While mild, well-controlled asthma is not a contraindication for SCIT with

aero-allergens, injections must not be administered during intercurrent respiratory infection when there is exaggerated bronchial reactivity, which may predispose patients to the development of a systemic reaction. Poor asthma control is suggested by excessive use of short-acting β2 agonist (more than twice a day), nocturnal symptoms, recurrent courses of oral steroids and hospitalization for acute asthma. A more objective evaluation of asthma control can be obtained by reviewing peak flow charts recorded twice daily for 3–4 weeks with documentation of click here short-acting β2 agonist usage, as well as baseline spirometry [forced expiratory volume in 1 s (FEV1) should be ≥ 70% predicted]. VIT injections must also not be administered during intercurrent respiratory infection. It is imperative to optimize the anti-inflammatory

therapy for asthma prior to commencing VIT and to perform an objective evaluation XAV-939 supplier of asthma as above. VIT is contraindicated in severe or ‘brittle’ asthma, but the approach is somewhat different in moderate asthmatics where a careful ‘risk–benefit’ analysis must be performed for VIT, taking into consideration co-morbid factors, occupation, hobbies and social circumstances as well as patient choice. Allergen immunotherapy in any form must not be initiated during pregnancy [38]. Although allergen immunotherapy is not known to have teratogenic effects, it should ideally be avoided in pregnancy, even in patients established on treatment who are in maintenance phase, in view of the rare but real possibility of anaphylaxis which may cause fetal Proteases inhibitor hypoxia [38]. Beta-blocker therapy is generally

considered an absolute contraindication during allergen-specific immunotherapy due to the risk of refractory anaphylaxis [36–38,80]. This is related to reduced therapeutic efficacy of adrenalin in anaphylaxis due to underlying beta blockade. Therefore, as far as possible, it is better to avoid beta-blockers during immunotherapy, but there are some special circumstances in patients requiring VIT where withdrawal of beta-blockers may put the patient at risk (such as of underlying tachyarrhythmias) [80,81]. In such circumstances, a careful ‘risk–benefit’ analysis must be undertaken, and liaison with the patient’s family physician and cardiologist will be beneficial. Where benefit of continuation of treatment of beta-blocker clearly outweigh the risk of their discontinuation, short-acting beta-blockers may be discontinued temporarily prior to injections or during the induction phase of VIT. Some groups have undertaken VIT successfully alongside treatment with beta-blockers. In such circumstances, glucagon must be readily available to treat refractory anaphylaxis [80].