• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of cmajCMAJ Information for AuthorsCMAJ Home Page
CMAJ. May 1, 1995; 152(9): 1413–1419.
PMCID: PMC1337905

Guidelines for the use of allergen immunotherapy. Canadian Society of Allergy and Clinical Immunology.


OBJECTIVES: To recommend guidelines for the use of allergen immunotherapy to treat allergies in patients for whom allergen avoidance and drug therapy have not been sufficiently effective. OPTIONS: High-dose or low-dose allergen immunotherapy for the treatment of IgE-mediated allergy to insect stings, allergic rhinoconjunctivitis and asthma. OUTCOMES: Clinical evaluation of symptoms, objective measurement of reactions to nasal or bronchial allergen challenge, immunologic changes as a result of allergen immunotherapy and, among patients with anaphylactic reactions to stinging insects, clinical outcome of intentional sting challenge. EVIDENCE: A search of MEDLINE was conducted to identify articles that presented results of allergen immunotherapy. Proceedings of symposia held by international subcommittees and of consensus meetings, as well as references obtained from these sources, were reviewed. The articles were grouped according to their main subject: immunologic effects, specific allergies, the results of randomized placebo-controlled clinical trials, types of allergen extract and protocols for allergen immunotherapy, adverse effects and deficiencies of allergen immunotherapy. VALUES: Each member of the working group assessed the importance of such issues as basic immunologic effects, clinical efficacy, adverse effects and inappropriate use; the working group then arrived at a consensus. BENEFITS, HARMS AND COSTS: Implementation of these guidelines would lead to the appropriate use of allergen immunotherapy and control inappropriate treatment, which could result in adverse effects and increased costs of services for patients with allergies. RECOMMENDATIONS: Allergen immunotherapy with specific, standardized allergenic materials, administered in high-dose schedules, is effective in patients with an allergy to insect stings or allergic rhinoconjunctivitis, and in some patients with asthma, who have been correctly diagnosed through a meticulous history corroborated by positive results of skin tests and for whom avoidance of the allergen and drug therapy are not sufficiently effective. VALIDATION: These guidelines are similar to others being developed in the United States and recommended by the Joint Council of Allergy and Immunology and the American Academy of Allergy, Asthma and Immunology. SPONSOR: These guidelines were developed by a working group of the Canadian Society of Allergy and Clinical Immunology; no funding was received from any other source.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Creticos PS. Immunotherapy with allergens. JAMA. 1992 Nov 25;268(20):2834–2839. [PubMed]
  • Norman PS, Lichtenstein LM. The clinical and immunologic specificity of immunotherapy. J Allergy Clin Immunol. 1978 Jun;61(6):370–377. [PubMed]
  • Evans R, Pence H, Kaplan H, Rocklin RE. The effect of immunotherapy on humoral and cellular responses in ragweed hayfever. J Clin Invest. 1976 May;57(5):1378–1385. [PMC free article] [PubMed]
  • Rocklin RE. Clinical and immunologic aspects of allergen-specific immunotherapy in patients with seasonal allergic rhinitis and/or allergic asthma. J Allergy Clin Immunol. 1983 Oct;72(4):323–338. [PubMed]
  • Rocklin RE, Sheffer AL, Greineder DK, Melmon KL. Generation of antigen-specific suppressor cells during allergy desensitization. N Engl J Med. 1980 May 29;302(22):1213–1219. [PubMed]
  • Lichtenstein LM, Norman PS, Winkenwerder WL, Osler AG. In vitro studies of human ragweed allergy: changes in cellular and humoral activity associated with specific desensitization. J Clin Invest. 1966 Jul;45(7):1126–1136. [PMC free article] [PubMed]
