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Chełmińska M, Specjalski K, Jassem E, Polańska J, Kita K, Górska L, Didkowska J, Wojciechowska U, Nittner-Marszalska M, Kuna P, Kupczyk M, Kruszewski J, Zakrzewski A, Czarnobilska E, Stobiecki M, Krenke R, Dąbrowski A, Kwaśniewski A, Jarząb J, Bożek A, Bodzenta-Łukaszyk A, Łukaszyk M, Kowalski M, Smorawska-Sabanty E, Fal A, Przybyłowska K, Bartuzi Z, Pałgan K, Niedoszytko M. Venom Immunotherapy Does Not Affect Survival of Patients with Malignant Tumor in Poland. J Clin Med 2024; 13:3152. [PMID: 38892863 PMCID: PMC11173344 DOI: 10.3390/jcm13113152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Allergen immunotherapy (AIT) is a well-established and efficient method of causative treatment for allergic rhinitis, asthma and insect venom allergy. Traditionally, a recent history of malignant neoplasm is regarded as a contraindication to AIT due to concerns that AIT might stimulate tumor growth. However, there are no data confirming that the silencing of the Th2 response affects prognosis in cancer. Objectives: The aim of this study was to investigate frequency of malignant tumors in patients undergoing AIT and the association between AIT and cancer-related mortality. Patients and Methods: A group of 2577 patients with insect venom allergy undergoing AIT in 10 Polish allergology centers was screened in the Polish National Cancer Registry. Data on cancer type, diagnosis time and patients' survival were collected and compared with the general population. Results: In the study group, 86 cases of malignancies were found in 85 patients (3.3% of the group). The most common were breast (19 cases), lung (9 cases), skin (8 cases), colon and prostate cancers (5 cases each). There were 21 cases diagnosed before AIT, 38 during and 27 after completing AIT. Laplace's crude incidence rate was 159.5/100,000/year (general population rate: 260/100,000/year). During follow-up, 13 deaths related to cancer were revealed (15% of patients with cancer). Laplace's cancer mortality rate was 37.3/100,000/year (general population rate: 136.8/100,000/year). Conclusions: Malignancy was found in patients undergoing immunotherapy less often than in the general population. Patients with cancer diagnosed during or after AIT did not show a lower survival rate, which suggests that AIT does not affect the prognosis.
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Affiliation(s)
- Marta Chełmińska
- Department of Allergology, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (M.C.); (K.K.); (L.G.); (M.N.)
| | - Krzysztof Specjalski
- Department of Allergology, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (M.C.); (K.K.); (L.G.); (M.N.)
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, 80-952 Gdańsk, Poland;
| | - Joanna Polańska
- Department of Data Science and Engineering, Silesian University of Technology, 44-100 Gliwice, Poland;
| | - Karolina Kita
- Department of Allergology, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (M.C.); (K.K.); (L.G.); (M.N.)
| | - Lucyna Górska
- Department of Allergology, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (M.C.); (K.K.); (L.G.); (M.N.)
| | - Joanna Didkowska
- National Institute of Oncology, 00-001 Warsaw, Poland; (J.D.); (U.W.)
| | | | - Marita Nittner-Marszalska
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Wroclaw, 50-368 Wroclaw, Poland;
| | - Piotr Kuna
- Department of Internal Diseases, Asthma and Allergy, Medical University of Łódź, 90-419 Łódż, Poland; (P.K.); (M.K.)
| | - Maciej Kupczyk
- Department of Internal Diseases, Asthma and Allergy, Medical University of Łódź, 90-419 Łódż, Poland; (P.K.); (M.K.)
| | - Jerzy Kruszewski
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.K.); (A.Z.)
| | - Aleksander Zakrzewski
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.K.); (A.Z.)
| | - Ewa Czarnobilska
- Centre of Clinical and Environmental Allergology, Jagiellonian University, 31-503 Cracow, Poland; (E.C.); (M.S.)
| | - Marcin Stobiecki
- Centre of Clinical and Environmental Allergology, Jagiellonian University, 31-503 Cracow, Poland; (E.C.); (M.S.)
| | - Rafał Krenke
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Warsaw, 02-097 Warsaw, Poland; (R.K.); (A.D.)
| | - Andrzej Dąbrowski
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Warsaw, 02-097 Warsaw, Poland; (R.K.); (A.D.)
| | | | - Jerzy Jarząb
- Clinical Department of Internal Medicine, Dermatology and Allergology, Medical University of Silesia, 40-055 Zabrze, Poland; (J.J.); (A.B.)
