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Question answered:19/02/07 Warning! this question is over two years old.
Prodigy guidance on allergic rhinitis (last revised July 2005) has a section on when immunotherapy (desensitisation) should be used (1). This states:
Treatment usually requires specialist referral. There is a small risk of anaphylaxis, and treatment should be given only where facilities for resuscitation are available. Anaphylaxis is particularly likely in people who also have chronic asthma.
Immunotherapy (desensitisation) should be considered in people whose symptoms are insufficiently controlled despite adequate antigen avoidance and pharmacotherapy, or who have adverse effects, or do not want to take treatment long-term.
Immunotherapy is only indicated in people who have been shown to have immunoglobulin-E (IgE) mediated disease (either by positive skin tests and /or by serum-specific IgE) and who also have symptoms demonstrated to be caused by a particular allergen. There is no evidence that immunotherapy for any allergen is effective in the absence of specific IgE antibodies.
Controlled studies have suggested that subcutaneous immunotherapy is an effective prophylactic treatment for allergic rhinitis. It is suitable for house-dust mite, pollen and cat allergy.
Sublingually immunotherapy (SLIT) is effective in reducing rhinitis symptom scores and anti-allergic medication requirements compared to placebo. There is insufficient evidence comparing it to injection immunotherapy to quantify the treatment effect. The studies in a recent Cochrane review did not report any clinically important adverse effects. It is suitable for people with mite or pollen allergies who have had a systemic reaction to injection immunotherapy or who do not wish to have an injection. It is currently only available privately or in research centres in the United Kingdom.
The Medical Research Council recently released a news story on Grazax (2), a sublingual immunotherapy pill for grass pollen allergy which they report will be available on prescription from January.
The University of Birmingham National Horizon Scanning Centre for new and emerging technologies has published a document entitled Grazax allergy vaccine for moderate to severe seasonal allergic rhinitis (grass pollen hay fever) (January 2006). The document should be read in full and is freely available at
http://pcpoh.bham.ac.uk/publichealth/horizon/PDF_files/2006reports/Grazax.pdf
The document suggests that when licensed, the therapy would be available initially under specialist supervision for patients whose symptoms have otherwise proved difficult to manage.
1. http://www.prodigy.nhs.uk/allergic_rhinitis/extended_information/management_issues
2. http://www.mrc.ac.uk/NewsViewsAndEvents/News/MRC003442
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