  • Furin MJ, Norman PS, Creticos PS, Proud D, Kagey-Sobotka A, Lichtenstein LM, Naclerio RM. Immunotherapy decreases antigen-induced eosinophil cell migration into the nasal cavity. J Allergy Clin Immunol. 1991 Jul;88(1):27–32. [PubMed]
  • Rak S, Håkanson L, Venge P. Immunotherapy abrogates the generation of eosinophil and neutrophil chemotactic activity during pollen season. J Allergy Clin Immunol. 1990 Nov;86(5):706–713. [PubMed]
  • Liao TN, Hsieh KH. Altered production of histamine-releasing factor (HRF) activity and responsiveness to HRF after immunotherapy in children with asthma. J Allergy Clin Immunol. 1990 Dec;86(6 Pt 1):894–901. [PubMed]
  • Sadan N, Rhyne MB, Mellits ED, Goldstein EO, Levy DA, Lichtenstein LM. Immunotherapy of pollinosis in children: investigation of the immunologic basis of clinical improvement. N Engl J Med. 1969 Mar 20;280(12):623–627. [PubMed]
  • The use of in vitro tests for IgE antibody in the specific diagnosis of IgE-mediated disorders and in the formulation of allergen immunotherapy. American Academy of Allergy and Immunology. J Allergy Clin Immunol. 1992 Aug;90(2):263–267. [PubMed]
  • Bousquet J, Michel FB. Specific immunotherapy in asthma: is it effective? J Allergy Clin Immunol. 1994 Jul;94(1):1–11. [PubMed]
  • Reid MJ, Moss RB, Hsu YP, Kwasnicki JM, Commerford TM, Nelson BL. Seasonal asthma in northern California: allergic causes and efficacy of immunotherapy. J Allergy Clin Immunol. 1986 Oct;78(4 Pt 1):590–600. [PubMed]
  • Bousquet J, Hejjaoui A, Michel FB. Specific immunotherapy in asthma. J Allergy Clin Immunol. 1990 Sep;86(3 Pt 1):292–305. [PubMed]
  • Pogliani E, Clini E. Fungal infection and haematological malignancies: a report about association therapy with amphotericin B and 5-flucytosine in primary lung involvement. Haematologica. 1990 May-Jun;75(3):304–305. [PubMed]
  • Lowell FC, Franklin W. A double-blind study of the effectiveness and specificity of injecton therapy in ragweed hay fever. N Engl J Med. 1965 Sep 23;273(13):675–679. [PubMed]
  • Van Metre TE, Adkinson NF, Jr, Amodio FJ, Lichtenstein LM, Mardiney MR, Norman PS, Rosenberg GL, Sobotka AK, Valentine MD. A comparative study of the effectiveness of the Rinkel method and the current standard method of immunotherapy for ragweed pollen hay fever. J Allergy Clin Immunol. 1980 Dec;66(6):500–513. [PubMed]
  • Creticos PS, Van Metre TE, Mardiney MR, Rosenberg GL, Norman PS, Adkinson NF., Jr Dose response of IgE and IgG antibodies during ragweed immunotherapy. J Allergy Clin Immunol. 1984 Jan;73(1 Pt 1):94–104. [PubMed]
  • Van Metre TE, Jr, Adkinson NF, Jr, Amodio FJ, Kagey-Sobotka A, Lichtenstein LM, Mardiney MR, Jr, Norman PS, Rosenberg GL. A comparison of immunotherapy schedules for injection treatment of ragweed pollen hay fever. J Allergy Clin Immunol. 1982 Feb;69(2):181–193. [PubMed]
  • Taylor B, Sanders SS, Norman AP. A double blind controlled trial of house mite fortified house dust vaccine in childhood asthma. Clin Allergy. 1974 Mar;4(1):35–40. [PubMed]
  • Bruce CA, Norman PS, Rosenthal RR, Lichtenstein LM. The role of ragweed pollen in autumnal asthma. J Allergy Clin Immunol. 1977 Jun;59(6):449–459. [PubMed]
  • McHugh SM, Lavelle B, Kemeny DM, Patel S, Ewan PW. A placebo-controlled trial of immunotherapy with two extracts of Dermatophagoides pteronyssinus in allergic rhinitis, comparing clinical outcome with changes in antigen-specific IgE, IgG, and IgG subclasses. J Allergy Clin Immunol. 1990 Oct;86(4 Pt 1):521–531. [PubMed]
  • Taylor WW, Ohman JL, Jr, Lowell FC. Immunotherapy in cat-induced asthma. Double-blind trial with evaluation of bronchial responses to cat allergen and histamine. J Allergy Clin Immunol. 1978 May;61(5):283–287. [PubMed]
  • Norman PS, Van Metre TE., Jr The safety of allergenic immunotherapy. J Allergy Clin Immunol. 1990 Feb;85(2):522–525. [PubMed]