| | - Andrzej Bożek
- Clinical Department of Internal Medicine, Dermatology and Allergology, Medical University of Silesia, 40-055 Zabrze, Poland; (J.J.); (A.B.)
| | - Anna Bodzenta-Łukaszyk
- Department of Allergology and Internal Diseases, University Hospital, 15-089 Białystok, Poland;
| | - Mateusz Łukaszyk
- I Department of Pulmonary Diseases and Tuberculosis, Medical University of Białystok, 15-089 Białystok, Poland;
| | - Marek Kowalski
- Department of Immunology, Reumatology and Allergy, Medical University of Łódź, 92-213 Łódź, Poland (E.S.-S.)
| | - Ewa Smorawska-Sabanty
- Department of Immunology, Reumatology and Allergy, Medical University of Łódź, 92-213 Łódź, Poland (E.S.-S.)
| | - Andrzej Fal
- Department of Allergology, Pulmonary Diseases and Internal Medicine, MSWiA Central Clinical Hospital, 02-507 Warsaw, Poland; (A.F.); (K.P.)
| | - Katarzyna Przybyłowska
- Department of Allergology, Pulmonary Diseases and Internal Medicine, MSWiA Central Clinical Hospital, 02-507 Warsaw, Poland; (A.F.); (K.P.)
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Jan Biziel University Hospital, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (Z.B.); (K.P.)
| | - Krzysztof Pałgan
- Department of Allergology, Clinical Immunology and Internal Diseases, Jan Biziel University Hospital, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (Z.B.); (K.P.)
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (M.C.); (K.K.); (L.G.); (M.N.)
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Golden DBK, Wang J, Waserman S, Akin C, Campbell RL, Ellis AK, Greenhawt M, Lang DM, Ledford DK, Lieberman J, Oppenheimer J, Shaker MS, Wallace DV, Abrams EM, Bernstein JA, Chu DK, Horner CC, Rank MA, Stukus DR, Burrows AG, Cruickshank H, Golden DBK, Wang J, Akin C, Campbell RL, Ellis AK, Greenhawt M, Lang DM, Ledford DK, Lieberman J, Oppenheimer J, Shaker MS, Wallace DV, Waserman S, Abrams EM, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt M, Horner CC, Ledford DK, Lieberman J, Rank MA, Shaker MS, Stukus DR, Wang J. Anaphylaxis: A 2023 practice parameter update. Ann Allergy Asthma Immunol 2024; 132:124-176. [PMID: 38108678 DOI: 10.1016/j.anai.2023.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 12/19/2023]
Abstract
This practice parameter update focuses on 7 areas in which there are new evidence and new recommendations. Diagnostic criteria for anaphylaxis have been revised, and patterns of anaphylaxis are defined. Measurement of serum tryptase is important for diagnosis of anaphylaxis and to identify underlying mast cell disorders. In infants and toddlers, age-specific symptoms may differ from older children and adults, patient age is not correlated with reaction severity, and anaphylaxis is unlikely to be the initial reaction to an allergen on first exposure. Different community settings for anaphylaxis require specific measures for prevention and treatment of anaphylaxis. Optimal prescribing and use of epinephrine autoinjector devices require specific counseling and training of patients and caregivers, including when and how to administer the epinephrine autoinjector and whether and when to call 911. If epinephrine is used promptly, immediate activation of emergency medical services may not be required if the patient experiences a prompt, complete, and durable response. For most medical indications, the risk of stopping or changing beta-blocker or angiotensin-converting enzyme inhibitor medication may exceed the risk of more severe anaphylaxis if the medication is continued, especially in patients with insect sting anaphylaxis. Evaluation for mastocytosis, including a bone marrow biopsy, should be considered for adult patients with severe insect sting anaphylaxis or recurrent idiopathic anaphylaxis. After perioperative anaphylaxis, repeat anesthesia may proceed in the context of shared decision-making and based on the history and results of diagnostic evaluation with skin tests or in vitro tests when available, and supervised challenge when necessary.
