Adding new allergens to current allergen immunotherapy
Question:
5/11/2017
If re-skin testing is done on a patient with worsening allergic rhinitis on 2 years of allergy injections, do you add the new allergens to existing allergy serum or do you only use the new allergens to make new serum?
Answer:
We sought the expert advice of Dr. Paul Greenberger. His response is below:
"The new allergens go into their own vial and are injected in the contralateral subcutaneous location from the ongoing maintenance allergen immunotherapy. The former may be administered weekly in build-up, and the latter will be continued every 4 weeks as maintenance. One should reassess the patient’s history and exposures to determine the seasonal, perennial or combined aspects of allergic rhinitis. Hypothetically, a patient with troublesome allergic rhinitis from tree, grass and ragweed pollens now has dust mite reactivity, the new allergen gets its own vial and schedule. Since practice parameters on allergen immunotherapy suggest 3-5 years of injections in patients who are improving, the pollens would be continued another 1-3 years depending on clinical response. This approach is consistent with the 2010 practice parameters for subcutaneous allergy immunotherapy: “Duration of treatment. Summary Statement 24: The patient’s response to immunotherapy should be evaluated on a regular basis. A decision about continuation of effective immunotherapy should generally be made after the initial period of 3 to 5 years of treatment.”
We hope this helps.
Patricia McNally, MD, FAAAAI