Safety and Patient Selection Table 1. Actions to Reduce Immunotherapy Risk
ÎThe patient should not receive an immunotherapy injection if his or her asthma is poorly controlled.
ÎAdjust the immunotherapy dose or injection frequency if symptoms of anaphylaxis occur and immunotherapy is continued.
ÎUse appropriately diluted initial allergen immunotherapy extract in patients who appear to have increased sensitivity on the basis of history or tests for specific IgE antibodies.
ÎInstruct patients to wait in the physician's office/medical facility for 30 minutes after an immunotherapy injection. Patients at greater risk of reaction from allergen immunotherapy (eg, patients who have previously had a systemic reaction) might need to wait longer.
ÎEducate patients on signs and symptoms of systemic reactions and instruct them to report symptoms immediately if in the office/medical facility or to report any delayed systemic reactions to his or her physician.
ÎEnsure procedures to avoid clerical or nursing errors (eg, careful checking of patient identification).
ÎRecognize that dosage adjustments downward are usually necessary with a newly prepared allergen immunotherapy extract or a patient who has had a significant interruption in the immunotherapy schedule.
Patient Selection
ÎPatients selected for immunotherapy should be cooperative and compliant. (D)
ÎImmunotherapy is effective for the treatment of allergic rhinitis, allergic conjunctivitis, allergic asthma, and stinging insect hypersensitivity. Therefore immunotherapy merits consideration in patients with these disorders as a possible treatment option. (A)
ÎAllergen immunotherapy should be considered for patients who have demonstrable evidence of specific IgE antibodies to clinically relevant allergens. The decision to begin allergen immunotherapy might depend on a number of factors, including but not limited to patient's preference/acceptability, adherence, medication requirements, response to avoidance measures, and the adverse effects of medications. (D)
ÎThere are some data indicating that immunotherapy can be effective for atopic dermatitis when this condition is associated with aeroallergen sensitivity. (B)
1
(cont'd)
