Talk:Allergen immunotherapy

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 24 August 2020 and 4 December 2020. Further details are available on the course page. Student editor(s): Itrauger.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 13:53, 16 January 2022 (UTC)

Neutrality Removed

As there was no mention as to WHAT it was that was being disputed (May 2011), my best guess was the use of links to Grazax.

Looking at the links and their date, given that the product was new it would be expected that there would be a number of articles using it specifically. While the article only mentions the product once, it claims the product is recommended as a matter of fact; the link however points out that Grazax was the first LICENSED sub-lingual product available. As such, that section has been edited to reflect the abstract of the article.

BayaniMillsτ 06:44, 19 August 2011 (UTC)

Analysis

An observation by Moises Claderon who has authored immunotherapy meta-analyses is that there are few injection therapy studies which makes meta-analysis difficult. By contrast, there were more than 45 placebo controlled studies on sublingual, which is greater than the number of injection immunotherapy studies since the 1970s. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001936. The outcomes of sublingual and injection therapy are similar so why not combine them? —Preceding unsigned comment added by Jimthompson md (talk • contribs) 17:32, 11 October 2008 (UTC)

IgE

"they bind to allergens and reduce the ability of IgA to detect the presence of the allergens" - shouldn't this be IgE?

Lumping of sublingual and injection imunotherapy together - Needs help

The sentences: "Immunotherapy administered through cutaneous injections or sublingually has substantial empirical support. Numerous research articles and several meta-analytic studies support its clinical effectiveness. " seem to suggest that both sublingual and injection imunotherapy are equally well tried and tested. As far as I can see this is not the case.

The Cochrane reviews of "Allergen immunotherapy for asthma" http://www.cochrane.org/reviews/en/ab001186.html "Allergen injection immunotherapy for seasonal allergic rhinitis" (2007) http://www.cochrane.org/reviews/en/ab001936.html and Grazax (sublingual imunothereapy) http://www.npc.co.uk/MeReC_Extra/2007/no27_2007_suppl.htm (2007) Sublingual immunotherapy for allergic rhinitis http://www.cochrane.org/reviews/en/ab002893.html (2003) imply to my reading that the sublingual is far newer and less tried & tested and (though results are encouraging) is less well established as effective, but the dates of these studies differ by four years making a proper comparison is difficult. I am no expert but this article could do with someone who is expert to clarify this point. --Sam 15:56, 15 April 2008 (UTC)

I'm no expert, however I've broken them both up; and included new methods of treatment.

BayaniMillsτ 06:25, 19 August 2011 (UTC)

Needs help

This article is a good start, but it needs the help of experts to flesh out and make appropriate citations. For example, in the "Mechanism of Therapeutic Action" section, the mechanism of the hypersensitivity itself is described adequately, but therapeutic action is described thus: "the individual's immune system is essentially 'retrained' to tolerate exposure." This suggests that the immune system learns to recognize the allergen as something innocuous. Current study does not support that idea. Instead, it is believed that repeated (controlled) exposure to increasing doses of the allergen causes 'increasing' immune response from plasma- and memory-type B-Cells, which leads to widespread circulation of IgG (and memory cells to augment immune response on future exposures). When the immune system later encounters uncontrolled or large doses of the antigen, the "invader" becomes coated with IgG molecules, which proliferate in the bloodstream and extracellular matrix. This makes the antigen's binding sites unavailable (invisible) to the IgE molecules on granular leukocytes. The immune system doesn't learn to "tolerate" the antigen; instead, it becomes hypersensitive to it and clobbers the substance with IgG. The antigen/IgG complex is then consumed and broken down by phagocytes like neutrophils and macrophages. This keeps any significant amount of antigen from getting to the IgE on (and degranulating) mast cells, which accumulate in tissues like the endothelium, rather than circulating in the blood. 151.151.73.166 (talk) 22:04, 16 December 2007 (UTC)

References For Use

The following are references that are yet to be added/used. They are from the references list at http://www.allergy.org.au/content/view/148/128/

Comparison Malling HJ. Comparison of the clinical efficacy and safety of subcutaneous and sublingual immunotherapy: methodological approaches and experimental results. Curr Opin Allergy Clin Immunol. 2004; 4(6): 539-42

Mechanism

Akdis M, Akdis CA. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol. 2007 Feb 23; [Epub ahead of print]

Sublingual

Pajno GB. Sublingual immunotherapy: The optimism and the issues. J Allergy Clin Immunol. 2007 Feb 13;

Berto P, Bassi M, Incorvaia C, Frati F, Puccinelli P, Giaquinto C, Cantarutti L, Ortolani C. Cost effectiveness of sublingual immunotherapy in children with allergic rhinitis and asthma. Allerg Immunol (Paris). 2005 Oct;37(8):303-8.