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Affiliation(s)
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - John Oppenheimer
- Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Allergy Group and Bernstein Clinical Research Center, Cincinnati, Ohio
| | - Derek K Chu
- Department of Medicine and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Caroline C Horner
- Division of Allergy & Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - David R Stukus
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Alyssa G Burrows
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Heather Cruickshank
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | | | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - John Oppenheimer
- Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Allergy Group and Bernstein Clinical Research Center, Cincinnati, Ohio
| | - Derek K Chu
- Department of Medicine and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | | | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - Caroline C Horner
- Division of Allergy & Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David R Stukus
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
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Effectiveness and safety of allergen immunotherapy in patients with allergic rhinitis complicated by rheumatic autoimmune diseases: a case series study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:63. [PMID: 35818067 PMCID: PMC9275025 DOI: 10.1186/s13223-022-00703-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/03/2022] [Indexed: 11/24/2022]
Abstract
Background Allergen immunotherapy (AIT) is the only treatment that has modified the natural history of allergic diseases. However, since its overall effect on the immune system has not been elucidated, AIT is either absolutely or relatively contraindicated in patients with rheumatic autoimmune diseases (RADs). Therefore, there have been no long-term observations of patients with RADs receiving AIT; thus, the effectiveness and safety of AIT in these patients remain unclear. Methods This was a single-center retrospective observational study. RAD patients receiving AIT for allergic rhinitis at our institution were selected. Changes in the activity of RAD patients were investigated for 2 years from baseline, including those who discontinued AIT. The effectiveness of AIT was also investigated using the Japan Allergic Rhinitis Standard Quality of Life Questionnaire. Results Thirteen patients with RADs were enrolled in the study. All patients received sublingual immunotherapy, of which four discontinued AIT owing to adverse events. Among all patients, the symptoms of RADs in three patients worsened during the observation period; however, none of them were causally related to AIT. Most of the adverse events associated with AIT were mild, in which only one patient required drug intervention due to worsening rhinitis symptoms. In the nine patients who were able to continue AIT, their eye and nasal symptom scores showed a significant improvement from 1.67 (1.5–2.0) at baseline to 0.67 (0–1.17) in the 2nd year of treatment (p = 0.0141). Conclusions AIT is a safe and effective treatment modality for patients with allergic rhinitis complicated by RADs.
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Pitsios C, Petalas K, Dimitriou A, Parperis K, Gerasimidou K, Chliva C. Workup and Clinical Assessment for Allergen Immunotherapy Candidates. Cells 2022; 11:cells11040653. [PMID: 35203303 PMCID: PMC8870157 DOI: 10.3390/cells11040653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
Allergen Immunotherapy (AIT) is a well-established, efficient, and safe way to treat respiratory and insect-venom allergies. After determining the diagnosis of the clinically relevant culprit allergen, AIT can be prescribed. However, not all patients are eligible for AIT, since some diseases/conditions represent contraindications to AIT use, as described in several guidelines. Allergists are often preoccupied on whether an extensive workup should be ordered in apparently healthy AIT candidates in order to detect contra-indicated diseases and conditions. These preoccupations often arise from clinical, ethical and legal issues. The aim of this article is to suggest an approach to the workup and assessment of the presence of any underlying diseases/conditions in patients with no case history before the start of AIT. Notably, there is a lack of published studies on the appropriate evaluation of AIT candidates, with no globally accepted guidelines. It appears that Allergists are mostly deciding based on their AIT training, as well as their clinical experience. Guidance is based mainly on experts’ opinions; the suggested preliminary workup can be divided into mandatory and optional testing. The evaluation for possible underlying neoplastic, autoimmune, and cardiovascular diseases, primary and acquired immunodeficiencies and pregnancy, might be helpful but only in subjects for whom the history and clinical examination raise suspicion of these conditions. A workup without any reasonable correlation with potential contraindications is useless. In conclusion, the evaluation of each individual candidate for possible medical conditions should be determined on a case-by-case basis.
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Affiliation(s)
| | - Konstantinos Petalas
- Department of Allergy and Clinical Immunology, 251 General Airforce Hospital, 155 61 Athens, Greece;
| | | | | | - Kyriaki Gerasimidou
- Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Caterina Chliva
- Allergy Unit, 2nd Department of Dermatology and Venereology, “Attikon” General University Hospital, 124 61 Haidari, Greece;
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El-Qutob D, Letrán A, Matheu V, Fernandez-Caldas E. Cancer: Still a contraindication for allergen immunotherapy?: Specific immunotherapy and cancer. World Allergy Organ J 2021; 14:100597. [PMID: 34786035 PMCID: PMC8526768 DOI: 10.1016/j.waojou.2021.100597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/19/2023] Open
Abstract
Allergen immunotherapy (AIT) is currently more than 100 years old. It is considered an evidence-based efficacious immune therapeutical treatment. It is at this time the only causative treatment for allergic respiratory and venom allergic diseases. Though clinical indications for AIT are well established, clinical contraindications to AIT differ among several guidelines. Regarding malignant neoplasia, traditionally, it has been considered as a relative or absolute contraindication with the concern that AIT might stimulate tumour growth even though pathogenic impact of AIT in cancer is not well understood. Furthermore, this contraindication is often based on observational case series, or case reports, with little real evidence-based data. Therefore, should cancer still be contemplated as an absolute contraindication for AIT?
