Guidelines for the use of allergen immunotherapy. Canadian Society of Allergy and Clinical Immunology.
OBJECTIVE
To recommend guidelines for the use of allergen immunotherapy to treat allergies in patients for whom allergen avoidance and drug therapy have not been sufficiently effective.


METHODS
High-dose or low-dose allergen immunotherapy for the treatment of IgE-mediated allergy to insect stings, allergic rhinoconjunctivitis and asthma.


RESULTS
Clinical evaluation of symptoms, objective measurement of reactions to nasal or bronchial allergen challenge, immunologic changes as a result of allergen immunotherapy and, among patients with anaphylactic reactions to stinging insects, clinical outcome of intentional sting challenge.


METHODS
A search of MEDLINE was conducted to identify articles that presented results of allergen immunotherapy. Proceedings of symposia 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 effects, specific allergies, the results of randomized placebo-controlled clinical trials, types of allergen extract and protocols for allergen immunotherapy, adverse effects and deficiencies of allergen immunotherapy.


METHODS
Each member of the working group assessed the importance of such issues as basic immunologic effects, clinical efficacy, adverse effects and inappropriate use; the working group then arrived at a consensus.


RESULTS
Implementation of these guidelines would lead to the appropriate use of allergen immunotherapy and control inappropriate treatment, which could result in adverse effects and increased costs of services for patients with allergies.


CONCLUSIONS
Allergen immunotherapy with specific, standardized allergenic materials, administered in high-dose schedules, is effective in patients with an allergy to insect stings or allergic rhinoconjunctivitis, and in some patients with asthma, who have been correctly diagnosed through a meticulous history corroborated by positive results of skin tests and for whom avoidance of the allergen and drug therapy are not sufficiently effective.


RESULTS
These guidelines are similar to others being developed in the United States and recommended by the Joint Council of Allergy and Immunology and the American Academy of Allergy, Asthma and Immunology.


BACKGROUND
These guidelines were developed by a working group of the Canadian Society of Allergy and Clinical Immunology; no funding was received from any other source.
D000485:Allergens / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000379:methods*; D006801:Humans; D006967:Hypersensitivity / Q000628:therapy*; D007299:Insect Bites and Stings / Q000628:therapy; D012130:Respiratory Hypersensitivity / Q000628:therapy
D000485:Allergens