ÎThe balance of possible risks and benefits is not the same for patients with the potential for life-threatening stinging insect reactions who are also taking a β-blocker.
ÎGlucagon might be efficacious for the treatment of refractory β-blocker-associated anaphylaxis. (C)
ÎACE inhibitors have been associated with greater risk for more severe reaction from VIT, as well as field stings. ACE inhibitor discontinuation should be considered for patients receiving VIT. Concurrent administration of VIT and an ACE inhibitor is warranted in selected cases in which no equally efficacious alternative for an ACE inhibitor exists and this is judged to be favorable from an individualized risk/benefit standpoint and consideration of patients' preferences. No evidence exists that angiotensin receptor blockers are associated with greater risk for anaphylaxis from allergen immunotherapy. (C)
Îβ-blockers and ACE inhibitors are frequently prescribed in combination. Concomitant administration of both of these
medications in a patient who requires VIT might be warranted, if favorable, from an individualized assessment of potential risks and benefits and patients' preferences. (D)
ÎEpinephrine is the treatment of choice for immunotherapy-induced systemic reactions. Risk factors for fatal immunotherapy-induced reactions include delayed administration of epinephrine. (B)
Injection Techniques
ÎThe preferred location for administration of allergen immunotherapy is in the office of the physician who prepared the patient's allergen immunotherapy extract. (D)
ÎPatients at high risk of systemic reactions, where possible, should receive immunotherapy in the office of the physician who prepared the patient's allergen immunotherapy extract. (D)
ÎRegardless of the location, allergen immunotherapy should be administered under the direct supervision of an appropriately trained physician, qualified physician extender (nurse practitioner or physician assistant), or both in a facility with the appropriate equipment, medications, and personnel to treat anaphylaxis. (D)
In patients who are unable to replace a β-blocker
with an equally efficacious alternative, concomitant administration of VIT and a β-blocker is warranted. (C)
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