Q:

1/31/2019
I saw a 55 year-old women with asthma and allergic rhinitis. She has significant flare-ups when being in areas with mice as well as their droppings. While she avoids mice as much as possible, she has had unanticipated exposures that leads to exacerbations. She has had persistent flare-ups for years with significant nasal congestion, post nasal drainage, shortness of breath and cough since 2011 which is thought related to exposure to mice. Although mold may be a trigger as well. Treatment with nasal antihistamine, nasal steroid, anti-leukotriene, and oral antihistamines as well as inhaled corticosteroids has helped but she continued to have bothersome recurrence annually. Skin testing was positive to dog, dust, mold, cockroach, and mouse. She would like to start allergen immunotherapy as symptoms have been bothersome for years. Please advise on immunotherapy for mouse as this is not common. Have you started immunotherapy for mouse and if so what dosing is recommended. Additionally, are there any reasons to not start immunotherapy to mouse?

A:

I do not personally have experience with prescribing mouse immunotherapy. There are no large studies demonstrating efficacy or to guide dosing of subcutaneous immunotherapy (SCIT) to mouse. Bunyavanich et al (1) provide a case series of SCIT for mouse allergy, including 1 patient with history of anaphylaxis. Thus, there is limited data but some experience in the literature to help guide therapy.

1) Bunyavanich S, Donovan MA, Sherry JM, Diamond DV. Immunotherapy for mouse bite anaphylaxis and allergy. Ann Allergy Asthma Immunol. 2013;111(3):223-4.

I hope this helps.

Best regards,
Daniel Jackson, MD, FAAAAI

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