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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Arzt L, Bokanovic D, Schrautzer C, Laipold K, Möbs C, Pfützner W, Herzog SA, Vollmann J, Reider N, Bohle B, Aberer W, Sturm GJ. Immunological differences between insect venom-allergic patients with and without immunotherapy and asymptomatically sensitized subjects. Allergy 2018; 73:1223-1231. [PMID: 29171032 DOI: 10.1111/all.13368] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently available tests are unable to distinguish between asymptomatic sensitization and clinically relevant Hymenoptera venom allergy. A reliable serological marker to monitor venom immunotherapy (VIT) does also not exist. Our aim was to find reliable serological markers to predict tolerance to bee and vespid stings. METHODS We included 77 asymptomatically sensitized subjects, 85 allergic patients with acute systemic sting reactions, and 61 allergic patients currently treated with VIT. Levels of sIgE and sIgG4 to bee and vespid venom, rApi m 1, and rVes v 5 were measured immediately after allergic sting reactions or before sting challenges and 4 weeks later. All sting challenges were tolerated. The inhibitory activity was determined using BAT inhibition and ELIFAB assay. RESULTS Median sIgG4 levels were 96-fold higher in VIT patients (P < .001) while sIgE/sIgG4 ratios were consistently lower (P < .001). The ELIFAB assay was paralleled by low sIgE/sIgG4 ratios in VIT patients, showing markedly higher allergen-blocking capacity (P < .001). An almost complete inhibition of the basophil response was seen in all patients treated with vespid venom, but not in those treated with bee venom. Four weeks after the sting, sIgE and sIgG4 levels were increased in allergic and asymptomatically sensitized patients, but not in VIT patients. CONCLUSION Immunological responses after stings varied in bee and vespid venom-allergic patients. In patients under VIT, sIgE and sIgG4 remained completely stable after sting challenges. Monitoring VIT efficacy was only possible in vespid venom allergy, and the sIgG4 threshold for rVes v 5 had the highest sensitivity to confirm tolerance. The BAT inhibition test was the most reliable tool to confirm tolerance on an individual basis.
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Affiliation(s)
- L. Arzt
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - D. Bokanovic
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - C. Schrautzer
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - K. Laipold
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - C. Möbs
- Clinical & Experimental Allergology, Department of Dermatology and Allergology Philipps‐University of Marburg Marburg Germany
| | - W. Pfützner
- Clinical & Experimental Allergology, Department of Dermatology and Allergology Philipps‐University of Marburg Marburg Germany
| | - S. A. Herzog
- Institute for Medical Informatics, Statistics and Documentation Medical University of Graz Graz Austria
| | - J. Vollmann
- Institute of Zoology University of Graz Graz Austria
| | - N. Reider
- Department of Dermatology, Venerology and Allergology Medical University of Innsbruck Innsbruck Austria
| | - B. Bohle
- Division of Cellular Allergology Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - W. Aberer
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - G. J. Sturm
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
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Muraro A, Roberts G, Halken S, Agache I, Angier E, Fernandez-Rivas M, Gerth van Wijk R, Jutel M, Lau S, Pajno G, Pfaar O, Ryan D, Sturm GJ, van Ree R, Varga EM, Bachert C, Calderon M, Canonica GW, Durham SR, Malling HJ, Wahn U, Sheikh A. EAACI guidelines on allergen immunotherapy: Executive statement. Allergy 2018; 73:739-743. [PMID: 29380390 DOI: 10.1111/all.13420] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- A. Muraro
- Department of Women and Child Health; Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region; University of Padua; Padua Italy
| | - G. Roberts
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
- NIHR Biomedical Research Centre; University Hospital Southampton NHS Foundation Trust; Southampton UK
- Clinical and Experimental Sciences and Human Development in Health Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
| | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - I. Agache
- Faculty of Medicine; Department of Allergy and Clinical Immunology; Transylvania University Brasov; Brasov Romania
| | - E. Angier
- Faculty of Medicine; Primary Care and Population Science; University of Southampton; Southampton UK
| | | | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus Medical Center; Otterdam the Netherlands
| | - M. Jutel
- ALL-MED Medical Research Institute; Wroclaw Medical University; Wroclaw Poland
| | - S. Lau
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin; Berlin Germany
| | - G. Pajno
- Department of Pediatrics; Allergy Unit; University of Messina; Messina Italy
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - D. Ryan
- Usher Institute of Population Health Sciences and Informatics; University of Edinburgh Medical School; Edinburgh UK
| | - G. J. Sturm
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
- Outpatient Allergy Clinic Reumannplaz; Vienna Austria
| | - R. van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - E.-M. Varga
- Department of Paediatric and Adolescent Medicine, Respiratory and Allergic Disease Division; Medical University of Graz; Graz Austria
| | - C. Bachert
- Upper Airways Research Laboratory and ENT-Department; University Hospital Ghent; Ghent Belgium
| | - M. Calderon
- Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College London; London UK
| | - G. W. Canonica
- Personalized Medicine Asthma & Allergy Clinic; Humanitas University and Research Hospital; Milano Italy
| | - S. R. Durham
- Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College London; London UK
| | - H. J. Malling
- Danish Allergy Centre; University of Copenhagen; Copenhagen Denmark
| | - U. Wahn
- Department for Pediatric Pneumology and Immunology; Charité Universitätsmedizin; Berlin Germany
| | - A. Sheikh
- Asthma UK Centre for Applied Research; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
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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: 232] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, Halken S, Larenas-Linnemann D, Pawankar R, Pitsios C, Sheikh A, Worm M, Arasi S, Calderon MA, Cingi C, Dhami S, Fauquert JL, Hamelmann E, Hellings P, Jacobsen L, Knol E, Lin SY, Maggina P, Mösges R, Oude Elberink JNG, Pajno G, Pastorello EA, Penagos M, Rotiroti G, Schmidt-Weber CB, Timmermans F, Tsilochristou O, Varga EM, Wilkinson JN, Williams A, Zhang L, Agache I, Angier E, Fernandez-Rivas M, Jutel M, Lau S, van Ree R, Ryan D, Sturm GJ, Muraro A. EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy 2018; 73:765-798. [PMID: 28940458 DOI: 10.1111/all.13317] [Citation(s) in RCA: 391] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 12/12/2022]
Abstract
Allergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease-modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergen Immunotherapy." It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short-term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children.