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Affiliation(s)
- David El-Qutob
- Allergy Unit, University Hospital of La Plana, Vila-real, Spain
- Corresponding author
| | - Antonio Letrán
- Allergy Unit, Hospital HLA Jerez Puerta del Sur, Jerez de la Frontera, Cádiz, Spain
| | - Victor Matheu
- Service of Allergology, University Hospital of Canarias, Spain
| | - Enrique Fernandez-Caldas
- Inmunotek SL, Alcalá de Henares, Madrid, Spain
- University of South Florida College of Medicine, Tampa, Florida, USA
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Venom immunotherapy in Europe and the United States. ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-0747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Insect sting allergy: new guidelines from the European and USA consensus groups: algorithms and recommendations. Curr Opin Allergy Clin Immunol 2019; 19:456-461. [DOI: 10.1097/aci.0000000000000570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pitsios C, Tsoumani M, Bilò MB, Sturm GJ, Rodríguez del Río P, Gawlik R, Ruëff F, Paraskevopoulos G, Valovirta E, Pfaar O, Calderón MA, Demoly P. Contraindications to immunotherapy: a global approach. Clin Transl Allergy 2019; 9:45. [PMID: 31528333 PMCID: PMC6737684 DOI: 10.1186/s13601-019-0285-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 09/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recommendations on contraindications to allergen immunotherapy (AIT) have been independently developed by National and International Societies/Academies. AIT contraindications are mainly based on case reports, case-series, or experts' opinion, while evidence-based information is limited. The aim of the present review was to describe existing guidelines on contraindications to AIT and to highlight differences between them. MAIN BODY An extended review of the literature regarding contraindications to AIT for respiratory allergy and venom hypersensitivity was performed. Furthermore, Societies and Academies registered in the World Allergy Organization and EAACI databases, were asked for additional information. Only AIT guidelines published under official auspicies were included. A large heterogeneity among the various recommendations on contraindications was registered. Common contraindications to most of the guidelines were: lack of adherence, pregnancy before the start of AIT, the use of beta-blockers, certain age groups, uncontrolled asthma, autoimmune diseases and malignancies. CONCLUSION As new data arise, revisions might soon be needed allowing AIT in the cases of patients treated with ACE inhibitors and beta-blockers, in elderly patients and in patients with concomitant autoimmune diseases and neoplasias in remission. The decision to prescribe AIT is always tailor-made, balancing risk vs benefit. Creating globally accepted guidelines would help Allergologists in their decision making.
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Affiliation(s)
- C. Pitsios
- Medical School, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus
| | - M. Tsoumani
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M. B. Bilò
- Dept. of Internal Medicine, Allergy Unit, University Hospital, Ancona, Italy
| | - G. J. Sturm
- Dept. of Dermatology and Venereology, Medical University of Graz, Graz, Austria
- Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
| | | | - R. Gawlik
- Dept. of Internal Medicine, Allergy and Clin. Immunology, Silesian University of Medicine, Katowice, Poland
| | - F. Ruëff
- Dermatology and Allergology Clinic and Policlinic, Ludwig-Maximilians University, Munich, Germany
| | - G. Paraskevopoulos
- Allergy Outpatient Clinic, 401 General Military Hospital of Athens, Athens, Greece
| | - E. Valovirta
- Terveystalo Turku, Allergy Clinic, University of Turku, Turku, Finland
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Manneim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - M. A. Calderón
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute and Royal Brompton Hospital NSH, London, UK
| | - P. Demoly
- Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Université, 75013 Paris, France
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Passalacqua G, Bagnasco D, Ferrando M, Heffler E, Puggioni F, Canonica GW. Current insights in allergen immunotherapy. Ann Allergy Asthma Immunol 2019; 120:152-154. [PMID: 29413339 DOI: 10.1016/j.anai.