GUIDELINES FOR THE USE OF ALLERGEN IMMUNOTHERAPY

Objectives: To recommend guidelines for the use of allergen immunother apy to treat allergies in patients for whom allergen avoidance and dru g therapy have not been sufficiently effective. Options: High-dose or low-dose allergen immunotherapy for the treatment of IgE-mediated alle rgy to insect stings, allergic rhinoconjunctivitis and asthma. Outcome s: Clinical evaluation of symptoms, objective measurement of reactions to nasal or bronchial allergen challenge, immunologic changes as a re sult of allergen immunotherapy and, among patients with anaphylactic r eactions to stinging insects, clinical outcome of intentional sting ch allenge. Evidence: A search of MEDLINE was conducted to identify artic les that presented results of allergen immunotherapy. Proceedings of s ymposia held by international subcommittees and of consensus meetings, as well as references obtained from these sources, were reviewed. The articles were grouped according to their main subject: immunologic ef fects, specific allergies, the results of randomized placebo-controlle d clinical trials, types oi allergen extract and protocols for allerge n immunotherapy, adverse effects and deficiencies of allergen immunoth erapy. Values: Each member of the working group assessed the importanc e of such issues as basic immunologic effects, clinical efficacy, adve rse effects and Inappropriate use, the working group then arrived at a consensus. Benefits, harms and costs: Implementation of these guideli nes would lead to the appropriate use of allergen immunotherapy and co ntrol inappropriate treatment, which could result in adverse effects a nd increased costs of services for patients with allergies. Recommenda tions: Allergen immunotherapy with specific, standardized allergenic m aterials, administered in high-dose schedules, is effective in patient s with an allergy to insect stings or allergic rhinoconjunctivitis, an d in some patients with asthma, who have been correctly diagnosed thro ugh a meticulous history corroborated by positive results of skin test s and for whom avoidance of the allergen and drug therapy are not suff iciently effective. Validation: These guidelines are similar to others being developed in the United States and recommended by the Joint Cou ncil of Allergy and Immunology and the American Academy of Allergy, As thma and Immunology. Sponsor: These guidelines were developed by a wor king group of the Canadian Society of Allergy and Clinical Immunology, no Funding was received from any other source.