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This section holds prescribing information, dosing protocols and product data for registered health care professionals. Confirm your registration to continue.
Evidence, protocols, ordering
Prepared for prescribers in South Africa. Product information is a summary and does not replace the approved package insert or, for named-patient supply, the manufacturer's documentation.
Subcutaneous and sublingual immunotherapy
Both routes have randomised evidence for allergic rhinitis with or without conjunctivitis, and for allergic asthma as an add-on to controller therapy. Efficacy is allergen-specific and product-specific: extrapolating from a grass tablet trial to an unstandardised mixed extract is not sound.
What the evidence supports
- Reduction in symptom and medication scores across a season, sustained for years after a three-to-five-year course.
- Reduced progression from rhinitis to asthma in children, and reduced development of new sensitisations.
- Venom immunotherapy: near-complete protection against further systemic sting reactions — the strongest effect size in the field.
- Efficacy depends on reaching and holding an adequate maintenance dose; under-dosed courses behave like placebo.
Choosing a route
| Consideration | SCIT | SLIT |
|---|---|---|
| Setting | Clinic, with resuscitation capability | First dose supervised, then at home |
| Schedule | Weekly build-up, then 4–8 weekly maintenance | Daily, continuous or pre/co-seasonal |
| Multi-allergen | Feasible with care in mixing | Generally single-allergen products |
| Systemic reaction risk | Low but real; observation mandatory | Rare; local oropharyngeal effects common |
| Adherence driver | Attendance | Daily self-administration |
Patient selection
- Symptoms that correlate with a confirmed sensitisation on skin prick or specific IgE testing — not sensitisation alone.
- Inadequate control on avoidance plus pharmacotherapy, or unacceptable medication burden.
- Asthma controlled before initiation, and reviewed before each dose.
- Realistic capacity to complete three to five years.
Oral and sublingual immunotherapy
OIT raises the eliciting dose threshold in the majority of treated patients, converting an accidental exposure from a potential emergency into a tolerable event. Desensitisation is dose-dependent and largely maintained only while dosing continues; sustained unresponsiveness after stopping is achieved in a minority.
Programme shape
- Baseline confirmation of allergy, ideally with a challenge-defined threshold where the diagnosis is not clear-cut.
- Supervised initial dose escalation, then fixed daily home dosing between supervised up-dosing visits.
- Maintenance dosing continued indefinitely unless a decision to stop is made deliberately and with follow-up.
- Written rules for illness, missed doses, exercise and hot showers around dosing, and for when to hold and call.
Counselling points that change outcomes
- Adverse reactions during OIT are expected, not a sign of failure; most are mild and gastrointestinal or oropharyngeal.
- Persistent abdominal pain, dysphagia or vomiting warrants consideration of eosinophilic oesophagitis and specialist review.
- Adrenaline stays prescribed and carried throughout. OIT is not a cure and avoidance continues.
- Sublingual immunotherapy for food uses far smaller doses: fewer and milder adverse effects, lower threshold gains.
Safety guides
Before every dose
- Confirm identity, vial, dilution and dose against the record. Wrong-vial errors are the commonest serious incident.
- Ask about asthma symptoms, peak flow if used, intercurrent illness, and the reaction to the previous dose.
- Check the interval since the last dose; extended gaps require dose reduction per protocol.
- Review beta-blocker and ACE-inhibitor use, which complicate the treatment of anaphylaxis.
After every SCIT dose
- Observe for 30 minutes, longer after a dose increase or a previous systemic reaction.
- Adrenaline, oxygen and resuscitation equipment immediately available; staff trained and drilled.
- Record local reaction size — it informs the next dose.
Systemic reactions
Grade using the World Allergy Organization system for subcutaneous immunotherapy reactions, from Grade 1 (one organ system, mild) to Grade 5 (death). Treat anaphylaxis with intramuscular adrenaline into the anterolateral thigh first, before antihistamines or corticosteroids. Document the grade, the dose given, the interval to onset, and the treatment; adjust the subsequent dose accordingly and report to us and to SAHPRA.
Contraindications and cautions
- Severe or uncontrolled asthma — absolute contraindication to initiation.
- Active malignancy, significant immunodeficiency, or active autoimmune disease — assess case by case.
- Pregnancy: do not initiate; established maintenance may usually continue after discussion.
- Beta-blockers: weigh the risk, and coordinate with the prescribing clinician.
How to order immunotherapy
1. Send the script
Email the prescription with the patient's allergen profile and the intended schedule. We confirm the product, presentation and dilution series.
2. Section 21, if needed
For unregistered products we prepare the application pack for your signature and submit it to SAHPRA. Build the authorisation turnaround into your start date.
3. Quote and confirm
You receive a written quote covering the full course, with the delivery schedule for maintenance refills.
4. Cold-chain delivery
Shipped at 2–8°C in validated packaging with a temperature record. Someone must be available to receive and refrigerate on arrival.
Medical resources
Attach your approved PDFs to these links before publishing — each entry is a placeholder until a file is uploaded.
- SCIT build-up and maintenance schedule
PDF · to be uploadedDownload - Dose adjustment after a missed dose or reaction
PDF · to be uploadedDownload - Anaphylaxis management protocol for the immunotherapy room
PDF · to be uploadedDownload - Patient consent and information sheet, SCIT
PDF · to be uploadedDownload - Patient consent and information sheet, SLIT
PDF · to be uploadedDownload - Oral immunotherapy home dosing rules
PDF · to be uploadedDownload - Section 21 application checklist
PDF · to be uploadedDownload - Skin prick testing standard operating procedure
PDF · to be uploadedDownload