Allergen immunotherapy: candidacy, safety & duration

Confirms candidacy, applies the per-visit asthma and updated beta-blocker/ACE-inhibitor safety rules, and sets route-specific observation and duration (including the venom lifelong-VIT carve-out).

Evidence tier: Guideline-derived.

Decision points

  • Which route?

Do-not-miss pitfalls

  • Do not give SCIT during uncontrolled asthma, and screen asthma control before EVERY injection (not only at initiation).
  • Do not automatically stop beta-blockers/ACE inhibitors before AIT, 2023 guidance permits continuation with shared decision-making.
  • Do not include irrelevant allergens just because tests are positive.
  • Do not start a SLIT tablet in a patient with a history of eosinophilic esophagitis (contraindicated).
  • Do not stop VIT at 5 years in mastocytosis/elevated-tryptase/near-fatal-reaction/honeybee patients, they need lifelong therapy.

Evidence & citations

  1. Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127(1 Suppl):S1-S55. PMID 21122901
  2. Golden DBK, Wang J, Waserman S, et al. Anaphylaxis: A 2023 practice parameter update (beta-blocker/ACE-inhibitor continuation; AIT safety). Ann Allergy Asthma Immunol. 2024;132(2):124-176. PMID 38108678
  3. Sturm GJ, Varga EM, Roberts G, et al. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy. 2018;73(4):744-764. PMID 28748641

Clinician decision support. Verify against the cited source. Not a substitute for clinical judgment. 100% on-device; no patient data is stored or transmitted.