Figure 1. Algorithm for Immunotherapy
Patient present with allergic rhinitis, allergic conjunctivitis, allergic asthma or insect allergy
Evidence of specific IgE antibodies? Test results
correlate with clinical symptoms and exposure?
> Immunotherapy > Allergen exposure reduction > Medications
Is immunotherapy
recommended for this patient?
NO YES Obtain informed consent
> Counsel and educate patient about the benefits and risks of immunotherapy including anticipated duration and onset of efficacy.
> Starting dose and immunotherapy schedule > Specific allergenic extracts
Identify > Maintenance dose Administer Immunotherapy
> Safety equipment and procedure in place > Medical personnel appropriately trained to identify and treat immunotherapy reactions
> At least 30 minutes wait in office after injection Reactions to
immunotherapy injections?
YES NO
> Reassess risk-benefit of immunotherapy > Consider dose/schedule adjustment > Consider discontinuing immunotherapy
Manage reaction:
Follow-up every 6 to 12 months while on immunotherapy or more frequently for evaluation/management of immunotherapy reactions and/or underlying allergic disease or comorbid conditions
Assess at follow up > Clinical response to immunotherapy (eg, symptoms, medication use) > Immunotherapy schedule, reactions, compliance > Continuation of immunotherapy treatment
5 NO YES Assess risks, benefits and costs of appropriate management options
> Patient preferences > Response to prior treatment > Severity of disease
Immunotherapy not given
Not a candidate for immunotherapy
