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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Aluminum Metallicum, Ailanthus, Baptisia Tinctoria, Fragaria Vesca, Yoscyamus Niger, Muriaticum Acid
Brand Name
D-114
Generic Name
Aluminum Metallicum, Ailanthus, Baptisia Tinctoria, Fragaria Vesca, Yoscyamus Niger, Muriaticum Acid
Active Ingredient
Ailanthus Altissima Flowering TwigCategory
Standardized Insect Venom Allergenic Extract [EPC]
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 30 [hp_X]/mL | SOLUTION | SUBLINGUAL | 58264-0120 |
Detailed information about D-114
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for D-114, you must consult a qualified healthcare professional.
Ailanthus Altissima Flowering Twig is a biological allergenic extract used primarily in the diagnosis and treatment of IgE-mediated allergic diseases through immunotherapy and skin testing.
Dosage for Ailanthus Altissima Flowering Twig is highly individualized and must be determined by a specialist (allergist or immunologist). There is no 'one-size-fits-all' dose. The treatment is divided into two distinct phases:
During this phase, the patient receives injections of increasing concentrations of the extract. Injections are typically given 1 to 3 times per week. The starting dose is usually a very dilute solution (e.g., 1:100,000 or 1:10,000 W/V), starting at 0.05 mL and increasing gradually to 0.5 mL. The goal is to reach the 'Maintenance Dose' without triggering a systemic reaction.
Once the target concentration is reached (the highest dose the patient can tolerate safely), the frequency of injections is reduced. Maintenance injections are typically administered every 2 to 4 weeks. A common maintenance dose is 0.5 mL of a 1:100 or 1:20 W/V concentration. Maintenance therapy usually lasts for 3 to 5 years to ensure long-term desensitization.
Ailanthus Altissima Flowering Twig extracts are generally considered safe for use in children, typically starting at age 5. Dosing protocols for children follow the same 'Build-up' and 'Maintenance' structure used for adults, though the physician may choose a more conservative escalation schedule. The safety and efficacy in children under the age of 5 have not been extensively established, primarily due to the difficulty of younger children communicating early symptoms of a systemic reaction.
No specific dose adjustments are required for patients with renal impairment, as the clearance of biological proteins is not significantly impacted by kidney function in a way that increases toxicity risk.
No dose adjustments are necessary for patients with liver disease.
Elderly patients (over 65) require careful assessment of their cardiovascular status. While the dose of the extract remains the same, the risk of being unable to tolerate a systemic reaction (or the epinephrine used to treat it) is higher. Physicians may use a slower build-up phase for geriatric patients.
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 how much time has passed. If more than 7-10 days have passed between build-up doses, the physician will typically 'backtrack' the dosage to ensure safety. If a maintenance dose is missed by more than a few weeks, the dose is usually reduced for one or two visits before returning to the full maintenance level.
An 'overdose' in the context of allergenic extracts usually refers to an accidental administration of a concentration higher than the patient's current tolerance level. Signs of overdose (systemic reaction) include:
Emergency Measures: Immediate administration of intramuscular epinephrine (0.3mg for adults) is the first-line treatment. The patient may also require antihistamines, corticosteroids, and emergency transport to a hospital.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or skip visits without medical guidance.
Most patients undergoing immunotherapy with Ailanthus Altissima Flowering Twig will experience local reactions at the site of injection. These are generally considered a normal part of the immune system's response to the extract.
> Warning: Stop taking Ailanthus Altissima Flowering Twig and call your doctor immediately or seek emergency care if you experience any of these symptoms of anaphylaxis.
There are no known long-term 'toxic' effects of Ailanthus Altissima Flowering Twig on internal organs like the liver or kidneys. The primary long-term consideration is the successful modulation of the immune system. However, in very rare cases, chronic over-stimulation of the immune system has been theoretically linked to autoimmune phenomena, though large-scale studies have not confirmed this as a significant risk for standard allergy shots.
Allergenic extracts, including Ailanthus Altissima Flowering Twig, carry a significant risk of Anaphylaxis.
Summary of FDA-required Warning Information:
Report any unusual symptoms to your healthcare provider. Even a 'large' local reaction should be reported, as it may be a precursor to a systemic reaction at the next dose.
Ailanthus Altissima Flowering Twig is a potent biological agent. It is not a 'cure' in the traditional sense but a long-term immunomodulatory therapy. Patients must be committed to the schedule and the safety protocols required by their allergist. If you are ill, have a fever, or are experiencing an asthma flare-up, you must inform your doctor before receiving your injection, as these conditions significantly increase the risk of a severe adverse reaction.
