Immunotherapy for Inhalant Allergy
Publication Date: February 26, 2024
Last Updated: February 27, 2024
Assessment
1. Candidacy for Allergen Immunotherapy
Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with allergic rhinitis with or without allergic asthma if their patients’ symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (Recommendation)
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2a. Who should not get Allergen Immunotherapy
Clinicians should not initiate allergen immunotherapy for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (Recommendation)
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2b. Who may not get Allergen Immunotherapy
Clinicians may choose not to initiate allergen immunotherapy for patients who use concomitant beta-blockers, have a history of anaphylaxis, or have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (Option)
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3. Asthma Assessment
Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating allergen immunotherapy and for signs and symptoms of uncontrolled asthma before administering subsequent allergen immunotherapy. (Recommendation)
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Education
4. Education regarding SLIT versus SCIT
Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (Recommendation)
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5. Education regarding Preventive Qualities of Allergen Immunotherapy
Clinicians should educate patients about the potential benefits of allergen immunotherapy in:
- preventing new allergen sensitizations,
- reducing the risk of developing allergic asthma and
- altering the natural history of the disease with continued benefit after discontinuation of therapy.
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Treatment
6. Pre-/Co-Seasonal Therapy
Clinicians who administer SLIT to patients with seasonal allergic rhinitis should offer pre- and co- seasonal immunotherapy. (Recommendation)
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7. Selecting Clinically Relevant Allergens
Clinicians prescribing allergen immunotherapy should limit treatment to only those clinically relevant allergens that correlate with the patient’s history and are confirmed by testing. (Recommendation)
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8. Treating Polysensitized Patients with Limited Allergens
Clinicians may treat polysensitized patients with a limited number of allergens. (Option)
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9. Local Reactions and Allergen Immunotherapy Escalation
Clinicians administering allergen immunotherapy should continue escalation or maintenance dosing when patients have local reactions to allergen immunotherapy. (Recommendation)
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10. Anaphylaxis Identification and Management
The clinician performing allergy skin testing or administering allergen immunotherapy must be able to diagnose and manage anaphylaxis. (Strong Recommendation)
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11. Retesting During Allergen Immunotherapy
Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing allergen immunotherapy unless there is a change in environmental exposures or a loss of control of symptoms. (Recommendation)
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12. Duration for Allergen Immunotherapy
For patients who are experiencing symptomatic control with allergen immunotherapy, clinicians should treat for a minimum duration of three years, with ongoing treatment duration based on patient response to treatment. (Recommendation)
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The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Title
Immunotherapy for Inhalant Allergy
Authoring Organization
American Academy of Otolaryngology - Head and Neck Surgery Foundation
Publication Month/Year
February 26, 2024
Last Updated Month/Year
March 13, 2024
Country of Publication
US
Document Objectives
To identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the management of inhaled allergies with immunotherapy
Target Patient Population
Any individuals aged 5 years and older with allergic rhinitis, with or without allergic asthma, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies
Target Provider Population
Clinicians involved in the administration of immunotherapy
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Assessment and screening, Treatment, Management
Keywords
allergic rhinitis, Allergen immunotherapy, allergy testing, immunologic tolerance, inhalant allergy, allergic asthma
Source Citation
Gurgel RK, Baroody FM, Damask CC, Mims J, et al. Clinical Practice Guideline: Immunotherapy for Inhalant Allergy. Otolaryngol Head Neck Surg. 2024;170(S1):S1-S42.
Methodology
Number of Source Documents
264
Literature Search Start Date
December 1, 2022
Literature Search End Date
March 1, 2023