Version May 2024
| Uncontrolled asthma |
| Risk factors for severe immunotherapy reactions include symptomatic asthma and injections administered during periods of symptom exacerbation. Before the administration of the allergy injection, the patient should be evaluated for the presence of asthma or allergy symptom exacerbation. One might also consider an objective measure of airway function (eg, peak flow) for the asthmatic patient before allergy injections. |
| Medical conditions that reduce the patient's ability to survive the systemic allergic reaction or the resultant treatment are relative contraindications for allergen immunotherapy. Examples include severe asthma uncontrolled by pharmacotherapy and significant cardiovascular disease. |
| Allergen immunotherapy in asthmatic patients should not be initiated unless the patient's asthma is stable with pharmacotherapy. |
| Optimizing safety in the clinic setting |
| Because most systemic reactions that result from allergen immunotherapy occur within 30 minutes after an injection, patients should remain in the clinician's office at least 30 minutes after an injection. Some patients may need to wait longer, such as patients with prior systemic reactions that occurred later than 30 minutes after an injection. |
| Allergen immunotherapy should be administered in a setting where procedures that can reduce the risk of anaphylaxis are in place and where the prompt recognition and treatment of anaphylaxis is ensured. |
| Concomitant administration of beta-blockers and ACE inhibitors |
| Beta-adrenergic blocking agents might make allergen immunotherapy-related systemic reactions more difficult to treat and delay the recovery. Therefore, a cautious attitude should be adopted toward the concomitant use of beta-blocker agents and inhalant allergen immunotherapy. However, immunotherapy is indicated in patients with life-threatening stinging insect hypersensitivity who also require beta-blocker medications because the risk of the stinging insect hypersensitivity is greater than the risk of an immunotherapy-related systemic reaction. |
| ACE inhibitors have been associated with a greater risk for more severe systemic reactions from venom immunotherapy, as well as from field stings. ACE inhibitor discontinuation should be considered for patients receiving venom immunotherapy. |
| Local reactions |
| Published studies indicate that individual local reactions do not appear to be predictive of subsequent systemic reactions. However, some patients with greater frequency of large local reactions might be at an increased risk for future systemic reactions. |
| Dose adjustments and administration in patients with prior systemic reactions |
| The dose of allergen immunotherapy extract should be appropriately reduced after a systemic reaction if immunotherapy is continued. |
| Patients at high risk of systemic reactions, where possible, should receive immunotherapy in the office of the clinician who prepared the patient's allergen immunotherapy extract. |
| Administration of SCIT during periods of high allergen exposure |
| Immunotherapy given during periods when the patient is exposed to increased levels of allergen to which he/she is sensitive might be associated with an increased risk of a systemic reaction. Consider not increasing or even reducing the immunotherapy dose in highly sensitive patients during the time period when they are exposed to increased levels of allergen, especially if they are experiencing an exacerbation of their symptoms. |
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