Allergy Immunotherapy During Pregnancy

Key Recommendations

• The American Academy of Otolaryngology recommends that women who are already on maintenance allergy immunotherapy can continue their treatment during pregnancy, without increasing their dose 1, 2
• Women on maintenance immunotherapy should maintain their current dose and not increase it during pregnancy, as recommended by the American Academy of Otolaryngology 3, 4, 9, 10
• Retrospective studies show no increased risk of prematurity, congenital malformations, hypertension, or perinatal deaths in women who continued immunotherapy during pregnancy, according to the American Academy of Otolaryngology 1, 2, 4, 5, 6, 7
• Both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) appear safe to continue during pregnancy, as stated by the American Academy of Otolaryngology 1, 2

Considerations for Initiating Immunotherapy

• The American Academy of Otolaryngology advises against initiating allergy immunotherapy for the first time during pregnancy, except in life-threatening cases of Hymenoptera anaphylaxis 1, 2
• The concern is the potential for systemic allergic reactions and their treatment effects on the fetus, including spontaneous abortion, premature labor, or fetal hypoxia, as noted by the American Academy of Otolaryngology 3, 4, 5, 6, 7, 8, 9, 10

Safety Precautions

• Strict adherence to safety protocols is critical during pregnancy, as systemic reactions could affect both the mother and the fetus, according to the American Academy of Otolaryngology 3, 4, 5, 6, 7, 8
• The American Academy of Otolaryngology recommends ensuring a full observation period after each injection, reporting any symptoms immediately, and having injectable epinephrine available 1, 2, 3

Clinical Reasoning

• The American Academy of Otolaryngology distinguishes between continuation and initiation of immunotherapy during pregnancy, reflecting a fundamental risk-benefit calculation 1, 2
• The approach prioritizes maternal and fetal safety while allowing women who are already benefiting from immunotherapy to continue their treatment, as recommended by the American Academy of Otolaryngology 1, 2