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Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement

Identifieur interne : 001790 ( Main/Exploration ); précédent : 001789; suivant : 001791

Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement

Auteurs : Marek L. Kowalski [Pologne] ; Ignacio Ansotegui [Espagne] ; Werner Aberer [Autriche] ; Mona Al-Ahmad [Koweït] ; Mubeccel Akdis [Suisse] ; Barbara K. Ballmer-Weber [Suisse] ; Kirsten Beyer [Allemagne] ; Miguel Blanca [Espagne] ; Simon Brown ; Chaweewan Bunnag [Thaïlande] ; Arnaldo Capriles Hulett [Venezuela] ; Mariana Castells [États-Unis] ; Hiok Hee Chng [Singapour] ; Frederic De Blay [France] ; Motohiro Ebisawa ; Stanley Fineman [Géorgie (pays)] ; David B. K. Golden [États-Unis] ; Tari Haahtela [Finlande] ; Michael Kaliner [États-Unis] ; Connie Katelaris [Australie] ; Bee Wah Lee [Singapour] ; Joanna Makowska [Pologne] ; Ulrich Muller [Suisse] ; Joaquim Mullol [Espagne] ; John Oppenheimer [États-Unis] ; Hae-Sim Park [Corée du Sud] ; James Parkerson [États-Unis] ; Giovanni Passalacqua [Italie] ; Ruby Pawankar [Japon] ; Harald Renz [Allemagne] ; Franziska Rueff [Allemagne] ; Mario Sanchez-Borges [Venezuela] ; Joaquin Sastre [Espagne] ; Glenis Scadding [Royaume-Uni] ; Scott Sicherer [États-Unis] ; Pongsakorn Tantilipikorn [Thaïlande] ; James Tracy [États-Unis] ; Vera Van Kempen [Allemagne] ; Barbara Bohle [Autriche] ; G Walter Canonica [Italie] ; Luis Caraballo [Colombie] ; Maximiliano Gomez [Argentine] ; Komei Ito [Japon] ; Erika Jensen-Jarolim [Autriche] ; Mark Larche [Canada] ; Giovanni Melioli [Italie] ; Lars K. Poulsen [Danemark] ; Rudolf Valenta [Autriche] ; Torsten Zuberbier [Allemagne]

Source :

RBID : PMC:5062928

Abstract

One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation.

Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures.

Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended.

This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.


Url:
DOI: 10.1186/s40413-016-0122-3
PubMed: 27777642
PubMed Central: 5062928


Affiliations:


