“But there are other reasons to pursue immunotherapy, as it is the only treatment that will modify the underlying disease, control and prevent asthma, and prevent new allergic sensitivities,” Dr. Lin said. “Some patients and physicians may choose immunotherapy for its positive effects, such as avoiding asthma. It may also be a good choice for a child who genetically is more likely to develop AR, because it doesn’t involve an injection and can be dosed at home.” The guideline discusses some of the differences and advantages of different types of immunotherapy.
Explore this issue:
April 2015Dr. Luong pointed out that the only treatment that has a chance to change a patient’s immune response is immunotherapy. “These treatments change the immune system so patients have a less allergic response,” she said. “All of the other current first-line treatment options are symptom-based treatments.”
—Whit Mims, MD
Alternative Therapies
When a patient is interested in nonpharmacologic therapy, the guideline recommends that clinicians refer the patient to a clinician who can offer acupuncture. “Readers may find it surprising that we discuss the use of acupuncture for AR,” Dr. Lin said. “We understand that patients may want to use therapies that physicians with medical degrees in the United States don’t typically prescribe. It is important for a physician to be aware of other options when counseling patients.”
Added Dr. Mims, “Otolaryngologists might be surprised that while there is not strong evidence that acupuncture is effective for AR, there was some evidence, and the multi-specialty committee was divided upon the strength of that evidence.”
In response, Dr. Luong said, “Acupuncture is something that a physician can consider recommending to AR patients. Unfortunately, a lot of treatments are noncurative and mainly focus on symptoms. When patients are looking for nonpharmacotherapy options, this is something we can tell them to consider and research on their own.”
Philip G. Chen, MD, an assistant professor at the University of Texas Health Science Center San Antonio, who did not partake in the guideline’s creation, said he was pleasantly surprised to see the inclusion of acupuncture and herbal remedies. “Patients are increasingly using the Internet to find nontraditional remedies; thus, it is important that practitioners know the data regarding these options,” he said. “The updated literature regarding the potential efficacy of acupuncture is interesting. Additional research will hopefully clarify whether acupuncture or other herbal remedies are efficacious.”