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Arzt L, Bokanovic D, Schrautzer C, Schwarz I, Laipold K, Aberer W, Sturm GJ. Questionable diagnostic benefit of the commercially available panel of bee venom components. Allergy 2017; 72:1419-1422. [PMID: 28273336 DOI: 10.1111/all.13154] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/27/2022]
Abstract
For many years, only the major allergen rApi m 1 has been available on the ImmunoCAP system for routine diagnosis of bee venom (BV) allergy. Now, there are five components available, and we aimed to detect the sensitivity and specificity of rApi m 1, 2, 3, 5, and 10 in BV-allergic patients. We further evaluated the sensitivity of rApi m 1 and 2 of an alternative platform and investigated possible differences in the sensitization profile between monosensitization and clinically relevant double sensitization. Analysis of the whole panel of BV allergens of the CAP system still resulted in a lower sensitivity than analysis of the combination of rApi m 1 and 2 of the Immulite (71.6% vs 85.8%). Sensitization rate of rApi m 5 was more than doubled in double-sensitized patients, while there was no difference for rApi m 2. The benefit of the commercially available panel of BV components is questionable, due to the insufficient sensitivity and still unavailable important cross-reacting allergens.
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Affiliation(s)
- L. Arzt
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - D. Bokanovic
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - C. Schrautzer
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - I. Schwarz
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - K. Laipold
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - W. Aberer
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - G. J. Sturm
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
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7
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Dhami S, Zaman H, Varga EM, Sturm GJ, Muraro A, Akdis CA, Antolín-Amérigo D, Bilò MB, Bokanovic D, Calderon MA, Cichocka-Jarosz E, Oude Elberink JNG, Gawlik R, Jakob T, Kosnik M, Lange J, Mingomataj E, Mitsias DI, Mosbech H, Ollert M, Pfaar O, Pitsios C, Pravettoni V, Roberts G, Ruëff F, Sin BA, Asaria M, Netuveli G, Sheikh A. Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis. Allergy 2017; 72:342-365. [PMID: 28120424 DOI: 10.1111/all.13077] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines on Allergen Immunotherapy (AIT) for the management of insect venom allergy. To inform this process, we sought to assess the effectiveness, cost-effectiveness and safety of AIT in the management of insect venom allergy. METHODS We undertook a systematic review, which involved searching 15 international biomedical databases for published and unpublished evidence. Studies were independently screened and critically appraised using established instruments. Data were descriptively summarized and, where possible, meta-analysed. RESULTS Our searches identified a total of 16 950 potentially eligible studies; of which, 17 satisfied our inclusion criteria. The available evidence was limited both in volume and in quality, but suggested that venom immunotherapy (VIT) could substantially reduce the risk of subsequent severe systemic sting reactions (OR = 0.08, 95% CI 0.03-0.26); meta-analysis showed that it also improved disease-specific quality of life (risk difference = 1.41, 95% CI 1.04-1.79). Adverse effects were experienced in both the build-up and maintenance phases, but most were mild with no fatalities being reported. The very limited evidence found on modelling cost-effectiveness suggested that VIT was likely to be cost-effective in those at high risk of repeated systemic sting reactions and/or impaired quality of life. CONCLUSIONS The limited available evidence suggested that VIT is effective in reducing severe subsequent systemic sting reactions and in improving disease-specific quality of life. VIT proved to be safe and no fatalities were recorded in the studies included in this review. The cost-effectiveness of VIT needs to be established.