Novembre E, Galli E, Landi F, Caffarelli C, Pifferi M, De Marco E, Burastero SE, Calori G, Benetti L, Bonazza P, Puccinelli P, Parmiani S, Bernardini R, Vierucci A. Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2004 Oct;114(4):851-7.

Wilson DR, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis. Allergy. 2005 Jan;60(1):4-12. Review.

Wilson DR, Torres LI, Durham SR. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2003;(2):CD002893. Review.

Lima MT, Wilson D, Pitkin L, Roberts A, Nouri-Aria K, Jacobson M, Walker S, Durham S. Grass pollen sublingual immunotherapy for seasonal rhinoconjunctivitis: a randomized controlled trial. Clin Exp Allergy. 2002 Apr;32(4):507-14.

Other

Bousquet PJ et. Sub-Lingual Immunotherapy - World Allergy Organisation Position Paper 2009. WAO Journal Nov 2009: 233-281

Bussmann C, Bockenhoff A, Henke H, Werfel T, Novak N. Does allergen-specific immunotherapy represent a therapeutic option for patients with atopic dermatitis? J Allergy Clin Immunol. 2006 Dec;118(6):1292-8.

Enrique E, Cistero-Bahima A. Specific immunotherapy for food allergy: basic principles and clinical aspects. Curr Opin Allergy Clin Immunol. 2006 Dec;6(6):466-9.

"'Specific Conditions'"

Abramson MJ, Puy RM, Weiner JM. Allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2003;(4):CD001186. Review.

Golden DB, Kagey-Sobotka A, Norman PS, Hamilton RG, Lichtenstein LM. Outcomes of allergy to insect stings in children, with and without venom immunotherapy. N Engl J Med. 2004 Aug 12; 351(7):668-74.

Brown SG, Wiese MD, Blackman KE, Heddle RJ. Ant venom immunotherapy: a double-blind, placebo-controlled, crossover trial. Lancet. 2003 Mar 22;361(9362):1001-6.

Hopefully they help BayaniMillsτ 06:23, 19 August 2011 (UTC)

Other Issues

removing silly image

there is an image of a girl in "anaphylactic shock". she is resting with her eyes closed and wearing an o2 mask. while she might be in mild anaphylactic shock, it must not be severe shock as she not even intubated. alternatively, she may just be sleeping with an oxygen mask on for any myriad of reasons. this image is not illustrative of a patient in true "shock" and adds nothing to the article overall. (shellac.) —Preceding unsigned comment added by Shellac (talk • contribs)

Actually, she is in the ER being treated for anaphylactic shock as a result of allergy shots. This image is even used in a biology book in a section about hyposensitization (allergy shots). I wouldn't say that it is "silly" by any means. There are different levels of anaphylactic shock. This patient's throat closed up, she was unable to breath, & she passed out. Please ask the author of the image before making broad assumptions. Thanks, нмŵוτнτ 02:06, 20 February 2008 (UTC)

Fatalaties from desensitization treatment

I have been keen to have this treatment for some time, but have not had it. However, two UK General Practisioners (Dr's) who I respect, have each recommended against because they say sometimes it kills the patient. I am unsure what the true risk is and whether their view is based on anecdote or out of date information. It would be good to have a section covering the frequency of fatalaties from this treatment, both in the past and (if things have improved in the last 20 years then) as compared to nowadays.

Also this article need backing up with reference to double blind controlled studies and scientific articles. --Sam 17:49, 7 April 2008

I have found further information on this. It seems fatalaties can occur but the most common cause is breathing difficulty in Asthmatics and fatalaty is relatively rare - many articles on the web say 1 in 2 million injections. fatalaties can be reduced by various medical procedures and precautions. Desensitisation injections are applied repeatedly so that increases the odds a bit but it is still relatively safe eg 1 person might have 150 or more injections. Non-fatal adverse reactions are more common.

