Allergen immunotherapy was introduced by Leonard Noon 100 years ago and is the only disease-modifying treatment for allergic individuals (Allergy, 2012).
Preventing systemic reactions
Premedication with antihistamines reduces risk of systemic reactions during immunotherapy, Antihistamine pretreatment in cluster and rush immunotherapy significantly decreases systemic reactions.
Systemic reactions are more frequent with rush immmunotherapy (as expected). Oral steroids in rush immunotherapy have benefit.
Omalizumab for preventing systemic reactions
Omalizumab has protective effect against systemic reactions during both rush and maintenance immunotherapy. There is no FDA-indication for it, but asthmatics on immunotherapy may benefit from omaluzumab.
Beta-blockers and immunotherapy
New practice parameters state that in life-threatening insect allergy, the use of beta blocker is not a contraindication. Venom mmunotherapy can be given during beta blocker therapy, based on risk-benefit analysis.
Skin prick testing (SPT) on beta-blockers was safe in 199 patients in a 2012 study (http://goo.gl/3vGSl). However, Incidence of systemic reactions is 1:250 with SPT.
Oral allergy syndrome
Immunotherapy for oral allergy syndrome? Academic answer: no evidence. Practical answer: worth a try!
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