Immunotherapy for Inhalant Allergy

Publication Date: February 25, 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:
  1. preventing new allergen sensitizations,
  2. reducing the risk of developing allergic asthma and
  3. altering the natural history of the disease with continued benefit after discontinuation of therapy.
(Recommendation)
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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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Recommendation Grading

Disclaimer

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.

Overview

Title

Immunotherapy for Inhalant Allergy

Authoring Organization

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Publication Month/Year

February 25, 2024

Last Updated Month/Year

October 24, 2024

Document Type

Guideline

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.  Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce the risk of harm. 

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
November 30, 2022
Literature Search End Date
February 28, 2023