Enhancing efficacy, safety, and convenience of immunotherapy: A workshop presentation

Objective: To discuss issues in delivering appropriate allergen immunotherapy. Data Sources: Review of Immunotherapy Collegium II workshop presented at the 2005 Annual Meeting of the American College of Allergy, Asthma and Immunology. Study Selection: Topics discussed during Immunotherapy Collegium II. Results: In the past, dosage schedules, levels, and rates of acceleration were linked to skin test results. The most recent published schedules for administration of immunotherapy do not reflect the initial reaction to the skin test, but leave it to the treating physician to factor in the results of testing with plans for administration in both increments and frequency. However, there are no official recommendations for physicians relevant to using a skin test to gauge patient sensitivity. Rather, allergists are advised to set up a maintenance concentrate and then make suitable dilutions when immunotherapy is initiated. Conclusion: Although recommendations are lacking regarding the use of a skin test to gauge patient sensitivity, official recommendations are clear in other areas of immunotherapy, such as the use of premedication. It is important that standard terms be adopted by all physicians who prescribe allergen immunotherapy and that modified allergens and/or oral immunotherapy be explored in the future to make immunotherapy more comfortable.