Nonpharmacologic Therapy

® The general approach for treatment of AR is fourfold: avoidance of allergen triggers, pharmacotherapy, immuno-therapy, and patient/family education. Three of these four are nonpharmacologic.

Avoidance of allergen triggers, to the extent they have been identified and to the extent such avoidance is possible, underlies the treatment for all patients with AR 1 2

(see Table 62-3). ' Immunotherapy must be administered by a physician. The initial evaluation includes identification of specific allergens to determine individualized therapy. The role of a pharmacist in immunotherapy is appropriate referral of patients to an allergist or immunologist. See Clinical Presentation and Diagnosis for considerations for referral. At the time of this writing, in the United States, subcutaneous injection immunotherapy is the only option.1-3,13,14 In other parts of the world, sublingual immunotherapy is an alternative.9,15-18 Proposed advantages are mostly ease of administration. Questions remain about comparative efficacy, and the details of optimal dosage, frequency of administration, and duration of therapy. Education of the patient as well as the patient's support system is essential.1 They need to understand the potential seriousness of AR (including complications such as asthma) and the chronic and/or recurrent nature of the disorder. The patient and significant others should be told about the various treatment options, including their relative advantages and disadvantages. Proper understanding and use of current medication in the patient's regimen should be assured. A better educated patient and support system will result in a better relationship with health care providers and hopefully will optimize patient outcomes.

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