No FDA black box warnings for Ailanthus Altissima Flowering Twig specifically, however, it falls under the general class warning for all Allergenic Extracts. The warning emphasizes that these products can cause life-threatening anaphylaxis even in patients who have previously tolerated them well. The warning also mandates that the treatment be administered only in settings where emergency resuscitation is possible.
Unlike many medications, Ailanthus Altissima Flowering Twig does not require routine blood work (like liver enzymes or CBC). Instead, monitoring is clinical:
Generally, this medication does not cause drowsiness or impairment. However, if a patient experiences a vasovagal reaction (fainting from the needle) or a mild systemic reaction, they should not drive until they have fully recovered and been cleared by the physician.
There is no direct chemical interaction between alcohol and Ailanthus extract. However, alcohol consumption can cause vasodilation (widening of blood vessels), which may theoretically increase the rate of allergen absorption or worsen the symptoms of a systemic reaction. It is generally advised to avoid heavy alcohol use on the day of an injection.
Immunotherapy can be stopped at any time, but stopping prematurely (before 3 years) usually results in the return of allergy symptoms. There is no 'withdrawal syndrome' associated with stopping allergenic extracts, but the 'allergic protection' will gradually fade. If the patient decides to restart after a long break, they must start back at the beginning of the build-up phase.
> Important: Discuss all your medical conditions with your healthcare provider before starting Ailanthus Altissima Flowering Twig.
There are no specific food interactions with Ailanthus Altissima Flowering Twig. However, patients should avoid eating a heavy, spicy meal or consuming very hot beverages immediately before or after an injection, as these can cause flushing and vasodilation that might complicate the clinical picture.
For each major interaction, the strategy is typically avoidance (in the case of beta-blockers) or close clinical monitoring (in the case of ACE inhibitors). The physician must weigh the benefit of the immunotherapy against the risk of the interacting medication.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking.
Patients sensitized to Ailanthus Altissima may show cross-reactivity with other members of the Simaroubaceae family, although this is rare in North America and Europe. More commonly, patients who are highly sensitive to tree pollens in general may have a lower 'threshold' for reactions during the spring season when environmental pollen counts are high.
> Important: Your healthcare provider will evaluate your complete medical history before prescribing Ailanthus Altissima Flowering Twig.
Pregnancy Category: C. There are no adequate and well-controlled studies of Ailanthus Altissima Flowering Twig in pregnant women.
It is generally considered safe to continue Ailanthus Altissima Flowering Twig while breastfeeding. The allergens are proteins that are digested in the mother's system and are not expected to pass into breast milk in any significant or harmful quantity. The nursing infant is not at risk of sensitization through breast milk.
No specific studies have been conducted in patients with renal impairment. However, since the allergens are proteins that are metabolized by proteases throughout the body, kidney failure is not expected to alter the safety or efficacy of the injections.
Liver disease does not affect the metabolism of allergenic extracts. No dosage adjustments are necessary for patients with any degree of hepatic impairment.
> Important: Special populations require individualized medical assessment to ensure the benefits of immunotherapy outweigh the potential risks.
Ailanthus Altissima Flowering Twig acts as an immunomodulator. Its molecular mechanism involves the presentation of specific tree antigens (proteins) to the immune system's dendritic cells. This interaction leads to the differentiation of T-cells into Regulatory T-cells (Tregs). These Tregs produce Interleukin-10 (IL-10), which suppresses the production of IgE by B-cells and instead promotes the production of IgG4. IgG4 acts as a 'decoy' or 'blocking' antibody, binding to the Ailanthus allergens before they can reach the IgE on mast cells. This prevents the release of histamine and other inflammatory chemicals.
| Parameter | Value |
|---|---|
| Bioavailability | N/A (Subcutaneous Injection) |
| Protein Binding | N/A (Metabolized by proteases) |
| Half-life | Minutes to hours (for the proteins) |
| Tmax | 1 - 2 hours (for peak systemic absorption) |
| Metabolism | Local and systemic proteolytic degradation |
| Excretion | Renal (as amino acids/small peptides) |
This agent is part of the Allergenic Extract class. Related medications include extracts for Timothy Grass, Ragweed, and various Dust Mites. It is specifically grouped under 'Standardized Insect Venom Allergenic Extract [EPC]' in some regulatory databases due to broad classification structures, but it functions clinically as a plant-based allergen.
Common questions about D-114
Ailanthus Altissima Flowering Twig is primarily used as an allergenic extract for the diagnosis and treatment of allergies related to the Tree of Heaven plant. In diagnostic settings, it is used in skin prick tests to identify if a patient has a specific IgE-mediated sensitivity to this tree's pollen or proteins. Therapeutically, it is used in allergen immunotherapy, commonly known as allergy shots, to desensitize the patient's immune system over time. This process involves giving gradually increasing doses of the extract to reduce the severity of allergic rhinitis, conjunctivitis, or asthma symptoms. It is an essential tool for patients who do not find sufficient relief from standard allergy medications.
