Allergy Immunotherapy - Repository Emulsion Therapy
DESCRIPTION
Repository emulsion therapy, sometimes called the oil repository method, involves the administration of allergens typically in a solution with vegetable or mineral oil into the body. The goal is a reduction in symptoms via a slow release of the allergen(s) from the administration site. This form of therapy is not equivalent to standard/conventional subcutaneous immunotherapy.
POLICY
Repository emulsion therapy for the treatment of allergic conditions is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The lack of randomized controlled trials and studies provide little evidence of the safety and efficacy of repository emulsion therapy for the treatment of allergic conditions.
SOURCES
Adlich, P. K. & Brecht, J. G. (2000), Economic evaluation of specific immunotherapy versus symptomatic treatment of allergic rhinitis in Germany. Pharmacoeconomics, 17 (1), 37-52. Abstract retrieved August 22, 2003 from Health Technology Assessment Information Service.
Bernstein, I.L., Li, J.T., Bernstein, R.H., Spector, S.L., Tan, R., Sicherer. S., et al. (2008). Allergy diagnostic testing: an updated practice parameter. Annals of Allergy, Asthma, & Immunology, 100 (3 Suppl 3), S1-S149.
Varney, V. A., Tabbah, K., Mavfoleon, G., & Frew, A. J. (2003). Usefulness of specific immunotherapy in patients with severe perennial allergic rhinitis induced by house dust mite: A double blind, randomized, placebo controlled trial. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology, 33 (8), 1076-1082. Abstract retrieved August 22, 2003 from PubMed database.
ORIGINAL EFFECTIVE DATE: 10/12/1998
MOST RECENT REVIEW DATE: 5/14/2009
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.