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Feature Article

Allergic rhinoconjunctivitis. Allergen-specific immunotherapy options in Australia

SAMANTHA CHAN, Katherine Nicholls

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©SEBASTIAN KAULITZKI/SPL
©SEBASTIAN KAULITZKI/SPL

Abstract

Allergen-specific immunotherapy (AIT) has traditionally been reserved for patients with moderate-to-severe allergic rhinoconjunctivitis that is refractory to maximal pharmacotherapy. However, there is mounting evidence that AIT should be considered not simply a symptom- control measure, but also a curative tool that may alter the course of allergic disease. Although specialist assessment is required to initiate treatment, GP familiarity with AIT administration, risks and benefits is crucial to maximising patient safety and satisfaction.

Key Points

  • Confirmation of sensitisation to a clinically relevant allergen is central to management of allergic rhinoconjunctivitis (ARC).
  • Allergen-specific immunotherapy (AIT) should be considered for patients with moderate-to-severe ARC, particularly when nonallergen-specific pharmacotherapy has failed.
  • AIT should be considered as a therapeutic option for managing asthma in allergen-sensitised patients and is particularly relevant for patients with a history of ‘thunderstorm asthma’.
  • AIT is generally contraindicated in poorly controlled asthma and absolutely contraindicated in active or refractory autoimmune disease; AIT should not be initiated during pregnancy.
  • Factors that may influence the choice of AIT include: allergen sensitisation and availability of a relevant allergen product; regulatory approval of products; cost; convenience of administration; and risk of adverse effects.
  • The modality of AIT and specific allergen should be selected after thorough specialist assessment, according to the individual patient’s clinical features, pattern of allergen sensitisation and personal preference for therapy.

Figures

©SEBASTIAN KAULITZKI/SPL
©SEBASTIAN KAULITZKI/SPL