Selecting a Treatment Regimen
ÎSeveral large studies demonstrate that life-threatening anaphylactic reactions after the first 30 minutes are rare. Delayed and biphasic immunotherapy-induced systemic reactions can occur outside of a supervised medical facility. Thus patients should be educated regarding the possible signs and symptoms of systemic reactions and to contact their health care professional or seek emergency medical attention, as indicated. The decision to prescribe epinephrine autoinjectors to patients receiving allergen immunotherapy is up to the physician's discretion and is based on a number of considerations. (C)
Premedication and Immunotherapy-Induced Systemic Reactions Premedication and Weekly Immunotherapy
ÎPremedication might reduce the frequency of systemic reactions caused by conventional immunotherapy. (A)
Premedication with Accelerated Immunotherapy Schedules
ÎAntihistamines have been demonstrated to be beneficial in decreasing local reactions during cluster and rush protocols, whereas leukotriene antagonists were shown to be effective in a rush protocol. Although commonly used, the effect of these medications in reducing local reactions during conventional build-up and maintenance immunotherapy injections has not been extensively reported. (A)
ÎPremedication before cluster and rush immunotherapy with aeroallergens might reduce the rate of systemic reactions. Combination therapy is effective in reducing systemic and local reactions during accelerated immunotherapy build-up protocols. (A)
Omalizumab in Combination with Immunotherapy
ÎOmalizumab pretreatment has been shown to improve the safety and tolerability of cluster and rush immunotherapy schedules in patients with moderate persistent asthma and allergic rhinitis, respectively. Additionally, omalizumab used in combination with immunotherapy has been shown to be effective in improving symptom scores compared with immunotherapy alone. (A)
Medication Interactions
ÎExposure to β-adrenergic blocking agents is a risk factor for more serious and treatment resistant anaphylaxis. Concomitant use
of β-blockers and allergen immunotherapy should be carefully considered from an individualized risk/benefit standpoint. It is
appropriate to incorporate patients' values and preferences into the
decision-making process to determine whether the β-blocker should be replaced with an acceptable alternative. (C)
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