The reticence to desensitisation treatment seems to be local to the UK. More on this here: Select Committee on Science and Technology Sixth Report http://www.parliament.the-stationery-office.co.uk/pa/ld200607/ldselect/ldsctech/166/16611.htm "witnesses forcefully told us that immunotherapy was not used to its full potential in the United Kingdom. The reason for this was partly historical; when early types of immunotherapy were administered by general practitioners, a number of patients had suffered anaphylactic shock. Professor Anthony Frew, President of the EAACI, told us that "between 1952 and 1986 there were about 27" associated fatalities (Q 195) and the EAACI felt that the limited use of immunotherapy in the United Kingdom "reflects concerns about safety""

The Cochrane review has useful information on "Allergen immunotherapy for asthma" http://www.cochrane.org/reviews/en/ab001186.html and regards it as relatively safe. "Deaths due to allergen immunotherapy were extremely rare, with estimates ranging from one per one million to one per two million injections. "

Could do with a higher resolution version of the picture, if possible. —Preceding unsigned comment added by 89.243.2.37 (talk) 14:02, 16 November 2008 (UTC)

--Sam 14:15, 15 April 2008 (UTC)

Rename of article

I think that this article should be moved/renamed to allergy immunotherapy or allergen specific immunotherapy. I prefer allergen specific immunotherapy. The term hyposensitization is not in common usage.--Literaturegeek | T@1k? 19:41, 5 April 2009 (UTC)

Non-existing word: efficious

In the 2nd last sentence of the start section, the word 'efficious' should probably be 'efficacious'. But it could also be that something else was meant (e.g. 'efficient'). Who could check / decide? (I don't see a quotation mark there.) Jacosi (talk) 11:33, 24 September 2009 (UTC)

No mention of Intralymphatic Immunotherapy

ImVision Therapuetics AG are currently testing the direct injection of small quantities of allergens directly into the lymphatic nodes (Phase 1 complete for Cat allergy) http://www.imvision-therapeutics.com/page2.asp?PageID=657. This method reportedly achieves allergy blocking within several weeks rather than 1 to 5 years needed with SCIT. Intralymphatic Immunotherapy isn't mentioned in the article. Spinstorm (talk) 09:16, 6 September 2010 (UTC)

Why don't you add it then? :) It certainly sounds interesting, but be cautious in the wording of the content as it is phase 1 and preliminary results.--Literaturegeek | T@1k? 16:07, 8 September 2010 (UTC)

Treatment Added. -- BayaniMillsτ 06:27, 19 August 2011 (UTC)

Bad grammar

The last paragraph in the "Mechanism of therapeutic action" section has several sentences that are poorly written. For example, "as that there occurs" or "It has been revealed that the mechanism of this immunotherapy consists of some more other components."

Advertisement for Allergen Injection Industry

This page has very little benefit for the average site visitor wishing to source balanced information on allergen injection immunotherapy (AII). The page is very similar to the numerous commercial websites published by allergists who have a financial motive for advocating and promoting and AII. The potential for serious adverse reactions including deaths from AII are glossed over, the fact that almost no long term immunological monitoring is taking place to establish if AII is associated with an increase in the incidence of auto-immune or other immunological conditions is not even mentioned. The ethical prerequisite for exploration of conventional alternative treatment options are not even touched on nor is there any mention of the importance of informed patient consent prior to AII.

Many allergists are justifying the prescription of AII on the basis of skin prick testing alone, in many instances the skin prick testing is conducted without positive and negative controls and without objective measurements of wheal and flare being taken, in those circumstances the skin prick test results are wholly unreliable. Skin prick reactions to some allergens are also controversial in that a significant percentage of patients who are proven not to be allergic on RAST testing are testing positive on skin prick tests, and the reverse is also true, patients who test positive on RAST can not infrequently test negative on skin prick tests.

The edit history for the page shows that any content that raises any of these types of issues has been removed or edited including links to articles in the medical literature about serious adverse events from AII. In its current form this page is nothing more than a blatant advertisement for the 'allergy injection industry'.

In most areas of medicine there is a reasonable arms length separation between the prescriber and the medicine supplier, a patient will visit their doctor be issued a prescription and the patient will attend a pharmacy to be issued the medicine, in that way there is not a direct conflict of interest whereby the doctor profits from the patient receiving a particular type of medicine. However with AII in many instances the doctor is both the prescriber and the supplier of the therapy profiting from both the prescribing and the supply, obviously that situation results in a direct conflict of interest. In such a situation is it possible to determine if AII is being prescribed for the benefit of the patient or for the benefit of the prescriber/supplier?

