The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) recently issued a new clinical practice guideline for treating inhaled allergies with immunotherapy. Because of the variabilities of patient selection, immunotherapy delivery modes, and safety and efficacy evaluation, the new guideline aims to provide physicians with trustworthy, evidence‐based recommendations.
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May 2024The target population is patients who are five years and older with allergic rhinitis, with or without allergic asthma, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The 12 key action statements cover:
1. Candidacy for allergen immunotherapy (AIM): Patients’ symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or they prefer immunomodulation.
2A. Who should not get AIM: Patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine.
2B. Who may not get AIM: Patients who use concomitant beta-blockers, have an anaphylaxis history, have systemic immunosuppression, or have eosinophilic esophagitis (sublingual immunotherapy [SLIT] only).
3. Asthma assessment: Evaluate for asthma signs and symptoms before initiating allergen immunotherapy and for uncontrolled asthma signs and symptoms before administering subsequent allergen immunotherapy.
4. Education regarding aqueous and tablet AIM forms: Educate patients regarding the differences, including risks, benefits, convenience, and costs.
5. Education regarding AIM preventive qualities: Educate patients about potential benefits in preventing new allergen sensitizations, reducing the risk of developing allergic asthma, and altering the natural history after therapy discontinuation.
6. Pre-/co-seasonal therapy: Physicians who offer sublingual immunotherapy to patients with seasonal allergic rhinitis should offer pre- and co-seasonal immunotherapy.
7. Selecting clinically relevant allergens: Limit treatment to only those clinically relevant allergens that correlate with the patient’s history and are confirmed by testing.
8. Treating polysensitized patients: Polysensitized patients may be treated with a limited number of allergens.
9: Local reactions/allergen immunotherapy escalation: Continue escalation or maintenance dosing when patients have local reactions to allergen immunotherapy.
10. Anaphylaxis identification, management: Physicians must be able to diagnose and manage anaphylaxis.
11. Retesting: Avoid repeat allergy testing unless there’s a change in environmental exposures or a loss of symptom control.
12. AIM duration: Treat for a minimum duration of three years, with ongoing treatment duration based on patient response to treatment.
More information on the guidelines can be found at www.entnet.org/AITCPG.