Immunotherapy
Allergen injectable immunotherapy helps to reduce symptoms of allergic
rhinitis. For those patients on maintenance, immunotherapy is considered
essential, but the administration can be spaced to up to 6 weeks to
reduce health care facility visits during the pandemic; dose adjustment
may be needed until a regular schedule can be resumed. For patients on
build-up dosing for inhalant allergens, consider allowing for a longer
period between injections (up to 14 days). Consideration of levelling
off dosing in patients who are coming less often for immunotherapy may
need to be individualized based on patient-specific characteristics and
tolerance of immunotherapy. The risk of reactions to ITS is highest
during the escalation phase, and the risk and benefits of such risk need
to be considered. Consequently, during the red zone, the initiation of
immunotherapy should be avoided. As restriction ease and PPE, emergency
services become more available more can be offered to patients in terms
of immunotherapy as a strategy to maintain allergic rhinitis under
control.15
For venom allergy immunotherapy is considered a life-saving treatment,
there should be no change in service for initiation or build-up venom
immunotherapy (VIT) of patients with a history of a systemic reaction to
the venom, this is an essential service provided by allergists. Patients
on maintenance VIT can be spaced to every 2-3 months if they have been
on maintenance for at least a year.15
Sublingual and oral immunotherapy environmental allergies should not be
initiated in red zone restrictions but can be continued at home.
Food allergy immunotherapy visits for initiation and escalation could
also be delayed, with patients maintaining current home dosing for those
who have already been initiated.6,7 The decision on
when and how to restart the immunotherapy for food should be taken based
on the availability of PPE, community transmission levels, and stage of
immunotherapy. If patients due to pandemic have been maintained on a
high dose and are 1-2 doses from maintenance, those patients are likely
low risk and can be restarted first, when conditions ease. Patients at
low risk of reaction (higher doses of oral immunotherapy, never reacted
before) should be restarted first followed by those patients at
increased risk of reactions as conditions improve.