Executive Summary of Clinical Practice Guideline on Immunotherapy for Inhalant Allergy

• Published in: Otolaryngology-head and neck surgery 2024-03, Vol.170 (3), p.635-667
• Main Authors: Gurgel, Richard K., Baroody, Fuad M., Damask, Cecelia C., Mims, James “Whit”, Ishman, Stacey L., Baker, Dole P., Contrera, Kevin J., Farid, Fariha S., Fornadley, John A., Gardner, Donna D., Henry, LaKeisha R., Kim, Jean, Levy, Joshua M., Reger, Christine M., Ritz, Howard J., Stachler, Robert J., Valdez, Tulio A., Reyes, Joe, Dhepyasuwan, Nui
• Format: Article
• Language: English
• Subjects: allergen immunotherapy; Allergens; allergic asthma; allergic rhinitis; Anaphylaxis; Asthma; Desensitization, Immunologic; Humans; inhalant allergy; Rhinitis, Allergic - diagnosis; Rhinitis, Allergic - therapy; subcutaneous immunotherapy; sublingual immunotherapy
• ISSN: 0194-5998; 1097-6817; 1097-6817
• DOI: 10.1002/ohn.650

Objective Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence‐based recommendations for improved patient care. Purpose The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence‐based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence‐based quality improvement opportunities judged most important by the guideline development group. It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. Action Statements The guideline development group made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The guideline development group made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3