The most common side effects are local reactions at the site where the injection was given. These typically include redness, itching, and a small bump or swelling, which may feel warm to the touch. These reactions are usually mild and disappear within a day or two. Some patients may also experience a temporary increase in their usual allergy symptoms, such as sneezing or nasal congestion, shortly after the injection. While rare, more significant swelling (large local reactions) can occur and should be reported to the doctor. Most patients tolerate these side effects well as part of the desensitization process.
There is no direct chemical interaction between alcohol and the proteins in Ailanthus Altissima Flowering Twig extract. However, healthcare providers generally recommend avoiding significant alcohol consumption on the day of your allergy injection. Alcohol can cause blood vessels to dilate (expand), which might theoretically increase the speed at which the allergen enters your bloodstream, potentially increasing the risk of a systemic reaction. Furthermore, alcohol can mask some of the early symptoms of a reaction or make it harder for you to notice them. It is best to remain clear-headed and hydrated following your treatment visits.
Ailanthus Altissima Flowering Twig is generally not started during pregnancy. This is because the initial 'build-up' phase of immunotherapy carries a higher risk of systemic allergic reactions (anaphylaxis), which could be dangerous for both the mother and the developing fetus. However, if a patient is already on a stable maintenance dose and becomes pregnant, most allergists will continue the treatment at that same dose. The extract itself is not known to cause birth defects. Every case is unique, so it is vital to discuss your pregnancy or plans to become pregnant with your allergist immediately.
Allergen immunotherapy is a long-term treatment and does not provide immediate relief like an antihistamine would. Most patients begin to notice a decrease in their allergy symptoms toward the end of the 'build-up' phase or during the first few months of the 'maintenance' phase, which usually takes about 3 to 6 months. Significant improvement is typically seen after one full year of consistent treatment. For the most lasting results, the treatment is usually continued for 3 to 5 years. Consistency with the injection schedule is the most important factor in how quickly and effectively the treatment works.
Yes, you can stop taking the injections suddenly without experiencing a 'withdrawal' effect like you might with some other medications. However, if you stop the treatment before completing the recommended 3-to-5-year course, your allergy symptoms are likely to return over time. The 'tolerance' that the treatment builds in your immune system requires long-term exposure to be permanent. If you miss several doses and then want to restart, you cannot simply resume at your previous dose; your doctor will likely need to restart the build-up process from a lower concentration to ensure your safety.
If you miss a scheduled injection, you should contact your allergist's office as soon as possible to reschedule. The procedure for a missed dose depends on how long it has been since your last injection. If you are in the build-up phase, your doctor may need to repeat the last dose or even reduce the dose slightly to ensure you don't have a reaction. If you are in the maintenance phase and miss a dose by more than a week or two, the next dose might be temporarily lowered. Never try to 'double up' on doses to make up for a missed one.
There is no clinical evidence to suggest that Ailanthus Altissima Flowering Twig or other allergenic extracts cause weight gain. These extracts consist of small amounts of proteins and do not contain hormones, steroids, or calories that would affect your metabolism or appetite. If you experience weight changes while on immunotherapy, it is likely due to other factors such as lifestyle changes, other medications (like oral steroids sometimes used for asthma), or unrelated medical conditions. You should discuss any unexpected weight changes with your primary care physician.
Ailanthus Altissima Flowering Twig can be taken alongside most common medications, but there are some critical exceptions. You must inform your doctor if you are taking beta-blockers (often used for blood pressure, heart rhythm, or glaucoma), as these can make it very difficult to treat a severe allergic reaction if one occurs. ACE inhibitors and certain antidepressants (MAOIs and TCAs) also require caution. Most standard allergy medications, like antihistamines and nasal sprays, are fine to continue, although your doctor might ask you to keep your use of them consistent so they can accurately judge how well the immunotherapy is working.
The concept of 'generic' vs. 'brand name' works differently for allergenic extracts than for pills. These are biological products, and while different laboratories (such as Greer, ALK, or HollisterStier) may produce Ailanthus Altissima extracts, they are not exactly identical 'generics' of each other. Each manufacturer's extract may have slight variations in protein concentration. Therefore, once you start treatment with a specific manufacturer's extract, your allergist will typically try to keep you on that same brand for the duration of your treatment to ensure consistent dosing and safety.
Other drugs with the same active ingredient (Ailanthus Altissima Flowering Twig)