Selecting a Treatment Regimen
Î Allergen immunotherapy extract injections should be given with a calibrated small-volume syringe with a 26- to 27-gauge 1/2- or 3/8- inch non-removable needle. (C)
ÎThe injection should be given subcutaneously in the lateral or posterior portion of the arm. (D)
ÎThe mixing of antigens in a syringe is not recommended because of the potential for treatment errors and cross-contamination of extracts. (C)
ÎAdministration of an incorrect injection is a potential risk of allergen immunotherapy. An incorrect injection is an injection given to the wrong patient or a correct patient receiving an injection of an incorrect dose. A customized individual maintenance concentrate of the allergen immunotherapy extract and serial dilutions, whether a single extract or a mixture of extracts, prepared and labeled with the patient's name and birth date might reduce the risk of incorrect (ie, wrong patient) injection. (D)
Maintenance Shedules
ÎOnce a patient reaches a maintenance dose, the interval between injections often can be progressively increased, as tolerated, up to an interval of 4 weeks for inhalant allergens and up to 8 weeks for venom. Some subjects might tolerate longer intervals between maintenance dose injections. (A)
Follow-Up Follow-Up Visits
ÎPatients should be evaluated at least every 6 to 12 months while they receive immunotherapy. (D)
ÎAlthough there are no specific tests to distinguish which patients will relapse after discontinuing VIT, there are clinical features that are associated with a higher chance of relapse, notably a history of a very severe reaction to a sting, an increased baseline serum tryptase level, a systemic reaction during VIT (to a sting or a venom injection), honeybee venom allergy, and treatment duration of less than 5 years. (C)
ÎAt present, there are no specific tests or clinical markers that will distinguish between patients who will relapse and those who will remain in long-term clinical remission after discontinuing effective inhalant allergen immunotherapy, and the duration of treatment should be determined by the physician and patient after considering the risks and benefits associated with discontinuing or continuing immunotherapy. (D)
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