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• W2472003311 abstract "Certain unique circumstances, such as pregnancy, underlying cardiovascular disease, requirement of continuous use of beta-adrenergic-blocking medications, or the use of rush immunotherapy schedules may change the relative risk associated with the administration of allergen immunotherapy. The increased risk involved in treating an adverse reaction in immunotherapy occurs in the pregnant patient or the patient with significant cardiovascular disease. Although immunotherapy is not associated with an increased risk of fetal morbidity or mortality or increased risk of fetal sensitization, the apparent enhanced risk of anaphylaxis during the acceleration phase of immunotherapy mitigates against instituting immunotherapy in the pregnant patient. Continuation of immunotherapy at slightly modified maintenance doses is, however, permissible during pregnancy. Significant underlying cardiovascular disease may preclude the initiation of inhalant allergy immunotherapy because of the excessive risk of anaphylaxis entailed in such a setting. Use of beta-adrenergic-blocking medications enhances the susceptibility to asthma in some individuals. Although the use of beta-adrenergic-blocking medications has not been associated with an increased risk for development of anaphylaxis consequent to immunotherapy, difficulty in treatment of anaphylaxis should it ensue consequent to immunotherapy may increase. Alternate forms of treatment of the underlying allergic disease are recommended in individuals requiring continuous use of beta-adrenergic-blocking medications. For those individuals who require immunotherapy, consideration should be given to the use of medications other than beta-adrenergic-blocking medications. In many instances, it may be possible to substitute other medications such as calcium channel blockers, which may not present the same deleterious effect on treatment of anaphylaxis as beta blockers. Increased susceptibility to allergic reactions resulting from the inherent methods of the protocol is seen in the initiation of rush immunotherapy. Rush immunotherapy is not recommended as a routine form of treatment for allergic disease because of this enhanced risk of anaphylaxis. Only in selected circumstances, such as the necessity for penicillin or insulin desensitization in life-threatening situations, are the risks involved in rush modalities justified. To minimize deaths and morbidity, immunotherapy must be administered under well-controlled conditions. All allergen immunotherapy recipients must be carefully evaluated before receiving an allergen injection. Evaluation of pulmonary status in conjunction with immunotherapy may be required for those individuals with unstable asthma.76 Observation of the patient for sufficient time after administration of allergen injection is essential. All patients should be kept for a minimum of 20 minutes of observation after administration of immunotherapy. Patients with asthma or a history of severe atopy associated with reactions to immunotherapy may require longer periods of observation. Through prospective studies of adverse events consequent to immunotherapy and a retrospective analysis of morbidity and fatalities resulting from immunotherapy, guidelines for the administration of immunotherapy have been designed such as those recommended by the Johns Hopkins Asthma and Allergy Center. All practitioners who administer immunotherapy should be well versed in the recognition of the signs and symptoms of anaphylaxis and be prepared to treat anaphylaxis occurring in patients receiving immunotherapy. The excess deaths reported in circumstances in which immunotherapy was administered by practitioners in poorly controlled settings where medications necessary for resuscitation and personnel educated in resuscitative techniques were not available dictates the necessity for close supervision of the administration of allergen extracts by physicians who are cognizant of the potential adverse effects of immunotherapy. To enhance the safety of immunotherapy, it is crucial that all physicians who administer immunotherapy are fully aware of the symptoms of anaphylaxis and are prepared to respond immediately to the onset of such manifestations." @default.
• W2472003311 created "2016-07-22" @default.
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• W2472003311 date "1992-02-01" @default.
• W2472003311 modified "2023-09-26" @default.
• W2472003311 title "SPECIAL PROBLEMS REGARDING ALLERGEN IMMUNOTHERAPY" @default.
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