New concepts in immunotherapy.

Various routes of immunotherapy (injection, intranasal, oral) using lyophilized, aqueous, glycerinated, and modified allergenic extracts have all produced blocking antibodies and symptomatic improvement. No single, empirical predetermined maintenance or optimal dose of allergenic extract right for every patient, can be predicted, nor can immunotherapy be administered to patients without possible adverse reactions. Patients are at a lesser risk of anaphylaxis when immunotherapy dosage is escalated to the optimal maintenance dose. The AU/mL (Amb a I) ragweed AgE, or weight/volume dose required to produce maximum IgG blocking antibody varies with each patient, indicating that not all patients require or tolerate the same optimal immunotherapeutic dose. Immunotherapy patient failures may be the result of inadequate treatment dose potency or failure to include relevant allergens. Allergen-specific IgG monitoring during immunotherapy can provide an objective method to identify allergens that could safely be escalated to a more potent immunotherapy dose.