Dose adjustment of allergen immunotherapy after interruption
Question:
4/11/2016
When a patient is late for immunotherapy, after building back to the maintenance dose, do you immediately go back to the maintenance frequency, such as q3-4 weeks, or do you stretch back out gradually, or does it depend on how late. We are debating a standardization in our practice. (I cannot locate table E5 mentioned in your 3/22 response by going to jacionline.org). Do you know how to locate it?
Answer:
I have copied the supplemental table from the practice parameter below. You can access the on line information by clicking here, clicking on Table E5 in section “Dose adjustments for late injections”, and selecting download of “Supplemental data” prior to the References.
“Table E5. Example of immunotherapy dose adjustment schedule for unscheduled gaps in allergen immunotherapy injection intervals (modification of the AAAAI skin testing and immunotherapy consent and instruction forms: immunotherapy administration instruction form, which can be found here.)
Build-up phase for weekly or biweekly injections (time intervals from missed injection)
• Up to 7 days, continue as scheduled (ie, if on weekly build-up, then it would be up to 14 days after administered injection or 7 days after the missed scheduled injection).
• Eight to 13 days after missed scheduled injection; repeat previous dose.
• Fourteen to 21 days after missed scheduled injection; reduce dose 25%.
• Twenty-one to 28 days after missed scheduled injection; reduce previous dose 50%.
Then increase dose each injection visit as directed on the immunotherapy schedule until therapeutic maintenance dose is reached.
This suggested approach to modification of doses of allergen immunotherapy because of gaps between treatment during the build-up phase is not based on retrospective or prospective published evidence, but it is presented as a sample for your consideration. The individual physician should use this or a similar protocol as a standard operating procedure for the specific clinical setting. A similar dose-reduction protocol should be developed for gaps in maintenance immunotherapy”
I hope this information is of help to you and your practice.
All my best.
Dennis K. Ledford, MD, FAAAAI