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Affiliation(s)
- S. Dhami
- Evidence-Based Health Care Ltd; Edinburgh UK
| | - H. Zaman
- School of Pharmacy; University of Bradford; Bradford UK
| | - E.-M. Varga
- Department of Pediatric and Adolescent Medicine; Respiratory and Allergic Disease Division; Medical University of Graz; Graz Austria
| | - G. J. Sturm
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
- Outpatient Allergy Clinic Reumannplatz; Vienna Austria
| | - A. Muraro
- Department of Women and Child Health; Food Allergy Referral Centre Veneto Region; Padua General University Hospital; Padua Italy
| | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); Switzerland Servicio de Enfermedades del Sistema Inmune-Alergia; University of Zurich; Zurich Switzerland
- Departamento de Medicina y Especialidades Médicas; Hospital Universitario Príncipe de Asturias; Madrid Spain
| | | | - M. B. Bilò
- Allergy Unit; Department of Internal Medicine; University Hospital of Ancona; Ancona Italy
| | - D. Bokanovic
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - M. A. Calderon
- Section of Allergy and Clinical Immunology; Imperial College London; National Heart and Lung Institute; Royal Brompton Hospital; London UK
| | - E. Cichocka-Jarosz
- Department of Pediatrics; Jagiellonian University Medical College; Krakow Poland
| | - J. N. G. Oude Elberink
- Department of Allergology and Internal Medicine; University of Groningen; University Medical Hospital Groningen; Groningen The Netherlands
- Groningen Research Center for Asthma and COPD (GRIAC); Groningen The Netherlands
| | - R. Gawlik
- Department of Internal Medicine, Allergy and Clinical Immunology; Medical University of Silesia; Katowice Poland
| | - T. Jakob
- Department of Dermatology and Allergology; University Medical Center Gießen and Marburg (UKGM); Justus Liebig University Gießen; Gießen Germany
| | - M. Kosnik
- Medical Faculty Ljubljana; University Clinic of Respiratory and Allergic Diseases Golnik; Golnik Slovenia
| | - J. Lange
- Department of Pediatric Pneumonology and Allergy; Medical University of Warsaw; Warsaw Poland
| | - E. Mingomataj
- Department of Allergology and Clinical Immunology; Mother Theresa School of Medicine; Tirana Albania
- Department of Paraclinical Disciplines; Faculty of Technical Medical Sciences; Medicine University of Tirana; Tirana Albania
| | - D. I. Mitsias
- Department of Allergy and Clinical Immunology; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - H. Mosbech
- Allergy Clinic; Copenhagen University Hospital Gentofte; Gentofte Denmark
| | - M. Ollert
- Department of Infection and Immunity; Luxembourg Institute of Health (LIH); Strassen Luxembourg
| | - O. Pfaar
- Department of Otorhinolaryngology; Head and Neck Surgery; Universitätsmedizin Mannheim; Mannheim Germany
- Medical Faculty Mannheim; Heidelberg University; Heidelberg Germany
- Center for Rhinology Allergology; Wiesbaden Germany
| | - C. Pitsios
- Medical School; University of Cyprus; Nicosia Cyprus
| | - V. Pravettoni
- UOC Clinical Allergy and Immunology; IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - G. Roberts
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
- Faculty of Medicine; University of Southampton; Southampton UK
| | - F. Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie; Klinikum der Universität München; Munich Germany
| | - B. A. Sin
- Department of Pulmonary Diseases; Division of Immunology and Allergy; Faculty of Medicine; Ankara University; Ankara Turkey
| | - M. Asaria
- Research Fellow Centre for Health Economics; University of York; UK
| | - G. Netuveli
- Institute for Health and Human Development; University of East London; London UK
| | - A. Sheikh
- Allergy and Respiratory Research Group; The University of Edinburgh; Edinburgh UK
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8
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Calderon MA, Demoly P, Casale T, Akdis CA, Bachert C, Bewick M, Bilò BM, Bohle B, Bonini S, Bush A, Caimmi DP, Canonica GW, Cardona V, Chiriac AM, Cox L, Custovic A, De Blay F, Devillier P, Didier A, Di Lorenzo G, Du Toit G, Durham SR, Eng P, Fiocchi A, Fox AT, van Wijk RG, Gomez RM, Haathela T, Halken S, Hellings PW, Jacobsen L, Just J, Tanno LK, Kleine-Tebbe J, Klimek L, Knol EF, Kuna P, Larenas-Linnemann DE, Linneberg A, Matricardi M, Malling HJ, Moesges R, Mullol J, Muraro A, Papadopoulos N, Passalacqua G, Pastorello E, Pfaar O, Price D, Del Rio PR, Ruëff R, Samolinski B, Scadding GK, Senti G, Shamji MH, Sheikh A, Sisul JC, Sole D, Sturm GJ, Tabar A, Van Ree R, Ventura MT, Vidal C, Varga EM, Worm M, Zuberbier T, Bousquet J. Allergy immunotherapy across the life cycle to promote active and healthy ageing: from research to policies: An AIRWAYS Integrated Care Pathways (ICPs) programme item (Action Plan B3 of the European Innovation Partnership on active and healthy ageing) and the Global Alliance against Chronic Respiratory Diseases (GARD), a World Health Organization GARD research demonstration project. Clin Transl Allergy 2016; 6:41. [PMID: 27895895 PMCID: PMC5120439 DOI: 10.1186/s13601-016-0131-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/02/2016] [Indexed: 12/17/2022] Open
Abstract
Allergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Santé). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.
