BlueCross BlueShield of Tennessee Medical Policy Manual

Allergy Immunotherapy - Sublingual Immunotherapy

DESCRIPTION

Sublingual immunotherapy involves the administration of antigen drops under the tongue. The antigen drops are administered in gradually increasing doses in an effort to build up individual tolerance to the allergy-causing substance.

POLICY

Sublingual immunotherapy for the treatment of allergies is considered investigational.

See also: General Policy for Allergy Testing and Treatment

ADDITIONAL INFORMATION

There is a lack of published data comparing the health outcomes of sublingual immunotherapy with current standards of practice or to permit conclusion on the outcomes of this therapy.

Sublingual immunotherapy does not meet the following technology evaluation criteria:

SOURCES

American Academy of Allergy, Asthma & Immunology, (2001, January). Immunotherapy. Retrieved March 17, 2006 from http://www.aaaai.org/aadmc/ate/category.asp?cat=1079&s=70&keywords=.

BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2005). Allergy immunotherapy (2.01.17). Retrieved March 17, 2006 from BlueWeb.

Complete Guide to Medicare Coverage Issues [Computer software]. (2005, March). Antigens prepared for sublingual administration (NCD 110.9, p. 95). St. Anthony Publishing.

Health Technology Assessment Information Service. Hotline Response. (2005, April). Specific allergen immunotherapy (SIT). Retrieved March 17, 2006 from ECRI HTAIS.

The Technology Evaluation Center. (2003, June). Sublingual immunotherapy for adults (Vol. 18, No. 4). Chicago: BlueCross BlueShield Association.

Wilson DR, Torres Lima M, Durham SR. Sublingual immunotherapy for allergic rhinitis. The Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD002893. DOI: 10.1002/14651858.CD002893.

EFFECTIVE DATE

5/25/2006

 

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.