracts. These warnings emphasize that the product is potentially lethal if administered incorrectly or to a highly sensitive individual, and that emergency equipment (epinephrine, airway management) must be immediately available.

• Anaphylaxis Risk: This is the primary concern. Reactions can occur even in patients who have previously tolerated the same dose. The risk is higher during the 'build-up' phase of immunotherapy.

• Beta-Blockers (e.g., Propranolol, Metoprolol): These are often considered a contraindication for allergenic extracts. Beta-blockers can make an allergic reaction more severe and, more importantly, they can make epinephrine (the treatment for anaphylaxis) ineffective. If a patient on a beta-blocker has a severe reaction, it is much harder to save their life.

• ACE Inhibitors (e.g., Lisinopril): These medications may increase the risk of systemic reactions or more severe hypotension (low blood pressure) during an allergic event.
• MAO Inhibitors (e.g., Phenelzine): These can interfere with the body's ability to process the medications used to treat a reaction, potentially leading to a hypertensive crisis if epinephrine is used.

• Severe, Uncontrolled Asthma: Patients with a Forced Expiratory Volume (FEV1) consistently below 70% of predicted values should not receive allergenic extracts, as they are at the highest risk for fatal bronchospasm.
• Recent Myocardial Infarction (Heart Attack): Within the last 3-6 months. The stress of a potential systemic reaction could trigger another cardiac event.
• Known Hypersensitivity to Diluents: Some extracts contain phenol or glycerin. If a patient is severely allergic to these preservatives, the extract cannot be used.

• Beta-Blocker Therapy: While some specialists will treat patients on beta-blockers, many consider it a relative contraindication due to the 'epinephrine-resistance' factor.

Pregnancy Category C (FDA): There are no adequate and well-controlled studies in pregnant women.

• Starting Immunotherapy: It is generally recommended NOT to start Picea Mariana Resin immunotherapy during pregnancy because of the risk of anaphylaxis, which can cause fetal hypoxia (lack of oxygen to the baby).
• Continuing Immunotherapy: If a woman is already on a stable maintenance dose and is tolerating it well, many allergists will continue the treatment, but they will NOT increase the dose during the pregnancy.

It is generally considered safe to continue Picea Mariana Resin immunotherapy while breastfeeding. The allergenic proteins are broken down locally and are unlikely to pass into breast milk in any significant or harmful quantity. However, the mother should be monitored for systemic reactions as usual.

Picea Mariana Resin works through the modulation of the immune system. In the diagnostic phase, it utilizes the 'Type I Hypersensitivity' pathway, where the resin's allergens cross-link IgE antibodies on the surface of mast cells. This triggers the 'SNARE complex' to facilitate the exocytosis (release) of pre-formed mediators like histamine.

In the therapeutic phase (immunotherapy), the repeated, low-dose exposure leads to 'Immune Deviation.' This involves the induction of IL-10 and TGF-beta producing Regulatory T-cells. These cytokines promote a class switch in B-cells from producing IgE (the 'allergy' antibody) to producing IgG4 (the 'blocking' antibody). IgG4 competes with IgE for the allergen, effectively neutralizing it before it can reach the mast cells.

• Dose-Response: There is a clear dose-response relationship in skin testing; higher concentrations produce larger wheals until a plateau is reached.
• Time to Onset: Skin test reactions occur within 15-20 minutes. The therapeutic effects of immunotherapy take much longer, usually 6 to 12 months for significant symptom reduction.