Routes of Immunotherapy

The ideal regime for desensitisation in terms of the dose, route, schedule, frequency and patient characteristics has yet to be determined. The method of delivering immunotherapy may in time be personalised according to patient age and threshold of responsiveness with potentially more than one route being used over the entire course. Various methods of immunotherapy have been described, and these have focussed on oral, sublingual and epicutaneous routes. Current protocols generally initiate in a graded fashion over weeks to months, with subsequently a maintenance phase. These are time demanding (for both patient/parents and health professional) and require multiple patient visits. Once the maintenance dose is achieved, ongoing allergen exposure is generally undertaken on a daily basis, but in some instances less frequent exposure is attempted to maintain the desensitised state. The optimal dosing frequency and ultimate duration has yet to be determined and is likely to be individual specific.

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