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Affiliation(s)
- M A Calderon
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - P Demoly
- Unité d'allergologie, Département de Pneumologie et AddictologieHôpital Arnaud de Villeneuve, CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - T Casale
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - C A Akdis
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Swiss Institute of Allergy and Asthma Research (SIAF)University of Zurich, Davos, Switzerland
| | - C Bachert
- Upper Airways Research Laboratory (URL), ENT Department, University Hospital Ghent, Ghent, Belgium
| | - M Bewick
- iQ4U consultants Ltd, London, UK
| | - B M Bilò
- Allergy Unit, Department of Internal Medicine, University Hosp Ospedali Riuniti, Ancona, Italy
| | - B Bohle
- Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - S Bonini
- Second University of Naples and IFT-CNR, Rome, Italy
| | - A Bush
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - D P Caimmi
- Unité d'allergologie, Département de Pneumologie et AddictologieHôpital Arnaud de Villeneuve, CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - G W Canonica
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - V Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A M Chiriac
- Division of Allergy, Hôpital Arnaud de Villeneuve, Department of Pulmonology, University Hospital of Montpellier, Montpellier - UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France
| | - L Cox
- Nova Southeastern University, Ft. Lauderdale, FL USA
| | - A Custovic
- National Heart and Lung Institute, Royal Brompton Hospital NHS, Imperial College London, London, UK
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
| | - P Devillier
- University Versailles Saint-Quentin and Clinical Pharmacology Unit, UPRES EA 220, Department of Airway Diseases, Foch Hospital, Suresnes, France
| | - A Didier
- Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
| | - G Di Lorenzo
- Dipartimento BioMedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), University of Palermo, Palermo, Italy
| | - G Du Toit
- Guy's and St. Thomas' NHS Trust, Kings College, London, UK
| | - S R Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - P Eng
- Department of Pediatric Pulmonology and Allergy, Children's Hospital, Aarau, Switzerland
| | - A Fiocchi
- Division of Allergy, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Vatican City, Rome, Italy
| | - A T Fox
- King's College London Allergy Academy, London, UK
| | - R Gerth van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Building Rochussenstraat, Rotterdam, The Netherlands
| | - R M Gomez
- Unidad Alergia and Asma, Hospital San Bernardo, Salta, Argentina
| | - T Haathela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - S Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - P W Hellings
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - L Jacobsen
- Allergy Learning and Consulting, Secretary Immunotherapy Interest Group EAACI, Copenhagen, Denmark
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau, INSERM, UMR_S 1136, Sorbonne Universités, UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - L K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil ; University Hospital of Montpellier, Montpellier, France ; UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Universités, Paris, France
| | - J Kleine-Tebbe
- Allergy and Asthma Center Westend, Outpatient Clinic and Clinical Research Center, Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - L Klimek
- Center for Rhinology and Allergology, German Society for Otorhinolaryngology HNS, Wiesbaden, Germany
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - P Kuna
- Medical University of Lodz, Lodz, Poland
| | | | - A Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark ; Department of Clinical Experimental Research, Rigshospitalet, Copenhagen, Denmark ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Matricardi
- Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - H J Malling
- Danish Allergy Centre, Allergy Clinic, Gentofte University Hospital, Hellerup, Denmark
| | - R Moesges
- IMSIE, Klinikum der Universität zu Köln A. ö. R., Cologne, Germany
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, ENT Department, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, Barcelona, Catalonia Spain
| | - A Muraro
- Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy
| | - N Papadopoulos
- Allergy Unit, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, Univesity of Genoa, Genoa, Italy
| | - E Pastorello
- ASST Grande Ospedale Metropolitano Niguarda, P.zza Ospedale Maggiore, Milan, Italy
| | - O Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Mannheim, Germany ; Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany ; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - D Price
- Division of Applied Health Sciences, Primary Care Respiratory Medicine, Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, UK ; Research in Real Life (RiRL), Oakington, Cambridge, UK ; Optimum Patient Care Ltd, Singapore, Singapore
| | | | - R Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximillian University, Munich, Germany
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - G K Scadding
- Royal National Throat, Nose and Ear Hospital, London, UK ; University College London, London, UK
| | - G Senti
- Clinical Trials Center, University Hospital of Zurich, Zurich, Switzerland
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK ; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - A Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | | | - D Sole
- Programa de Pòs-Graduação em Pediatria e Ciências Aplicadas à Pediatria, Departamento de Pediatria EPM, UNIFESP, São Paulo, Brazil
| | - G J Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria ; Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
| | - A Tabar
- Servicio de Alergologia, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - R Van Ree
- Departments of Experimental Immunology and Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M T Ventura
- Unit of Geriatric Immunoallergology, Interdisciplinary Department of Medicine, University of Bari Medical School, Bari, Italy
| | - C Vidal
- Allergy Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E M Varga
- Respiratory and Allergic Disease Division, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - M Worm
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Zuberbier
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Bousquet
- University Hospital of Montpellier, Montpellier, France ; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Paris, France ; INSERM, VIMA, U1168, Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, Paris, France ; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles Cedex, France ; CHRU, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
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9
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Bilò MB, Cichocka-Jarosz E, Pumphrey R, Oude-Elberink JN, Lange J, Jakob T, Bonadonna P, Fernandez J, Kosnik M, Helbling A, Mosbech H, Gawlik R, Niedoszytko M, Patella V, Pravettoni V, Rodrigues-Alves R, Sturm GJ, Rueff F. Self-medication of anaphylactic reactions due to Hymenoptera stings-an EAACI Task Force Consensus Statement. Allergy 2016; 71:931-43. [PMID: 27060567 DOI: 10.1111/all.12908] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 11/29/2022]
Abstract
An anaphylactic reaction due to a Hymenoptera sting is a clinical emergency, and patients, their caregivers as well as all healthcare professionals should be familiar with its recognition and acute management. This consensus report has been prepared by a European expert panel of the EAACI Interest Group of Insect Venom Hypersensitivity. It is targeted at allergists, clinical immunologists, internal medicine specialists, pediatricians, general practitioners, emergency department doctors, and any other healthcare professional involved. The aim was to report the scientific evidence on self-medication of anaphylactic reactions due to Hymenoptera stings, to inform healthcare staff about appropriate patient self-management of sting reactions, to propose indications for the prescription of an adrenaline auto-injector (AAI), and to discuss other forms of medication. First-line treatment for Hymenoptera sting anaphylaxis is intramuscular adrenaline. Prescription of AAIs is mandatory in the case of venom-allergic patients who suffer from mast cell diseases or with an elevated baseline serum tryptase level and in untreated patients with a history of a systemic reaction involving at least two different organ systems. AAI prescription should also be considered in other specific situations before, during, and after stopping venom immunotherapy.
