Selecting a Treatment Regimen
ÎThe frequency of allergen immunotherapy administration during a conventional build-up phase is generally 1 to 3 injections per week. (D)
ÎThe dose of allergen immunotherapy extract should be appropriately reduced after a systemic reaction if immunotherapy is continued. (D)
ÎImmunotherapy given during periods when the patient is exposed to increased levels of allergens to which they are highly sensitive might be associated with an increased risk of a systemic reaction. However, although survey data have noted this to be a risk factor for severe reactions, several published studies have not found an association between pollen seasons and systemic reactions. (C)
ÎThere is no retrospective or prospective published evidence to support modification of doses of allergen immunotherapy because of treatment gaps during the build-up or maintenance immunotherapy phases. However, it is customary to reduce the dose of allergen immunotherapy extract when the interval between injections is prolonged. (D)
ÎWith cluster immunotherapy, 2 or more injections are administered per visit to achieve a maintenance dose more rapidly than with conventional schedules. (C)
ÎStudies with single allergens using a cluster schedule demonstrated a similar or increased frequency of systemic reactions compared with immunotherapy with conventional schedules. (A)
Rush Schedules
ÎRush schedules can achieve a maintenance dose more quickly than weekly schedules. (A)
ÎRush schedules with inhalant allergens are associated with an increased risk of systemic reactions. However, rush protocols for administration of stinging Hymenoptera venom have not been associated with a similarly high incidence of systemic reactions. (A)
Time Course of Improvement
ÎClinical and physiological improvement can be demonstrated very shortly after the patient reaches a maintenance dose. (A)
ÎClinical parameters, such as symptoms and medication use, might be useful measures of the efficacy of immunotherapy in a clinical setting. However, repetitive skin testing of patients receiving immunotherapy is not recommended. (A)
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