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Published on: February 2, 2014
Dose adjustment practices among allergists for local reactions to immunotherapy
Christopher A Coop1, Michael S Tankersley
1Department of Allergy and Immunology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA. christopher.coop@lackland.af.mil
Summary
Most allergists adjust immunotherapy doses following local reactions, primarily to prevent patient noncompliance and predict future local reactions. This practice persists despite evidence that local reactions do not predict systemic reactions.
Area of Science:
- Allergy and Immunology
- Clinical Practice Guidelines
- Immunotherapy Protocols
Background:
- Local reactions to immunotherapy are common, but their impact on future reactions is debated.
- Previous studies suggest local reactions do not predict systemic reactions.
- The prevalence and rationale for dose adjustments in clinical practice remain unclear.
Purpose of the Study:
- To investigate allergists' practices regarding dose adjustments for local reactions during immunotherapy.
- To understand the reasons behind allergists' decisions to adjust immunotherapy doses based on local reactions.
Main Methods:
- An electronic survey was distributed to allergists by the American College of Allergy, Asthma and Immunology (ACAAI).
- The survey assessed dose adjustment practices, rationale, and preventative strategies for local immunotherapy reactions.
- Data were collected from allergists regarding their protocols for managing local reactions.
Main Results:
- A significant majority of allergists (91.9%) reported dose adjusting for local reactions.
- Common strategies included dose adjustment based on reaction size and antihistamine pretreatment.
- Primary rationales for dose adjustment were to prevent patient noncompliance and predict future local reactions.
Conclusions:
- Most allergists adjust immunotherapy doses in response to local reactions.
- Concerns about patient noncompliance and prediction of future local reactions drive these adjustments.
- Despite evidence, the link between local reactions and future systemic reactions is less emphasized in practice.
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