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<name sortKey="Sastre, Joaquin" sort="Sastre, Joaquin" uniqKey="Sastre J" first="Joaquin" last="Sastre">Joaquin Sastre</name>
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<nlm:aff id="Aff10">Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand</nlm:aff>
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<wicri:regionArea>Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok</wicri:regionArea>
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</affiliation>
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<author>
<name sortKey="Tracy, James" sort="Tracy, James" uniqKey="Tracy J" first="James" last="Tracy">James Tracy</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff36">University of Nebraska, Omaha, NE USA</nlm:aff>
<country>États-Unis</country>
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<region type="state">Nebraska</region>
</placeName>
<wicri:cityArea>University of Nebraska, Omaha</wicri:cityArea>
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<affiliation wicri:level="1">
<nlm:aff id="Aff37">Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany</nlm:aff>
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<wicri:regionArea>Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum</wicri:regionArea>
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<wicri:noRegion>Bochum</wicri:noRegion>
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<affiliation wicri:level="3">
<nlm:aff id="Aff38">Division of Experimental Allergology, Department of Pathophysiology, Allergy Research Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
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<settlement type="city">Vienne (Autriche)</settlement>
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<name sortKey="Canonica, G Walter" sort="Canonica, G Walter" uniqKey="Canonica G" first="G Walter" last="Canonica">G Walter Canonica</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff39">Allergy & Respiratory Disease Clinic, DIMI – Department Int Med, University of Genoa, IRCCS AOU, San Martino – IST, Genoa, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Allergy & Respiratory Disease Clinic, DIMI – Department Int Med, University of Genoa, IRCCS AOU, San Martino – IST, Genoa</wicri:regionArea>
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<author>
<name sortKey="Caraballo, Luis" sort="Caraballo, Luis" uniqKey="Caraballo L" first="Luis" last="Caraballo">Luis Caraballo</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff40">Immunology Department, Universidad De Cartagena, Cartagena, Colombia</nlm:aff>
<country xml:lang="fr">Colombie</country>
<wicri:regionArea>Immunology Department, Universidad De Cartagena, Cartagena</wicri:regionArea>
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</author>
<author>
<name sortKey="Gomez, Maximiliano" sort="Gomez, Maximiliano" uniqKey="Gomez M" first="Maximiliano" last="Gomez">Maximiliano Gomez</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff41">Hospital San Bernardo, Salta, Argentina</nlm:aff>
<country xml:lang="fr">Argentine</country>
<wicri:regionArea>Hospital San Bernardo, Salta</wicri:regionArea>
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<affiliation wicri:level="1">
<nlm:aff id="Aff42">Department of Allergy, Aichi Children’s Health and Medical Center, Aichi, Japan</nlm:aff>
<country xml:lang="fr">Japon</country>
<wicri:regionArea>Department of Allergy, Aichi Children’s Health and Medical Center, Aichi</wicri:regionArea>
<wicri:noRegion>Aichi</wicri:noRegion>
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<author>
<name sortKey="Jensen Jarolim, Erika" sort="Jensen Jarolim, Erika" uniqKey="Jensen Jarolim E" first="Erika" last="Jensen-Jarolim">Erika Jensen-Jarolim</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff43">Messerli Research Institute, Medical University Vienna, University Vienna, Vienna, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea>Messerli Research Institute, Medical University Vienna, University Vienna, Vienna</wicri:regionArea>
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<settlement type="city">Vienne (Autriche)</settlement>
<region nuts="2" type="province">Vienne (Autriche)</region>
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</affiliation>
</author>
<author>
<name sortKey="Larche, Mark" sort="Larche, Mark" uniqKey="Larche M" first="Mark" last="Larche">Mark Larche</name>
<affiliation wicri:level="4">
<nlm:aff id="Aff44">Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton</wicri:regionArea>
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<settlement type="city">Hamilton (Ontario)</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Melioli, Giovanni" sort="Melioli, Giovanni" uniqKey="Melioli G" first="Giovanni" last="Melioli">Giovanni Melioli</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff45">Istituto Giannina Gaslini, Genoa, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Istituto Giannina Gaslini, Genoa</wicri:regionArea>
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<affiliation wicri:level="1">
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<country xml:lang="fr">Danemark</country>
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<name sortKey="Valenta, Rudolf" sort="Valenta, Rudolf" uniqKey="Valenta R" first="Rudolf" last="Valenta">Rudolf Valenta</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff47">Department of Pathophysiology, AKH, Wien, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea>Department of Pathophysiology, AKH, Wien</wicri:regionArea>
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<settlement type="city">Vienne (Autriche)</settlement>
<region nuts="2" type="province">Vienne (Autriche)</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Zuberbier, Torsten" sort="Zuberbier, Torsten" uniqKey="Zuberbier T" first="Torsten" last="Zuberbier">Torsten Zuberbier</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff48">Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin</wicri:regionArea>
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<region type="land" nuts="3">Berlin</region>
<settlement type="city">Berlin</settlement>
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</affiliation>
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<title xml:lang="en" level="a" type="main">Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement</title>