There are a plethora of publications by allergists on the benefits of AII overwhelmingly those publications are anecdotal uncontrolled studies that lack the scientific credibility of a double blind controlled study with three arms with at least 100 patients in each arm. The US supreme court has already ruled on anecdotal medical evidence and determined it to be treacherous. Given that allergists appear to have a paucity of ammunition in their therapeutic armoury it is unsurprising that almost every paper written by an allergist on AII ends with the predetermined conclusion that AII is a highly beneficial therapy that should be used more often. This is no different to any other product manufacturer/supplier endorsing and marketing their particular brand of kool-aid.

There is absolutely no incentive for allergen manufacturers or the allergists to conduct any statistically reliable studies to establish if AII (for example) increased the long term incidence of Rheumatoid Arthritis, if it were discovered and accepted that AII did result in a significant long term increase in immunological illness then it would be hard to justify the massive number of injections currently given for relatively minor conditions. If AII was restricted to a small minority of patients in special circumstances then what other services would the allergists offer to be able to remain in practice?

This is a therapy that should not be entered into lightly and this page should reflect a balanced perspective on the pros and cons of this sort of treatment rather than it simply being a marketing page for the allergen injection industry. — Preceding unsigned comment added by 58.96.98.54 (talk) 05:14, 31 December 2011 (UTC)

A couple of relevant review articles that could be used

Potentially useful review article: Allergen injection immunotherapy for seasonal allergic rhinitis. http://www.ncbi.nlm.nih.gov/pubmed/17253469 24.218.111.172 (talk) 21:05, 5 March 2012 (UTC)

A more recent (but less cited) article: Long-term clinical and immunological effects of allergen immunotherapy. http://journals.lww.com/co-allergy/Abstract/2011/12000/Long_term_clinical_and_immunological_effects_of.16.aspx 24.218.111.172 (talk) 21:32, 5 March 2012 (UTC)

Sublingual immunotherapy is presented in too positive a light in the article

I have posted information about an article that points to concerns with sub lingual immunotherapy efficacy. (although totally anecdotal, I have experienced both forms of treatment, and lost all of the benefits gained through sub-cutaneous treatment, when I switched to sub lingual.) There are also older studies with rats that showed a lack of treatment effect with sub lingual treatment, unfortunately, I researched this in 1993 and do not have the peer reviewed publication and article information any longer. Also, in regards to the edit mentioning the monetary aspect of subcutaneous immunotherapy, it is more common to see board certified allergists use subcutaneous immunotherapy and general practitioners who know the lesser hazards of sub lingual immunotherapy to branch out to increase their practices. There are manufacturers of the sub lingual solutions and if it was just as effective, wouldn't it make more sense for even allergists to increase the size of their practice by having patients who are deterred by injections and the limitations of injection hours to move to sub lingual immunotherapy if money were the deciding factor in choosing which treatment to offer? There is also no control of sub lingual drops and that the variance of concentrations of allergens are not consistent and that each solution must be tested to pass muster.The subcutaneous solutions are tested and controlled. Sub lingual drops are akin to folk remedies of eating local honey because it contains local pollens.

http://www.medicalnewstoday.com/releases/128492.php Efficacy, Dosage Concerns Unresolved On Sublingual Immunotherapy Main Category: Immune System / Vaccines Also Included In: Allergy Article Date: 07 Nov 2008 - 0:00 PDT 68.227.231.169 (talk) 23:30, 13 May 2012 (UTC)

Agreed, the sections about Sublingual immunotherapy reads like an advertisement without citations 216.10.193.23 (talk) 14:50, 3 May 2013 (UTC)

negative side-effects

I have gone through vaccination against wasps for 5 years. It is now ca 10 years ago, and I still have itching in my arm at the place where I took the injection every now and then. I looked hard to find any information on this on the net but found nothing, but when I contacted the hospital they urgently explained that it was a known side-effect that they don't tell of, but that it is harmless, even though they didn't know why it happened... I think this should be included in the part about side-effects, both to calm people that wonder what it is, and if there are any explanaitions as to why this happen so many years later and if there are any risks. Some expert here who knows? — Preceding unsigned comment added by 85.226.37.229 (talk) 21:37, 26 June 2012 (UTC)

Repetitive Information

The section entitled "Procedures" is simply a repeat of the rest of the article. It even contains some of the exact same phrases. Should I delete it? Bfotino (talk) 16:33, 16 February 2013 (UTC)

