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.