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Affiliation(s)
- M. B. Bilò
- Allergy Unit; Department of Internal Medicine; University Hospital; Ancona Italy
| | - E. Cichocka-Jarosz
- Department of Pediatrics; Jagiellonian University Medical College; Krakow Poland
| | - R. Pumphrey
- Immunology; Central Manchester University Hospitals; Manchester UK
| | - J. N. Oude-Elberink
- Department of Allergology; GRIAC Research Institute; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - J. Lange
- Department of Pediatric Pulmonology and Allergy; Medical University of Warsaw; Warsaw Poland
| | - T. Jakob
- Department of Dermatology and Allergology; Justus Liebig University Gießen; University Medical Center Gießen and Marburg GmbH; Gießen Germany
| | - P. Bonadonna
- Allergy Unit; Azienda Ospedaliera Universitaria Integrata of Verona; Verona Italy
| | - J. Fernandez
- Allergy Service; Department of Clinical Medicine; Alicante University Hospital; UMH; Alicante Spain
| | - M. Kosnik
- University Clinic of Respiratory and Allergic Disease; Golnik Slovenia
| | - A. Helbling
- Division of Allergology; University Clinic of Rheumatology, Immunology and Allergology; University Hospital/Inselspital; Bern Switzerland
| | - H. Mosbech
- Allergy Unit; Department of Dermatology and Allergy; Copenhagen University Hospital Gentofte; Hellerup Denmark
| | - R. Gawlik
- Department of Internal Medicine, Allergy and Clinical Immunology; Silesian University of Medicine; Katowice Poland
| | - M. Niedoszytko
- Department of Allergology; Medical University of Gdansk; Gdansk Poland
| | - V. Patella
- Division and School of Allergy and Clinical Immunology; ASL Salerno and University of Naples Federico II, Naples; Battipaglia Hospital; Salerno Italy
| | - V. Pravettoni
- Clinical Allergy and Immunology Unit; Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - R. Rodrigues-Alves
- Allergy and Clinical Immunology Division; Divino Espirito Santo Hospital; Ponta Delgada Portugal
| | - G. J. Sturm
- Ambulatory for Allergy and Clinical Immunology; Vienna Austria
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - F. Rueff
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
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10
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Pitsios C, Demoly P, Bilò MB, Gerth van Wijk R, Pfaar O, Sturm GJ, Rodriguez del Rio P, Tsoumani M, Gawlik R, Paraskevopoulos G, Ruëff F, Valovirta E, Papadopoulos NG, Calderón MA. Clinical contraindications to allergen immunotherapy: an EAACI position paper. Allergy 2015; 70:897-909. [PMID: 25913519 DOI: 10.1111/all.12638] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
Clinical indications for allergen immunotherapy (AIT) in respiratory and Hymenoptera venom allergy are well established; however, clinical contraindications to AIT are not always well documented. There are some discrepancies when classifying clinical contraindications for different forms of AIT as 'absolute' or 'relative'. EAACI Task Force on 'Contraindications to AIT' was created to evaluate and review current literature on clinical contraindications, and to update recommendations for both sublingual and subcutaneous AIT for respiratory and venom immunotherapy. An extensive review of the literature was performed on the use of AIT in asthma, autoimmune disorders, malignant neoplasias, cardiovascular diseases, acquired immunodeficiencies and other chronic diseases (including mental disorders), in patients treated with β-blockers, ACE inhibitors or monoamine oxidase inhibitors, in children under 5 years of age, during pregnancy and in patients with poor compliance. Each topic was addressed by the following three questions: (1) Are there any negative effects of AIT on this concomitant condition/disease? (2) Are more frequent or more severe AIT-related side-effects expected? and (3) Is AIT expected to be less efficacious? The evidence, for the evaluation of these clinical conditions as contraindications, was limited, and most of the conclusions were based on case reports. Based on an extended literature research, recommendations for each medical condition assessed are provided. The final decision on the administration of AIT should be based on individual evaluation of any medical condition and a risk/benefit assessment for each patient.