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<name sortKey="Kowalski, Marek L" sort="Kowalski, Marek L" uniqKey="Kowalski M" first="Marek L." last="Kowalski">Marek L. Kowalski</name>
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<nlm:aff id="Aff1">Department of Immunology, Rheumatology & Allergy, Medical University of Lodz, 251 Pomorska Str, 92-213 Lodz, Poland</nlm:aff>
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<name sortKey="Ansotegui, Ignacio" sort="Ansotegui, Ignacio" uniqKey="Ansotegui I" first="Ignacio" last="Ansotegui">Ignacio Ansotegui</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff2">Department of Allergy and Immunology, Hospital Quiron Bizkaia, Bilbao, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Department of Allergy and Immunology, Hospital Quiron Bizkaia, Bilbao</wicri:regionArea>
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<name sortKey="Aberer, Werner" sort="Aberer, Werner" uniqKey="Aberer W" first="Werner" last="Aberer">Werner Aberer</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff3">Department of Dermatology, Medical University of Graz, Graz, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea>Department of Dermatology, Medical University of Graz, Graz</wicri:regionArea>
<wicri:noRegion>Graz</wicri:noRegion>
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</author>
<author>
<name sortKey="Al Ahmad, Mona" sort="Al Ahmad, Mona" uniqKey="Al Ahmad M" first="Mona" last="Al-Ahmad">Mona Al-Ahmad</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff4">Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait</nlm:aff>
<country xml:lang="fr">Koweït</country>
<wicri:regionArea>Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait City</wicri:regionArea>
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<author>
<name sortKey="Akdis, Mubeccel" sort="Akdis, Mubeccel" uniqKey="Akdis M" first="Mubeccel" last="Akdis">Mubeccel Akdis</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff5">Swiss institute of Allergy & Asthma research, Davos, Switzerland</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Swiss institute of Allergy & Asthma research, Davos</wicri:regionArea>
<wicri:noRegion>Davos</wicri:noRegion>
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<author>
<name sortKey="Ballmer Weber, Barbara K" sort="Ballmer Weber, Barbara K" uniqKey="Ballmer Weber B" first="Barbara K." last="Ballmer-Weber">Barbara K. Ballmer-Weber</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff6">Allergy Unit, Dermatology Clinic, University Hospital Zürich, University Zürich, Zürich, Switzerland</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Allergy Unit, Dermatology Clinic, University Hospital Zürich, University Zürich, Zürich</wicri:regionArea>
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<settlement type="city">Zurich</settlement>
<region nuts="3" type="region">Canton de Zurich</region>
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</affiliation>
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<author>
<name sortKey="Beyer, Kirsten" sort="Beyer, Kirsten" uniqKey="Beyer K" first="Kirsten" last="Beyer">Kirsten Beyer</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff7">Kirsten Beyer, Charité Universitätsmedizin Berlin, Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Berlin, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Kirsten Beyer, Charité Universitätsmedizin Berlin, Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Berlin</wicri:regionArea>
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<region type="land" nuts="3">Berlin</region>
<settlement type="city">Berlin</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Blanca, Miguel" sort="Blanca, Miguel" uniqKey="Blanca M" first="Miguel" last="Blanca">Miguel Blanca</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff8">Hospital Reg. Univ. Carlos Haya, Allergy Serv, Malaga, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Hospital Reg. Univ. Carlos Haya, Allergy Serv, Malaga</wicri:regionArea>
<wicri:noRegion>Malaga</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Brown, Simon" sort="Brown, Simon" uniqKey="Brown S" first="Simon" last="Brown">Simon Brown</name>
<affiliation>
<nlm:aff id="Aff9">Royal Perth Hospital, Department of Emergency Medicine, Perth, WA Australia</nlm:aff>
<wicri:noCountry code="subfield">WA Australia</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Bunnag, Chaweewan" sort="Bunnag, Chaweewan" uniqKey="Bunnag C" first="Chaweewan" last="Bunnag">Chaweewan Bunnag</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff10">Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Hulett, Arnaldo Capriles" sort="Hulett, Arnaldo Capriles" uniqKey="Hulett A" first="Arnaldo Capriles" last="Hulett">Arnaldo Capriles Hulett</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff11">Allergology Unit, Hospital San Juan de Dios, Caracas, Venezuela</nlm:aff>
<country xml:lang="fr">Venezuela</country>
<wicri:regionArea>Allergology Unit, Hospital San Juan de Dios, Caracas</wicri:regionArea>
<wicri:noRegion>Caracas</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Castells, Mariana" sort="Castells, Mariana" uniqKey="Castells M" first="Mariana" last="Castells">Mariana Castells</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff12">Brigham & Women’s Hospital, Harvard Medical School, Boston, MA USA</nlm:aff>
<country>États-Unis</country>
<placeName>
<region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Brigham & Women’s Hospital, Harvard Medical School, Boston</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Chng, Hiok Hee" sort="Chng, Hiok Hee" uniqKey="Chng H" first="Hiok Hee" last="Chng">Hiok Hee Chng</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff13">Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore</wicri:regionArea>
<wicri:noRegion>Singapore</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="De Blay, Frederic" sort="De Blay, Frederic" uniqKey="De Blay F" first="Frederic" last="De Blay">Frederic De Blay</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff14">Hôpitaux Universitaires de Strasbourg, Chest Diseases Department, Strasbourg, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Hôpitaux Universitaires de Strasbourg, Chest Diseases Department, Strasbourg</wicri:regionArea>
