What is the role of immunotherapy injections in the treatment of allergic rhinitis?

Updated: Jan 02, 2019
  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Immunotherapy is indicated for patients whose symptoms are not well controlled with avoidance measures and pharmacotherapy. It is also appropriate for those with symptoms lasting more than 1 season and documented allergen-specific IgE antibodies.

Immunotherapy should be considered only in individuals who can comply with weekly injections for approximately 3 years.

Immunotherapy should be avoided in those receiving beta-blockers and those who have poorly controlled asthma, autoimmune disorders, or immunodeficiency disorders.

During pregnancy, injections should not be initiated, and doses should not be increased.

Although the exact mechanisms of immunotherapy are not known, they are associated with decreased allergen-specific IgE levels and increased allergen-specific immunoglobulin G (IgG) levels. These IgG molecules are thought to be blocking antibodies that are important in impeding the allergic reaction.

Immunotherapy involves regular injections (every 5-7 d) of increasing amounts of each reacting allergen until the symptoms are relieved or the maximum tolerated dose is reached, at which time a maintenance dose is given every 2-4 weeks. This dose is maintained until symptoms are controlled for 2-3 seasons and then tapered.

Although systemic reactions are rare when immunotherapy is properly administered, only qualified personnel should give injections, and resuscitative equipment should be available.


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