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It summarizes evidence for treatment benefit, expected timing of improvement, and factors that may require reassessment or discontinuation. 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Nelson, MD, PhD, FAAAAI Linda Cox, MD, FAAAAI  \nTABLE OF CONTENTS  \n1. Introduction  \n2. Practitioner Qualifications  \n3. Allergen Extracts  \n4. Allergen Extract Mixing Conditions  \n5. Allergen Immunotherapy Prescriptions  \n6. Color Coding, Labels and Expiration Dates  \n7. Mixing Individual Patient Allergen Extract Treatment Sets  \n8. Stinging Insect Allergen Extract Preparation  \n9. Allergen Extract Stability and Storage  \n10. Summary  \n11. References  \n12. Appendices  \nINTRODUCTION  \nAllergen immunotherapy was first introduced by Leonard Noon in 1911.1 Dr. Noon originally hypothesized that patients suffering from“hay fever” were sensitive to a “toxin” contained in grass pollen. He proposed that patients would benefit by stimulating the immune system against the toxin by use of inoculations of pollen extract. These inoculations involve giving increasing amounts of allergen extracts to reduce symptoms on re-exposure to those particular allergens. The procedure has been widely used since its inception to treat immediate  \nhypersensitivity disorders mediated by allergenspecific IgE antibodies. These same principles hold true today, more than100 years later, for current allergen immunotherapy.  \nThere is good evidence that allergen immunotherapy is effective for the treatment of2-25:  \n• Allergic rhinitis  \n• Allergic conjunctivitis  \n• Asthma  \n• Atopic dermatitis  \n• Insect allergy (Hymenoptera)  \nMultiple studies have demonstrated the effectiveness of allergen immunotherapy in these conditions for both children and adults.2-25 The degree of effectiveness may vary for the individual patient. Clinical improvement should occur within or soon after the first year of treatment, and this benefit may improve with continued treatment. The Allergen Immunotherapy Practice Parameters26 suggest that, “If clinical improvement is not apparent after 1 year of maintenance therapy, possible reasons for lack of efficacy should be evaluated. If none are found, discontinuation of immunotherapy should be considered, and other treatment options should be pursued.” It has been observed that some patients may experience a worsening of their asthma, atopic dermatitis and allergic rhinitis or conjunctivitis symptoms during treatment, especially during the first few months of therapy.  \nThere is no consensus on when to discontinue aeroallergen immunotherapy, but benefits are often maintained for years after stopping therapy in some individuals, and indefinitely in others. In grasspollen allergy, a three-year course of subcutaneous immunotherapy gave prolonged relief of symptoms.25 For many patients with stinging insect allergy, 3-5  \nAAAAI-0114-420  \nAAAAI Practice Management Resource Guide, 2014 edition 1  \nyears of treatment may be sufficient for sustained effectiveness after discontinuing therapy. Patients experiencing more severe reactions to stings maybe considered for longer durations of treatment, given the risk of the recurrence of a life-threatening reaction over time.  \nSubcutaneous allergen immunotherapy is not used for patients with food allergies. Although studies have demonstrated an increased tolerance to peanut challenge in patients who received subcutaneous peanut immunotherapy,27, 28 there was an unacceptably high incidence of systemic reactions (e.g., anaphylaxis) in most of the patients during treatment.28  \nAdverse reactions to allergen immunotherapy do occur, including death from severe systemic allergic reactions. Although very rare, deaths associated with immunotherapy may be due to clerical and medical errors by healthcare personnel. Examples include administering a wrong dose or wrong extract to the wrong patient. Other factors that may contribute to immunotherapy fatalities include symptomatic asthma and delay in the administration of epinephrine during a systemic reaction. Nonetheless, allergen immunotherapy extracts are relatively easy to prepare and ","cbCaimYOZ8toBSdz","https://ap.wps.com/l/cbCaimYOZ8toBSdz","pdf",742171,"English","# Introduction\n## Practitioner Qualifications\n## Allergen Extracts\n## Allergen Extract Mixing Conditions\n## Allergen Immunotherapy Prescriptions\n## Color Coding, Labels and Expiration Dates\n## Mixing Individual Patient Allergen Extract Treatment Sets\n## Stinging Insect Allergen Extract Preparation\n## Allergen Extract Stability and Storage\n## Summary\n## References\n## Appendices","[{\"question\":\"What conditions does allergen immunotherapy treat according to this chapter?\",\"answer\":\"It is presented as effective for allergic rhinitis, allergic conjunctivitis, asthma, atopic dermatitis, and insect allergy (Hymenoptera). Multiple studies are noted to support benefits for children and adults.\"},{\"question\":\"When should clinicians expect clinical improvement during allergen immunotherapy?\",\"answer\":\"Clinical improvement should occur within or soon after the first year of treatment, and the benefit may improve with continued therapy.\"},{\"question\":\"Why are practitioner qualifications and training critical for allergen immunotherapy?\",\"answer\":\"Because allergen immunotherapy carries a significant risk for life-threatening anaphylaxis, supervision and competency training for staff are required. Documentation and quality management practices are emphasized to reduce risks such as incorrect dosing.\"}]","CHAPTER 9 - Allergen Immunotherapy Extract Preparation Manual - Introduction | PDF",1790668646,76]