Allergen Immunotherapy: A Practice Parameter Second Update
PrefaceS27
Algorithm and annotations for immunotherapyS28
Immunotherapy glossaryS31
IntroductionS33
Summary statementsS33
Mechanisms of immunotherapyS38
Allergen extractsS38
Cross-reactivity of allergen extractS39
Efficacy of immunotherapyS41
Allergic rhinitis, allergic asthma, and stinging insect hypersensitivityS41
Food allergy, urticaria, and atopic dermatitisS42
Measures of efficacyS43
Safety of immunotherapyS43
Reaction ratesS43
Timing of anaphylactic reactions to immunotherapy injectionsS44
β-Adrenergic blocking agentsS45
ContraindicationsS45
Reducing the risk of anaphylaxis to immunotherapy injectionsS46
Patient selectionS46
Clinical indicationsS46
Special precautions in patients with asthmaS47
Clinical indications for VITS48
Allergen selection and handlingS48
Allergen selectionS48
Specific allergensS49
Mixing of extractsS50
Allergen immunotherapy extract handlingS52
Immunotherapy schedules and dosesS53
Recommended dosesS54
Effect of dilution on doseS55
Dilutions of the maintenance concentrateS56
Labeling dilutionsS56
Individualized treatment vialsS57
Starting dosesS57
Frequency of build-up injectionsS57
Dose adjustments for systemic reactionsS58
Reductions during periods of exacerbation of symptomsS58
Dose adjustments for late injectionsS58
Cluster schedulesS58
Rush schedulesS58
Systemic reactions and rush schedulesS58
Premedication and weekly immunotherapyS59
Premedication with cluster and rush immunotherapyS59
Maintenance schedulesS59
Continuing careS59
Duration of treatmentS60
Location of allergen immunotherapy administrationS61
Physician's officeS61
Other locationsS62
Special considerations in immunotherapyS63
Allergen immunotherapy in childrenS63
Immunotherapy in pregnancyS64
Immunotherapy in the elderly patientS64
Immunotherapy in patients with immunodeficiency and autoimmune disordersS64
Alternative routes of immunotherapyS64
Sublingual and oral immunotherapyS64
Intranasal immunotherapyS66
Immunotherapy techniques that are not recommendedS66
Future trends in immunotherapyS66
AppendixS75
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