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/26/2017] [Accepted: 11/03/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Allergen-specific immunotherapy (AIT) in its subcutaneous and sublingual forms is currently a well-established and experimentally supported treatment for respiratory allergy and hymenoptera venom allergy. There have been advances in its use linked strictly to the advancement in the knowledge of the molecular mechanisms of allergy, the production of well-characterized extracts, and diagnostic techniques. The use of AIT in asthma and the application of new approaches are expanding. We briefly review the advances and concerns in the use of AIT. DATA SOURCES PubMed and Scopus. STUDY SELECTIONS The most recent and clinically relevant literature was selected and reviewed. RESULTS The introduction of high-quality products supported by large dose-finding trials has yielded better defined indications, contraindications, and modalities of use. Some specific products in tablet form have recently been approved in the United States. Sublingual immunotherapy has been found to be effective in asthma, which until recently had been a matter of debate. Another promising therapy is oral and sublingual desensitization for food allergy, for which encouraging results have recently been reported. In the near future, other options will be available, including new routes of administration (intralymphatic and epicutaneous), allergoids, engineered allergens, and peptides. The use of component-resolved diagnosis techniques will further refine and target AIT prescriptions. CONCLUSION This condensed and updated review shows that AIT remains a viable treatment option, especially after the introduction of standardized tablets for some allergens. Food allergy and new administration routes represent a promising expansion.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, Policlinico San Martino, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, Policlinico San Martino, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Matteo Ferrando
- Allergy and Respiratory Diseases, Policlinico San Martino, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Enrico Heffler
- Personalized Medicine Clinic Asthma and Allergy, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Francesca Puggioni
- Personalized Medicine Clinic Asthma and Allergy, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases, Policlinico San Martino, Department of Internal Medicine, University of Genoa, Genoa, Italy; Personalized Medicine Clinic Asthma and Allergy, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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Sturm GJ, Varga EM, Roberts G, Mosbech H, Bilò MB, Akdis CA, Antolín-Amérigo D, Cichocka-Jarosz E, Gawlik R, Jakob T, Kosnik M, Lange J, Mingomataj E, Mitsias DI, Ollert M, Oude Elberink JNG, Pfaar O, Pitsios C, Pravettoni V, Ruëff F, Sin BA, Agache I, Angier E, Arasi S, Calderón MA, Fernandez-Rivas M, Halken S, Jutel M, Lau S, Pajno GB, van Ree R, Ryan D, Spranger O, van Wijk RG, Dhami S, Zaman H, Sheikh A, Muraro A. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy 2018; 73:744-764. [PMID: 28748641 DOI: 10.1111/all.13262] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 01/27/2023]
Abstract
Hymenoptera venom allergy is a potentially life-threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic-allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life-threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H1 -antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence-based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta-analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom-allergic children and adults to prevent further moderate-to-severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence-based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.
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Pajno GB, Fernandez-Rivas M, Arasi S, Roberts G, Akdis CA, Alvaro-Lozano M, Beyer K, Bindslev-Jensen C, Burks W, Ebisawa M, Eigenmann P, Knol E, Nadeau KC, Poulsen LK, van Ree R, Santos AF, du Toit G, Dhami S, Nurmatov U, Boloh Y, Makela M, O'Mahony L, Papadopoulos N, Sackesen C, Agache I, Angier E, Halken S, Jutel M, Lau S, Pfaar O, Ryan D, Sturm G, Varga EM, van Wijk RG, Sheikh A, Muraro A. EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy. Allergy 2018; 73:799-815. [PMID: 29205393 DOI: 10.1111/all.13319] [Citation(s) in RCA: 351] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 02/05/2023]
Abstract
Food allergy can result in considerable morbidity, impairment of quality of life, and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food allergen immunotherapy (FA-AIT) through the oral (OIT), sublingual (SLIT), or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE-mediated Food Allergy, aims to provide evidence-based recommendations for active treatment of IgE-mediated food allergy with FA-AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post-discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA-AIT has most frequently been assessed: here, the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cow's milk, hen's egg, and peanut allergies. A benefit post-discontinuation is also suggested, but not confirmed. Adverse events during FA-AIT have been frequently reported, but few subjects discontinue FA-AIT as a result of these. Taking into account the current evidence, FA-AIT should only be performed in research centers or in clinical centers with an extensive experience in FA-AIT. Patients and their families should be provided with information about the use of FA-AIT for IgE-mediated food allergy to allow them to make an informed decision about the therapy.
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