Neutrality of POV

This article (as pointed out by others) focuses primarily on the benefits of sublingual immunotherapy. There is no data detailing the studies referenced, or any countervailing data on the topic. The sublingual section begins by claiming that sublingual administration is "preferred by doctors and patients," but provides no citation. I added a reference because sublingual administration is not FDA approved and is often used off-label in the U.S., but I do not have the necessary knowledge to edit/update the historical data on immunotherapy. Subdermal therapy is references as "historical," though it is still the standard for immunotherapy in the United States. The procedures section is essentially a rehash of the sublingual/subdermal sections.

I compared with historical edits, and it also seems that good data on methods/history of/studies related to subdermal allergen immunotherapy were removed over the last year and replaced with the pro-sublingual data. I am hesitant to change this without in-depth knowledge of the field, as I may be misunderstanding the reason for their removal. I'm hoping someone else will take a look!

Jrdwiki (talk) 00:29, 23 July 2013 (UTC)

Update

I updated the article in order to complete the missing references. — Preceding unsigned comment added by 46.218.50.66 (talk) 13:19, 4 October 2013 (UTC)

Sublingual immunotherapy

... doesn't work very well: doi:10.1001/jamainternmed.2015.2840 JFW | T@lk 11:54, 30 June 2015 (UTC)

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IgE-mediated food allergies

Following this edit by an ip, I have reviewed the related information.

These are the conclusions of a 2017 systematic review and meta-analysis PMID 28058751:

"Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis. CONCLUSIONS: AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE‐mediated food allergy whilst receiving (i.e. desensitization) and post‐discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost‐effectiveness of AIT."

I am not sure how (and where) to summarize this in the lede to update this sentence of the current version "Its benefit for food allergies is unclear and thus not recommended" and which is the better section of the article to develop it. --BallenaBlanca 🐳 ♂ (Talk) 09:49, 15 April 2018 (UTC)

EAACI guideline

doi:10.1111/all.13420 JFW | T@lk 09:34, 17 July 2018 (UTC)

Queen's University Student Editing Initiative

Hello all Allergen Immunotherapy editors!

We are a group of medical students from Queen's University working to improve this article over the next month and will be posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit.

Thank you,

Reid95 (talk) 18:13, 1 October 2018 (UTC)

Paulhuit (talk) 18:13, 1 October 2018 (UTC)

itsliamdowling (talk) 18:13, 1 October 2018 (UTC)

Caravdm (talk) 18:13, 1 October 2018 (UTC)

nicoleczqu (talk) 18:13, 1 October 2018 (UTC)

mkuksis (talk) 18:13, 1 October 2018 (UTC)

marikamoskalyk (talk) 18:13, 1 October 2018 (UTC) — Preceding unsigned comment added by Reid95 (talk • contribs)

Hello again, we have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

1. In the opening the paragraph, there is a full sentence about the benefits of oral immunotherapy for food allergies. However, this sentence is not sourced and after reviewing the literature, is not a major area of allergen immunotherapy. Therefore, we suggest removing this sentence and refocusing on environmental allergies. Please see https://en.wikipedia.org/wiki/User:Paulhuit/sandbox for suggested new opening paragraph.

Comment in sandbox.JenOttawa (talk) 03:05, 7 November 2018 (UTC)

2. The final line of the fourth paragraph talks about current research being done on eczema and food allergies. It is dated however, and current secondary sources suggest that eczema is not a focus of allergen immunotherapy, and that use of food allergies remains controversial. We propose editing this line to focus on food allergies and what is currently known about them. Please see the https://en.wikipedia.org/wiki/User:Paulhuit/sandbox for edits.

Comment in sandbox.JenOttawa (talk) 03:05, 7 November 2018 (UTC)

3. Presently, the Recognition by International Guidelines section was removed due to lack of citations. We propose updating this section with two brief paragraphs that detail recognition of this therapy from allergy and food/drug agencies. Please see the https://en.m.wikipedia.org/wiki/User:Itsliamdowling/sandbox# for edits.