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Affiliation(s)
- C. Pitsios
- Department of Nutrition and Dietetics; Harokopio University; Athens Greece
| | - P. Demoly
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
| | - M. B. Bilò
- Allergy Unit; Department of Internal Medicine; University Hospital; Ancona Italy
| | - R. Gerth van Wijk
- Department of Internal Medicine; Section of Allergology; Erasmus MC; Rotterdam The Netherlands
| | - O. Pfaar
- Center for Rhinology and Allergology; Wiesbaden Germany
- Department of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - G. J. Sturm
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | | | - M. Tsoumani
- Centre for Respiratory Medicine and Allergy; University Hospital of South Manchester; The University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - R. Gawlik
- Department of Internal Medicine, Allergy and Clinical Immunology; Medical University of Silesia; Katowice Poland
| | - G. Paraskevopoulos
- Allergy Outpatient Clinic; 401 General Military Hospital of Athens; Athens Greece
| | - F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilians University; Munich Germany
| | - E. Valovirta
- Department of Lung Diseases and Clinical Allergology; University of Turku; Turku Finland
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Center for Pediatrics & Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - M. A. Calderón
- Section of Allergy and Clinical Immunology; Imperial College London; National Heart and Lung Institute and Royal Brompton Hospital NHS; London UK
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Bretterklieber A, Beham-Schmid C, Sturm GJ, Berghold A, Brezinschek R, Aberer W, Aberer E. Anaphylaxis with clonal mast cells in normal looking skin - a new entity? Allergy 2015; 70:864-72. [PMID: 25899109 DOI: 10.1111/all.12634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with elevated basal tryptase (sBT) >15 μg/l and anaphylaxis may have an underlying mastocytosis. A monoclonal mast cell activation syndrome with aberrant mast cells (MC) at extracutaneous sites has been described in patients with severe hypotension or anaphylaxis. METHODS As MC in patients with elevated sBT might be altered in the skin as well, we studied MC in normal neck skin in anaphylaxis and urticaria patients with elevated sBT. RESULTS A mean of 93.1 (SD 19.1) MC/mm² was counted in normal neck skin in 14 patients with anaphylaxis, 84.0 (SD 13.6) in seven patients with urticaria, 142.0 (SD 24.0) in two patients with eczema, 124.4 (SD 43.2) in five patients with systemic mastocytosis (SM) in comparison with autopsy skin (39.1 MC/mm², SD 12.4). In five of 14 (35.7%) of the anaphylaxis and three of five (60%) SM patients more than 25% of MC were spindle shaped and expressed CD25 antigen. CONCLUSIONS We could show for the first time that the normal skin can harbour clonal MC in anaphylaxis patients. Analogous to the criteria for mastocytosis, we suggest a skin score criteria including an elevated number of MC, spindle shape, CD25 expression, c-Kit mutation and sBT values >20 μg/l. In patients with anaphylaxis and elevated sBT, skin should be biopsied and, as with the approach for mastocytosis diagnosis in the bone marrow, MC should be analysed for their number, clonality and c-Kit mutation. This approach should be confirmed in further studies. Patients with aberrant skin MC should be handled as mastocytosis patients.
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Affiliation(s)
- A. Bretterklieber
- Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
| | - C. Beham-Schmid
- Institute of Pathology; Medical University of Graz; Graz Austria
| | - G. J. Sturm
- Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
| | - A. Berghold
- Institute for Medical Informatics, Statistics and Documentation; Medical University of Graz; Graz Austria
| | - R. Brezinschek
- Department of Hematology; Medical University of Graz; Graz Austria
| | - W. Aberer
- Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
| | - E. Aberer
- Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
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Bokanovic D, Aberer W, Hemmer W, Heinemann A, Komericki P, Scheffel J, Sturm GJ. Determination of sIgE to rPhl p 1 is sufficient to diagnose grass pollen allergy. Allergy 2013; 68:1403-9. [PMID: 24117513 DOI: 10.1111/all.12263] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND New diagnostic tools such as the basophil activation test (BAT) and component-resolved diagnosis (CRD) are promising for Hymenoptera venom or food allergy. A clear benefit for inhalant allergens has not yet been shown. Our aim was to compare new and established tests for grass pollen allergy. METHODS Forty-nine patients with grass pollen allergy and 47 controls were prospectively enrolled in the study. A symptom score was calculated for each patient. Conjunctival provocation tests (CPT), skin prick tests (SPT), BAT, and sIgE determination including CRD were performed. Sensitivity and specificity were compared and results were correlated with the symptom score. RESULTS Single determination of sIgE to rPhl p 1 showed the best balance between sensitivity (98%) and specificity (92%). Use of additional components, such as rPhl p 2 and 5, did not increase sensitivity. Generally, sensitivity of tests was high: SPT 100%, ISAC-112 100%, sIgE to timothy grass 98%, BAT 98%, ISAC-103 84%, and CPT 83%. Specificity ranged from 79% (SPT) to 96% (CPT). All test results and calculated values (e.g. ratio sIgE/tIgE) did not correlate with symptom severity. Asymptomatic sensitization to timothy grass in controls was rare in the CAP (11%) and predominantly due to Phl p 1 sensitization. CONCLUSION rPhl p 1 was sufficient to diagnose grass pollen allergy, and sIgE patterns were the same in symptomatically and asymptomatically sensitized subjects. The testing of multiple components was of minor importance, and no test correlated with symptom severity.
