How's my dosing? A one-step, math-free guide for comparing your clinic's maintenance immunotherapy doses to current practice parameter recommendations.

BACKGROUND Immunotherapy dose recommendations for allergens specified in practice parameter updates have varied from version to version, and no convenient methods are available to incorporate dose changes or targets into maintenance vial formulations for patients. OBJECTIVES To compare the allergen immunotherapy dose recommendations published between 2003-2011, and to provide math-free dosing tables that translate dose targets for single or multiple extracts into maintenance vial compositions. METHODS Dose recommendations obtained from immunotherapy practice parameters published in 2003, 2007 and 2011, plus a worksheet created in 2004, were tabulated and compared. Conversion tables were created based on the fixed mathematical relationships between extract concentrate strengths and maintenance immunotherapy dose targets. Considerations of stock mixes, glycerin levels, and allergen compatibilities were applied using two examples of common extract formulations. RESULTS Changes to immunotherapy dose ranges for standardized extracts included adjustment of upper limits (short ragweed), lower limits (pasture grasses), or both (cat, dust mites, Bermuda grass). Dose ranges for non-standardized products have also been modified over time. Conversion tables specified the extract concentrate volumes or percentages required to deliver minimum, midrange and maximum recommended doses with 0.5 mL injection volumes. CONCLUSIONS These dosing guides, used in conjunction with cross-reactivity, compatibility and glycerin tolerance information, provide clinicians with a convenient and systematic method for determining the numbers and strengths of extracts that can be combined into treatment vials at various dose levels, and can facilitate optimization of maintenance immunotherapy mixtures for patients exhibiting a wide range of allergen sensitivities and specificities.