Q:

3/9/2013
Is there precedent or are there objections to aeroallergen immunotherapy being provided at a dental clinic under supervision of a dentist? Are there limitations to the definition for "healthcare provider" in reference to aeroallergen immunotherapy injection administration supervision? Thank you.

A:

Thank you for your inquiry.

The best way to answer your question is to look at the most recent Parameters on Allergen Immunotherapy (1). Below you will see quotes from this Parameter dealing with the personnel which should be present at the location where allergen immunotherapy is administered.

Nowhere in this Parameter does it mention dentists or a dental office. Therefore there is no definite admonition against immunotherapy being administered in a dental office, but clearly the absence of mention of a dentist administering immunotherapy implies that the Parameter does not endorse a dental office as a preferred location for administration of injections. Thus, any decision to administer immunotherapy in a dental office would be left to your own personal discretion since there is neither a direct admonition against this nor approval of a dental office location.

Thank you again for your inquiry and we hope this response is helpful to you.

"Immunotherapy should be administered in a setting that permits the prompt recognition and management of adverse reactions. The preferred location for such administration is the prescribing physician’s office. However, patients can receive immunotherapy injections at another health care facility if the physician and staff at that location are trained and equipped to recognize and manage immunotherapy reactions, particularly anaphylaxis".

"LOCATION OF ALLERGEN IMMUNOTHERAPY ADMINISTRATION
Supervising medical personnel
Summary Statement 62: Regardless of the location, allergen immunotherapy should be administered under the direct supervision of an appropriately trained physician, qualified
physician extender (nurse practitioner or physician assistant), or both in a facility with the appropriate equipment, medications, and personnel to treat anaphylaxis."

"A physician or qualified physician extender (nurse practitioner or physician’s assistant)
should be present and immediately available and be prepared to treat anaphylaxis when immunotherapy injections are administered."

Reference:
1.Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter, third update. Journal of Allergy and Clinical Immunology, January 2011; Volume 127 (1), Supplement, page S1-S55.

Sincerely,
Phil Lieberman, M.D.


 

AAAAI - American Academy of Allergy Asthma & Immunology