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Affiliation(s)
- D. Bokanovic
- Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
| | - W. Aberer
- Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
| | - W. Hemmer
- Floridsdorf Allergy Center; Vienna Austria
| | - A. Heinemann
- Institute of Experimental and Clinical Pharmacology; Medical University of Graz; Austria
| | - P. Komericki
- Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
| | - J. Scheffel
- Laboratory of Molecular Immunogenetics; National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institutes of Health; Bethesda MD USA
| | - G. J. Sturm
- Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
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Strohmeier B, Aberer W, Bokanovic D, Komericki P, Sturm GJ. Simultaneous intradermal testing with hymenoptera venoms is safe and more efficient than sequential testing. Allergy 2013; 68:542-4. [PMID: 23405953 DOI: 10.1111/all.12123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND According to current guidelines, skin testing for hymenoptera venom allergy should be performed in a stepwise manner, maintaining 15- to 20-min intervals between the injections of venom. Given the long-winded procedure of sequential skin testing, we retrospectively explored the safety of simultaneous intradermal testing. METHODS Four hundred and seventy-eight consecutive patients with a convincing history of an anaphylactic reaction after a hymenoptera sting were tested. All venom concentrations (0.02 ml of 0.001, 0.01, 0.1, and 1.0 μg/ml of honey bee and wasp venom) were administered simultaneously to the skin. RESULTS Four hundred and seventy-two (98.7%) patients tolerated the simultaneous intradermal test without any side-effects. Only three subjects (0.6%) had a presumed allergic reaction during the test; another three reactions were considered vasovagal. CONCLUSION Our skin test protocol with four simultaneously injected concentrations of two hymenoptera venoms is safe and permits the investigator to draw rapid conclusions about the individual's sensitization pattern.
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Affiliation(s)
- B. Strohmeier
- Division of Environmental Dermatology and Venerology, Department of Dermatology; Medical University of Graz; Graz; Austria
| | - W. Aberer
- Division of Environmental Dermatology and Venerology, Department of Dermatology; Medical University of Graz; Graz; Austria
| | - D. Bokanovic
- Division of Environmental Dermatology and Venerology, Department of Dermatology; Medical University of Graz; Graz; Austria
| | - P. Komericki
- Division of Environmental Dermatology and Venerology, Department of Dermatology; Medical University of Graz; Graz; Austria
| | - G. J. Sturm
- Division of Environmental Dermatology and Venerology, Department of Dermatology; Medical University of Graz; Graz; Austria
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14
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Affiliation(s)
- D Bokanovic
- Division of Environmental Dermatology and Venerology, Department of Dermatology, Medical University of Graz, Austria.
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15
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Sieber W, Bernkopf K, Bauer A, Brenner M, Walker A, Liptak J, Przybilla B, Eben R, Ruëff F, Koschel D, Schmies M, Höffken G, Balck F, Sturm GJ, Kranzelbinder B, Schuster C, Bokanovic D, Sturm E, Vollmann J, Griesbacher A, Crailsheim K, Aberer W, Laipold K. Langfristige Patientenversorgung. Allergo J 2011. [DOI: 10.1007/bf03362490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Sturm GJ, Kranzelbinder B, Sturm EM, Heinemann A, Groselj-Strele A, Aberer W. The basophil activation test in the diagnosis of allergy: technical issues and critical factors. Allergy 2009; 64:1319-26. [PMID: 19243362 DOI: 10.1111/j.1398-9995.2009.02004.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The basophil activation test (BAT) is a widely validated and reliable tool especially for the diagnosis of hymenoptera venom allergy. Nevertheless, several pitfalls have to be considered and outcomes may differ because of diverse in-house protocols and commercially available kits. We aimed to identify the factors that may influence results of the CD63-based BAT. METHODS Basophil responses to monoclonal anti-IgE (clone E124.2.8) and bee and wasp venom were determined by BAT based on CD63. The effect of stimulating factors such as, IL-3, cytochalasin B and prewarming of the samples was investigated. Furthermore, we compared two different flow cytometer systems and evaluated the influence of storage time, different staining protocols and anti-allergic drugs on the test results. RESULTS Interleukin-3 enhanced the reactivity of basophils at 300 pM, but not at 75 and 150 pM. Prewarming of samples and reagents did not affect basophil reactivity. CD63 expression assayed after storage time of up to 48 h showed that basophil reactivity already started to decline after 4 h. Basophils stained with HLA-DR-PC5 and CD123-PE antibodies gated as HLA-DR(neg)/CD123(pos) cells showed the highest reactivity. No effect on test outcomes was observed at therapeutic doses of dimetindene and desloratadine. Finally, slight differences in the percentage of activated basophils, depending on the cytometer system used, were found. CONCLUSION Basophil activation test should be performed as early as possible after taking the blood sample, preferably within 4 h. In contrast to the skin test, BAT can be performed in patients undergoing treatment with antihistamines. For reasons of multiple influencing factors, BAT should be performed only at validated laboratories.