  • Johnstone DE, Dutton A. The value of hyposensitization therapy for bronchial asthma in children--a 14-year study. Pediatrics. 1968 Nov;42(5):793–802. [PubMed]
  • Hedlin G, Graff-Lonnevig V, Heilborn H, Lilja G, Norrlind K, Pegelow K, Sundin B, Lowenstein H. Immunotherapy with cat- and dog-dander extracts. V. Effects of 3 years of treatment. J Allergy Clin Immunol. 1991 May;87(5):955–964. [PubMed]
  • Juniper EF, Kline PA, Ramsdale EH, Hargreave FE. Comparison of the efficacy and side effects of aqueous steroid nasal spray (budesonide) and allergen-injection therapy (Pollinex-R) in the treatment of seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 1990 Mar;85(3):606–611. [PubMed]
  • Varney VA, Gaga M, Frew AJ, Aber VR, Kay AB, Durham SR. Usefulness of immunotherapy in patients with severe summer hay fever uncontrolled by antiallergic drugs. BMJ. 1991 Feb 2;302(6771):265–269. [PMC free article] [PubMed]
  • Creticos PS, Adkinson NF, Jr, Kagey-Sobotka A, Proud D, Meier HL, Naclerio RM, Lichtenstein LM, Norman PS. Nasal challenge with ragweed pollen in hay fever patients. Effect of immunotherapy. J Clin Invest. 1985 Dec;76(6):2247–2253. [PMC free article] [PubMed]
  • Ohman JL., Jr Allergen immunotherapy in asthma: evidence for efficacy. J Allergy Clin Immunol. 1989 Aug;84(2):133–140. [PubMed]
  • Lichtenstein LM, Valentine MD, Norman PS. A reevaluation of immunotherapy for asthma. Am Rev Respir Dis. 1984 May;129(5):657–659. [PubMed]
  • Hargreave FE, Dolovich J, Newhouse MT. The assessment and treatment of asthma: a conference report. J Allergy Clin Immunol. 1990 Jun;85(6):1098–1111. [PubMed]
  • Warner JO, Price JF, Soothill JF, Hey EN. Controlled trial of hyposensitisation to Dermatophagoides pteronyssinus in children with asthma. Lancet. 1978 Oct 28;2(8096):912–915. [PubMed]
  • Van Metre TE, Jr, Marsh DG, Adkinson NF, Jr, Kagey-Sobotka A, Khattignavong A, Norman PS, Jr, Rosenberg GL. Immunotherapy for cat asthma. J Allergy Clin Immunol. 1988 Dec;82(6):1055–1068. [PubMed]
  • Bousquet J, Hejjaoui A, Soussana M, Michel FB. Double-blind, placebo-controlled immunotherapy with mixed grass-pollen allergoids. IV. Comparison of the safety and efficacy of two dosages of a high-molecular-weight allergoid. J Allergy Clin Immunol. 1990 Feb;85(2):490–497. [PubMed]
  • Horst M, Hejjaoui A, Horst V, Michel FB, Bousquet J. Double-blind, placebo-controlled rush immunotherapy with a standardized Alternaria extract. J Allergy Clin Immunol. 1990 Feb;85(2):460–472. [PubMed]
  • Van Bever HP, Stevens WJ. Suppression of the late asthmatic reaction by hyposensitization in asthmatic children allergic to house dust mite (Dermatophagoides pteronyssinus). Clin Exp Allergy. 1989 Jul;19(4):399–404. [PubMed]
  • Van Bever HP, Stevens WJ. Evolution of the late asthmatic reaction during immunotherapy and after stopping immunotherapy. J Allergy Clin Immunol. 1990 Aug;86(2):141–146. [PubMed]
  • Hunt KJ, Valentine MD, Sobotka AK, Benton AW, Amodio FJ, Lichtenstein LM. A controlled trial of immunotherapy in insect hypersensitivity. N Engl J Med. 1978 Jul 27;299(4):157–161. [PubMed]
  • Valentine MD. Insect venom allergy: diagnosis and treatment. J Allergy Clin Immunol. 1984 Mar;73(3):299–304. [PubMed]
  • Stewart GE, 2nd, Lockey RF. Systemic reactions from allergen immunotherapy. J Allergy Clin Immunol. 1992 Oct;90(4 Pt 1):567–578. [PubMed]
  • Wallner BP, Gefter ML. Immunotherapy with T-cell-reactive peptides derived from allergens. Allergy. 1994 May;49(5):302–308. [PubMed]
  • Ownby DR, Adinoff AD. The appropriate use of skin testing and allergen immunotherapy in young children. J Allergy Clin Immunol. 1994 Oct;94(4):662–665. [PubMed]

Articles from CMAJ : Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles
  • Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...