When medical therapy and counseling don’t effectively control symptoms, the guideline recommends referring patients to specialists for possible further testing and treatment. “This may involve a higher level of expert advice on how to best use pharmacological agents or the possible use of allergy testing and immunotherapy, which have been very effective in this population,” Dr. Mims said.
Summary of Guidance Action Statements
The guidelines advise clinicians to refer patients with AR who have an inadequate response to pharmacologic therapy with or without environmental controls to a clinician who can offer immunotherapy—either sublingual or subcutaneous. The guideline is the first to discuss sublingual tablets since the FDA approved them in 2014.
“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.