Using allergen immunotherapy: A shot in the arm for allergy control

Allergen-specific immunotherapy (IT) can be an effective adjunctive therapy for allergic rhinoconjunctivitis, venom hypersensitivity, and allergic asthma when symptoms are severe or the response to medication is insufficient. Good candidates for IT are determined by thorough allergic evaluation and demonstrable evidence of clinically relevant specific IgE with skin testing and/or in vitro assays. An appropriate waiting period is necessary before testing patients who recently stopped taking antihistamines. For IT to be successful, patients need to be compliant and aware of the risks and extracts must be handled properly and administered correctly. Standardized extracts should be used. Once the optimal dose is achieved, injections are often given in monthly intervals for 3 or more years. Steps to reduce the risk of anaphylaxis from IT include instructing patients to wait in the physician's office for 20 to 30 minutes after an injection, avoiding injections in patients with respiratory infections or asthma exacerbation, and having adequate equipment and epinephrine available to treat a reaction.