Comment in sandbox. Thanks!JenOttawa (talk) 03:11, 7 November 2018 (UTC)

4. In “Sublingual” section, we propose changing the last two sentences. We think it is important to the reader to find out whether this therapy is effective. The best way to do this is to include a comprehensive summary of the literature. The content can be found in the following sandbox: https://en.wikipedia.org/wiki/User:Mkuksis/sandbox

I left a comment in this sandbox. Thanks.JenOttawa (talk) 03:12, 7 November 2018 (UTC)

5. At the end of the “Sublingual” section, we thought it would be important to include a section on the safety of this method. We propose adding a paragraph containing adverse effect information and statistics. The content can be found in the following sandbox: https://en.wikipedia.org/wiki/User:Mkuksis/sandbox

See your sandbox for comments. Thanks.JenOttawa (talk) 03:13, 7 November 2018 (UTC)

6. The final paragraph within the first section does not have any references and we would like to add some references. See https://en.wikipedia.org/wiki/User:Caravdm/sandbox for exact details.

6. We plan to add two sentences under the heading Subcutaneous about the evidence-based probability that subcutaneous AI may provide greater clinical and immunological responses than sublingual AI, and there are no significant differences observed in quality of life. This is important to include as it informs decision making for both allergists and patients when deciding which treatment to move forward with. Please see https://en.wikipedia.org/wiki/User:Marikamoskalyk/sandbox for edits.

7. We plan to remove the last two sentences under the heading Subcutaneous about the likelihood of anaphylactic events. To clarify the information presented, we plan to indicate the rare occurrence of a fatal anaphylactic event when undergoing subcutaneous AI. The last sentence was not relevant to include. Please see https://en.wikipedia.org/wiki/User:Marikamoskalyk/sandbox for edits.

Comment added to sandbox. Thanks.JenOttawa (talk) 03:23, 7 November 2018 (UTC)

8. Adding citations for and clarifying existing statements about the side effects and risks of sublingual immunotherapy. Adding the same reference to the first sentence and clarifying that both sentences are referring to sublingual immunotherapy will distinguish its risks from subcutaneous immunotherapies. https://en.wikipedia.org/wiki/User:Reid95/sandbox

Adding statements about the side effects and risks of subcutaneous immunotherapy for asthma and allergic rhinoconjunctivitis. This information was only previously summarized for sublingual immunotherapy. https://en.wikipedia.org/wiki/User:Reid95/sandbox

Commented in sandbox. JenOttawa (talk) 03:24, 7 November 2018 (UTC)

We will let you know if we have any more edits in the future!

Thanks! Your group did a nice job organizing your proposed changes and sharing these with the community.JenOttawa (talk) 03:16, 7 November 2018 (UTC)

Paulhuit (talk) 16:17, 6 November 2018 (UTC) (on behalf of the group)

9. Under the “Sublingual Immunotherapy” heading, add a description of the practical use of sublingual immunotherapy. This content is summarized https://en.wikipedia.org/wiki/User:NicoleCzQU/sandbox

10. In the “Sublingual immunotherapy” subsection, remove the sentence “For seasonal… small” as justified https://en.wikipedia.org/wiki/User:NicoleCzQU/sandbox

Thanks, comment in your sandbox.JenOttawa (talk) 17:52, 12 November 2018 (UTC)

NicoleCzQU (talk) 12:20, 12 November 2018 (UTC)

This article is confusing, disjointed, and lacking critical information

A few things I'm confused about after reading this article:

• The lead and the "Types" section talk about subcutaneous immunotherapy and sublingual immunotherapy, but the rest of the body mostly talks about oral immunotherapy (which is never defined). Is oral immunotherapy the same thing as sublingual immunotherapy or it is only for food allergies?
• The lead says that subcutaneous immunotherapy has been shown to be effective in children, but nowhere in the article does it address whether subcutaneous immunotherapy has been shown to be effective in adults, or even if it's been studied in adults. That would seem to be an important topic to cover in the article.
• The "Protocol" section lists 3 phases, but doesn't say what the phases are or how long they last. The "Subcutaneous" section, however, talks about just 2 phases. How many phases are there?

Kaldari (talk) 16:45, 12 September 2019 (UTC)

Including new and improved sources

• Adding new and improved sources and review articles may help to shed light on new information about allergen immunotherapy and also help to connect it further to science communication. It may also help to add more balance and information to the less common forms of immunotherapy like oral and sublingual. Because most of the sources in this article focus on the effectiveness of subcutaneous therapy, most of the information in the article revolves around subcutaneous therapy. It isn't necessarily overrepresented because it is the most common form of therapy.

Itrauger (talk) 22:03, 11 October 2020 (UTC)