The Challenges of Delivering Allergen Immunotherapy in the Military Health System.

Background: Many military members suffer from allergic rhinoconjunctivitis, which causes burdensome symptoms such as rhinorrhea, sneezing, nasal congestion, and itchy, watery eyes. These symptoms are not controlled by medications, and many require aeroallergen immunotherapy. However, many patients in the military have difficulty remaining on immunotherapy due to frequent moves, deployments, and temporary duty assignments. Case Presentation: A 34-year-old active-duty service member was referred to the Keesler Medical Center allergy clinic with severe allergic rhinoconjunctivitis. His symptoms included rhinorrhea, sneezing, nasal congestion, and itchy, watery eyes, which had been present for several years, occurring seasonally and when exposed to animals. The patient previously received aeroallergen immunotherapy but discontinued the therapy due to frequent military deployments and duty station changes. He restarted immunotherapy and received counseling on aeroallergen avoidance. However, a subsequent military deployment interrupted the continued aeroallergen immunotherapy. Conclusions: The case highlights the difficulty of managing allergy immunotherapy in the military health system due to frequent moves, deployments, and temporary duty assignments. Access to allergists and others trained to administer immunotherapy in deployed settings may help alleviate this challenge to mission readiness.