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Affiliation(s)
- G J Sturm
- Department of Dermatology, Medical University of Graz, Austria
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17
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De Weck AL, Sanz ML, Gamboa PM, Aberer W, Blanca M, Correia S, Erdman S, Jermann JM, Kanny G, Kowalski M, Mayorga L, Medrala W, Merk A, Sturm GJ, Sainte-Laudy J, Schneider MS, Sczczeklik A, Weber JM, Wedi A. Nonsteroidal anti-inflammatory drug hypersensitivity syndrome. A multicenter study. I. Clinical findings and in vitro diagnosis. J Investig Allergol Clin Immunol 2009; 19:355-369. [PMID: 19862935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND We present the results obtained from the largest series of in vitro diagnostic tests ever reported in patients with clinically validated hypersensitivity to acetylsalicylic acid (ASA)/nonsteroidal anti-inflammatory drugs (NSAID) compared with various categories of controls tolerating ASA/NSAIDs. This multicenter study, which was performed within the framework of the European Network for Drug Allergy (ENDA) group, showed that the basophil activation test (BAT), particularly when used with the 3 NSAIDs aspirin (ASA), diclofenac (DIC), and naproxen (NAP), allows us to confirm the diagnosis of NSAID hypersensitivity syndrome. The results of the cellular allergen stimulation test (CAST) frequently correlate with those of the BAT, although not always. An unexpected finding was that basophil activation by NSAIDs is not an all-or-nothing phenomenon restricted to clinically hypersensitive patients, but that it also occurs in a dose-related manner in some NSAID-tolerant control individuals.Therefore, NSAID hypersensitivity appears as a shift in the normal pharmacological response to NSAIDs. These findings allow us to formulate a new rational hypothesis about the mechanism of NSAID hypersensitivity syndrome, a mechanism that most authors continue to describe as "unknown." METHODS We enrolled 152 patients with a history of hypersensitivity to NSAIDs and 136 control participants in 11 different centers between spring 2003 and spring 2006. Flowcytometric BAT was performed. RESULTS The most noteworthy results of our study were that 57% of 140 patients presented very clear-cut positive BAT results to multiple NSAIDs, and 16% were entirely negative. In about 27% of cases, positive results were obtained with 1 or 2 concentrations of a single NSAID. There is clearly a correlation between the results of BAT and CAST. CONCLUSIONS BAT seems particularly indicated in patients with a clinical history of NSAID intolerance, and in whom a provocation test is not advisable for ethical, clinical, or other reasons. Clear-cut positive results can be considered as confirming a history of NSAID hypersensitivity, although negative results may not exclude it.
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Affiliation(s)
- A L De Weck
- Department of Allergology and Clinical Immunology, Clinica Universidad de Navarra, Collaborative center of Pamplona, Spain
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Sturm GJ, Heinemann A, Schuster C, Wiednig M, Groselj-Strele A, Sturm EM, Aberer W. Influence of total IgE levels on the severity of sting reactions in Hymenoptera venom allergy. Allergy 2007; 62:884-9. [PMID: 17620065 DOI: 10.1111/j.1398-9995.2007.01413.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Detection of specific IgE for Hymenoptera venoms and skin tests are well established diagnostic tools for the diagnosis of insect venom hypersensitivity. The aim of our study was to analyze the effect of total IgE levels on the outcome of generalized anaphylactic reactions after a Hymenoptera sting. METHODS Two hundred and twenty patients allergic to bee, wasp, or European hornet venom were included in the study. Their specific and total IgE levels, serum tryptase levels, skin tests, and sting history were analyzed. RESULTS In patients with mild reactions (grade I, generalized skin symptoms) we observed higher total IgE levels (248.0 kU/l) compared to patients with moderate reactions (grade II, moderate pulmonary, cardiovascular, or gastrointestinal symptoms; 75.2 kU/l) and severe reactions (grade III, bronchoconstriction, emesis, anaphylactic shock, or loss of consciousness; 56.5 kU/l; P < 0.001). Accordingly, 25% of the patients with low levels of total IgE (<50 kU/l), but no individual with total IgE levels >250 kU/l, developed loss of consciousness (P = 0.001). Additionally, specific IgE levels were related to total IgE levels: Specific IgE levels increased from 1.6 to 7.1 kU/l in patients with low (<50 kU/l) and high (>250 kU/l) total IgE levels, respectively (P < 0.001). Specific IgE levels correlated inversely to the clinical reaction grades, however, this trend was not statistically significant (P = 0.083). CONCLUSION Patients with Hymenoptera venom allergy and high levels (>250 kU/l) of total IgE, predominantly develop grade I and grade II reactions and appear to be protected from grade III reactions. However, this hypothesis should be confirmed by extended studies with sting challenges.
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Affiliation(s)
- G J Sturm
- Department of Environmental Dermatology and Allergy, Medical University of Graz, Auenbruggerplatz, Graz, Austria
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Abstract
BACKGROUND The basophil activation test (BAT), which relies on flow cytometric quantitation of the allergen-induced up-regulation of the granule-associated marker CD63 in peripheral blood basophils, has been suggested to be a useful approach in detecting responsiveness to allergens. The purpose of this study was to establish the usefulness of the BAT with regard to the clinical history and current diagnostic tools in Hymenoptera venom allergy using a prospective study design. METHODS Fifty-seven consecutive patients allergic to Hymenoptera venom as defined by a systemic reaction after an insect sting, and 30 age- and sex-matched control subjects with a negative history were included. The degree and nature of sensitization was confirmed by skin testing, specific immunoglobulin E (IgE), serum tryptase levels and BAT. In the nonallergic control group only analysis of specific IgE and BAT were performed. Correlation of BAT, skin test and specific IgE, respectively, with the clinical history in the allergic group was termed as sensitivity and in the control group as specificity. RESULTS Twenty one of 23 (91.3%) bee venom allergic patients and 29 of 34 (85.3%) patients allergic to wasp and hornet venom tested positive in BAT. The overall sensitivity of BAT, specific IgE and skin tests were 87.7, 91.2 and 93.0%, respectively. The overall specificities were 86.7% for BAT and 66.7% for specific IgE. No correlation between the severity of clinical symptoms and the magnitude of basophil activation was observed. CONCLUSION The BAT seems to be an appropriate method to identify patients allergic to bee or wasp venom with a comparable sensitivity to standard diagnostic regimens. The higher specificity of BAT as compared with specific IgE makes this test a useful tool in the diagnosis of Hymenoptera venom allergy.
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Affiliation(s)
- G J Sturm
- Department of Experimental and Clinical Pharmacology, University of Graz, Graz, Austria
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