Safety and Patient Selection
ÎThe potential for benefit in symptoms related to oral allergy syndrome with inhalant immunotherapy directed at the cross-reacting pollens has been observed in some studies but not in others. For this reason, more investigation is required to substantiate that a benefit in oral allergy symptoms will occur with allergen immunotherapy. (C)
Venom Immunotherapy (VIT)
ÎImmunotherapy should be considered if the patient has had a systemic reaction to a Hymenoptera sting, especially if such a reaction was associated with respiratory symptoms, cardiovascular symptoms, or both and if the patient has demonstrable evidence of specific IgE. (A)
ÎMeasurement of baseline serum tryptase level is recommended in patients with moderate or severe anaphylactic reactions to stings because its predictive value is useful regardless of the decision about VIT.
Increased tryptase levels are associated with more frequent and
more severe anaphylactic reactions to stings, as well as greater failure rates with VIT and greater relapse rates after stopping VIT. (B)
ÎLarge local reactions (LLRs) to insect stings can cause significant morbidity and impair quality of life. VIT might significantly reduce the size and duration of LLRs and might be considered in patients who have frequent and disabling LLRs, particularly those with occupational exposure. (B)
Food Hypersensitivity
ÎClinical trials do not support the use of subcutaneous immunotherapy for food hypersensitivity. (A)
ÎThe safety and efficacy of oral and sublingual immunotherapy for food hypersensitivity is currently investigational. (NR)
Urticaria and Angioedema
ÎClinical studies do not support the use of allergen immunotherapy for chronic urticaria, angioedema, or both. Therefore allergen immunotherapy for patients with chronic urticaria, angioedema, or both is not recommended. (D)
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