4
Table 2. Summary of Guideline Key Action Statements (KAS)
Statement Action Strength
Assessment
1. Candidacy
for Allergen
Immunotherapy
Clinicians should offer or refer to a clinician
who can offer immunotherapy for patients
with allergic rhinitis with or without
allergic asthma if their patients' symptoms
are inadequately controlled with medical
therapy, allergen avoidance, or both, or have a
preference for immunomodulation.
Recommendation
2a. Who should
not get Allergen
Immunotherapy
Clinicians should not initiate allergen
immunotherapy for patients who are
pregnant, have uncontrolled asthma, or are
unable to tolerate injectable epinephrine.
Recommendation
2b. Who may not
get Allergen
Immunotherapy
Clinicians may choose not to initiate
allergen immunotherapy for patients who
use concomitant beta-blockers, have a
history of anaphylaxis, or have systemic
immunosuppression, or have eosinophilic
esophagitis (SLIT only).
Option
3. Asthma
Assessment
Clinicians should evaluate the patient or
refer the patient to a clinician who can
evaluate for signs and symptoms of asthma
before initiating allergen immunotherapy
and for signs and symptoms of uncontrolled
asthma before administering subsequent
allergen immunotherapy.
Recommendation
Education
4. Education
regarding SLIT
versus SCIT
Clinicians should educate patients who
are immunotherapy candidates regarding
the differences between SCIT and SLIT
(aqueous and tablet) including risks,
benefits, convenience, and costs.
Recommendation
5. Education
regarding
Preventive
Qualities
of Allergen
Immunotherapy
Clinicians should educate patients about the
potential benefits of allergen immunotherapy in
1. preventing new allergen sensitizations,
2. reducing the risk of developing allergic
asthma and
3. altering the natural history of the
disease with continued benefit after
discontinuation of therapy.
Recommendation
Treatment
6. Pre-/Co-
Seasonal
erapy
Clinicians who administer SLIT to patients
with seasonal allergic rhinitis should offer
pre- and co- seasonal immunotherapy.
Recommendation
7. Selecting
Clinically
Relevant
Allergens
Clinicians prescribing allergen immunotherapy
should limit treatment to only those clinically
relevant allergens that correlate with the
patient's history and are confirmed by testing.
Recommendation
Introduction
