Table 1 Indications, available allergens, contraindications and special considerations for AIT [6]

Indications

• Patients with symptoms of rhinitis, conjunctivitis and/or asthma induced by allergen exposure; includes patients who:

 — Do not want ongoing or long-term pharmacotherapy

 — Experience undesirable side effects with pharmacotherapy

 — Wish to receive a potentially disease-modifying therapy

• Patients with atopic dermatitis associated with HDM or aeroallergen sensitization (may be considered)

• Individuals of all ages with anaphylactic reactions to stinging insects

• Individuals with troublesome, likely recurrent, large local reactions

Available allergens

• Birch

• Grass

• Ragweed

• HDM

• Cat

• Dog

• Alternaria

• Cockroach

• Birch

• Grass

• Ragweed

• HDM

(see Table 2 for approved products and age indications)

• Honeybee

• Yellow jacket

• Hornet

• Wasp

• Fire ants

Contraindications

• Poorly controlled or severe asthma

• Significant co-morbid diseases such as cardiovascular disability

• Caution advised and shared decision making required for the concomitant use of beta-blockers (generally considered a contraindication to environmental AIT, and a relative contraindication to venom immunotherapy)

• Eosinophilic esophagitis (SLIT)

• Inflammation, injury or surgical intervention in oral cavity (SLIT)

• Previous severe, systemic reaction to AIT

Special populations

Immunotherapy may be used in the following special populations, but there may be specific clinical issues that need to be addressed in these groups:

• Children < 5 years of age

• Pregnant patients

• Elderly patients

• Patients with malignancy, immunodeficiency or autoimmune diseases