What are the indications for using immunotherapy in patients with allergic conditions in primary care?

In primary care, the use of immunotherapy for allergic conditions is primarily focused on identifying suitable patients for referral to specialist allergy services, rather than initiating or managing the treatment directly NICE CKS. Current UK guidelines do not recommend initiating immunotherapy in primary care, particularly for children [1, Scadding, 2017; Euforea, 2021a; Euforea, 2021b].

Indications for considering referral for specialist immunotherapy include:

• Persistent Symptoms: Patients with persistent allergic symptoms despite optimal management with conventional drug treatments in primary care [1, Mahesh et al., 2025].
• Specific Allergen Sensitivity: Individuals whose symptoms are predominantly due to a single allergen, such as grass pollen or house dust mite, with objective confirmation of IgE sensitivity [1, Mahesh et al., 2025].
• Desire for Long-Term Solution: Patients who wish to consider specialist immunotherapy treatment as an alternative to long-term medication use [1, Mahesh et al., 2025].
• Moderate to Severe Symptoms: For those with moderate to severe allergic symptoms that are not adequately controlled by standard pharmacotherapy [Mahesh et al., 2025].

Immunotherapy is a disease-modifying treatment for conditions like allergic rhinitis, allergic asthma, and stinging insect hypersensitivity [Craig et al., 1998]. It may also be indicated for ocular allergy [Mahesh et al., 2025]. While some older literature suggests immunotherapy can be safely administered in a primary care office, current UK guidance emphasizes specialist assessment and management due to the need for a supervised clinical setting and the risk of systemic reactions [1, Craig et al., 1998; Mahesh et al., 2025]. Subcutaneous and sublingual immunotherapy are the common forms, typically involving a course of treatment over several years NICE CKS.