Figure 1. Algorithm for Immunotherapy
Patient present with allergic rhinitis, allergic conjunctivitis, allergic asthma or insect allergy
correlate with clinical symptoms and exposure?
IgE antibodies? Test results Evidence of specific NO YES
> Immunotherapy > Allergen exposure reduction > Medications
recommended for this patient?
Is immunotherapy
Not a candidate for immunotherapy
Assess risks, benefits and costs of appropriate management options
> Patient preferences > Response to prior treatment > Severity of disease
NO YES
> Counsel and educate patient about the benefits and risks of immunotherapy including anticipated duration and onset of efficacy.
Obtain informed consent
> Starting dose and immunotherapy schedule > Specific allergenic extracts
Identify > Maintenance dose
> Safety equipment and procedure in place > Medical personnel appropriately trained to identify and treat immunotherapy reactions
Administer Immunotherapy > At least 30 minutes wait in office after injection
immunotherapy injections?
Reactions to
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
Immunotherapy not given
