1. Treatment Philosophy for Inhalant Allergy— Key Concepts George F. Kroker MD FACAAI

2. Copyright 2014 Allergy Associates of La Crosse David Morris M.D.

3. Copyright 2014 Allergy Associates of La Crosse Inhalant Allergy Treatment  Immunotherapy (SCIT or SLIT) is the only therapy considered to be disease- modifying for the treatment of inhalant allergy

4. Copyright 2014 Allergy Associates of La Crosse Why Treat Inhalant Allergy? The LCM Philosophy  Simple avoidance often not possible  Immunotherapy is only disease- modifying tool available  Helps stop the atopic march in children  Important part of total load  Improves quality of life

5. Copyright 2014 Allergy Associates of La Crosse Inhalant Allergy Axioms  Inhalant Allergies may affect any mucosal system—respiratory, gastrointestinal, vaginal, as well as dermal  Different allergy conditions require different dosing schedules to achieve optimum results  Inhalant allergy should never be viewed in isolation, but as part of a bigger picture in the allergy patient

6. Copyright 2014 Allergy Associates of La Crosse Total Load Concept

7. Copyright 2014 Allergy Associates of La Crosse The La Crosse Protocol  Clinical efficacy  Used in treating multiple patients over many years  Safety  Versatility  Cost-effectiveness  Supported by medical literature

8. Copyright 2014 Allergy Associates of La Crosse AAOA & La Crosse Protocols: Comparisons--Experience AAOA Protocol La Crosse Protocol Clinical Experience 6 years (approx)40+ years Number of Patients Rx’ed Several thousand(?) 140,000+ patients (2013) Dose/FrequencyHi dose Low Frequency Lower Dose Higher Frequency

9. Copyright 2014 Allergy Associates of La Crosse AAOA & La Crosse Protocols: Comparisons--Comprehensiveness AAOA Protocol La Crosse Protocol Initial DoseStandard, based on qualitative testing Optimized with IDT Delayed inhalant Food Allergy Rx Not in ProtocolIn Protocol Number of Antigens Limited to <10Not limited to <10

10. Copyright 2014 Allergy Associates of La Crosse AAOA & La Crosse Protocols: Comparisons--Versatility/Safety AAOA Protocol La Crosse Protocol Protocol Flexibility“One Size Fits All”“A Family of dosing Protocols” SafetyHigher risk of side effects Lower risk of side effects CostHigher cost for larger antigen amt Lower cost for lower antigen amt

11. Copyright 2014 Allergy Associates of La Crosse The La Crosse Method is a Family of Dosing Protocols  Protocol for multiple inhalant/food allergies (“threshold dosing”)  Protocol for monosensitized pollen allergy (“hi dose preseasonal”)  Protocol for delayed onset allergy  Protocol for treating food anaphylaxis

12. Copyright 2014 Allergy Associates of La Crosse Thank you