Administration
in conjunction
with SCIT (using
different allergens,
eg, perennial
allergens)
Although using multiple allergens in SCIT has not been associated
with increased risks, combining SCIT and SLIT has not been well
studied.
Increased risks of
SLIT when using
multiple allergen,
multiple tablet
treatment
e limited data on SLIT are mixed, with some studies
demonstrating no increased risk, but one case study indicating
increased risk. Reduced efficacy has also been a concern with the
use of multiple SLIT tablets.
Use of concurrent
thyroid medication,
first-generation
antihistamines,
tricyclics,
α-adrenergic
blockers, and/or
cardiac glycosides or
diuretics
e FDA indicates that it may not be suitable to start SLIT in a
patient taking one of these medications, in that, were anaphylaxis
to occur, these medications could potentiate or inhibit the effect of
epinephrine. On the basis largely of the favorable experience with
SCIT, it is recommended that the patient and physician determine,
before initiating SLIT, whether the benefits of treatment outweigh
the risks.
Must use of
monoamine oxidase
inhibitors be
stopped?
e risk of adverse effects of epinephrine administration is
theoretically greater if the patient is taking a monamine oxidase
inhibitor. erefore, the allergist should discuss an alternative
medication with the prescribing physician. Consider monoamine
oxidase inhibitors a relative contraindication to the use of SLIT.
Must use of
β-blockers be
stopped?
A patient taking a β-blocker may be less responsive to the
beneficial effect of epinephrine when this drug is administered
for the treatment of anaphylaxis. erefore, the concomitant use
of β-blockers and allergen immunotherapy should be carefully
considered from an individualized risk-benefit standpoint, and
the patient's preferences should be incorporated into the medical
decision-making process.
Must use of
angiotensin-
converting enzyme
(ACE) inhibitors be
stopped?
Although there is a theoretical risk of more severe or unresponsive
anaphylaxis when the patient is taking an ACE inhibitor, there
is no evidence that ACE inhibitors infer any increased risk for
inhalant immunotherapy.
Does use of NSAIDs
need to be stopped?
It is not advised that use of NSAIDs needs to be stopped for SLIT.
Table 3. Suggested Guidelines for the Practicing Allergist
Regarding the Use of FDA-Approved SLIT Products
(cont'd)
Question or
concern Expert suggestion and rationale