<placeName>
<region type="region">Grand Est</region>
<region type="old region">Alsace (région administrative)</region>
<settlement type="city">Strasbourg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Ebisawa, Motohiro" sort="Ebisawa, Motohiro" uniqKey="Ebisawa M" first="Motohiro" last="Ebisawa">Motohiro Ebisawa</name>
<affiliation>
<nlm:aff id="Aff15">Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan</nlm:aff>
<wicri:noCountry code="subfield">Kanagawa Japan</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Fineman, Stanley" sort="Fineman, Stanley" uniqKey="Fineman S" first="Stanley" last="Fineman">Stanley Fineman</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff16">Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, Georgia</nlm:aff>
<country xml:lang="fr">Géorgie (pays)</country>
<wicri:regionArea>Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta</wicri:regionArea>
<wicri:noRegion>Atlanta</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Golden, David B K" sort="Golden, David B K" uniqKey="Golden D" first="David B. K." last="Golden">David B. K. Golden</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff17">Johns Hopkins University, Baltimore, MD USA</nlm:aff>
<country>États-Unis</country>
<placeName>
<region type="state">Maryland</region>
</placeName>
<wicri:cityArea>Johns Hopkins University, Baltimore</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Haahtela, Tari" sort="Haahtela, Tari" uniqKey="Haahtela T" first="Tari" last="Haahtela">Tari Haahtela</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff18">Helsinki University Central Hospital, Helsinki, Finland</nlm:aff>
<country xml:lang="fr">Finlande</country>
<wicri:regionArea>Helsinki University Central Hospital, Helsinki</wicri:regionArea>
<wicri:noRegion>Helsinki</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Kaliner, Michael" sort="Kaliner, Michael" uniqKey="Kaliner M" first="Michael" last="Kaliner">Michael Kaliner</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff19">Institute for Asthma & Allergy, Bethesda, MD USA</nlm:aff>
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<placeName>
<region type="state">Maryland</region>
</placeName>
<wicri:cityArea>Institute for Asthma & Allergy, Bethesda</wicri:cityArea>
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<author>
<name sortKey="Katelaris, Connie" sort="Katelaris, Connie" uniqKey="Katelaris C" first="Connie" last="Katelaris">Connie Katelaris</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff20">Westmead Medical Centre, Westmead, NSW Australia</nlm:aff>
<country>Australie</country>
<placeName>
<region type="state">Nouvelle-Galles du Sud</region>
</placeName>
<wicri:cityArea>Westmead Medical Centre, Westmead</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Lee, Bee Wah" sort="Lee, Bee Wah" uniqKey="Lee B" first="Bee Wah" last="Lee">Bee Wah Lee</name>
<affiliation wicri:level="4">
<nlm:aff id="Aff21">Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore</wicri:regionArea>
<orgName type="university">Université nationale de Singapour</orgName>
</affiliation>
</author>
<author>
<name sortKey="Makowska, Joanna" sort="Makowska, Joanna" uniqKey="Makowska J" first="Joanna" last="Makowska">Joanna Makowska</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff22">CSK, Department of Allergy & Clinical Immunology, Lodz, Poland</nlm:aff>
<country xml:lang="fr">Pologne</country>
<wicri:regionArea>CSK, Department of Allergy & Clinical Immunology, Lodz</wicri:regionArea>
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</author>
<author>
<name sortKey="Muller, Ulrich" sort="Muller, Ulrich" uniqKey="Muller U" first="Ulrich" last="Muller">Ulrich Muller</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff23">Spitalnetz, Bern, Switzerland</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Spitalnetz, Bern</wicri:regionArea>
<placeName>
<settlement type="city">Berne</settlement>
<region type="région" nuts="3">Canton de Berne</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Mullol, Joaquim" sort="Mullol, Joaquim" uniqKey="Mullol J" first="Joaquim" last="Mullol">Joaquim Mullol</name>
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<nlm:aff id="Aff24">Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, and CIBERES, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, and CIBERES, Barcelona</wicri:regionArea>
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<settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Oppenheimer, John" sort="Oppenheimer, John" uniqKey="Oppenheimer J" first="John" last="Oppenheimer">John Oppenheimer</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff25">UMDNJ – Rutgers Medical School, c/o Pulmonary and Allergy Associates, Summit, New Jersey, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>UMDNJ – Rutgers Medical School, c/o Pulmonary and Allergy Associates, Summit, New Jersey</wicri:regionArea>
<placeName>
<region type="state">New Jersey</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Park, Hae Sim" sort="Park, Hae Sim" uniqKey="Park H" first="Hae-Sim" last="Park">Hae-Sim Park</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff26">Department of Internal Medicine, Ajou University School of Medicine, Suwon, South Korea</nlm:aff>
<country xml:lang="fr">Corée du Sud</country>
<wicri:regionArea>Department of Internal Medicine, Ajou University School of Medicine, Suwon</wicri:regionArea>
<wicri:noRegion>Suwon</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Parkerson, James" sort="Parkerson, James" uniqKey="Parkerson J" first="James" last="Parkerson">James Parkerson</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff27">University of South Florida, Tampa, FL USA</nlm:aff>
<country>États-Unis</country>
<placeName>
<region type="state">Floride</region>
</placeName>
<wicri:cityArea>University of South Florida, Tampa</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Passalacqua, Giovanni" sort="Passalacqua, Giovanni" uniqKey="Passalacqua G" first="Giovanni" last="Passalacqua">Giovanni Passalacqua</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff28">Allergy and Respiratory Diseases, IRCCS San Martino Hospital IST, University of Genoa, Genoa, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Allergy and Respiratory Diseases, IRCCS San Martino Hospital IST, University of Genoa, Genoa</wicri:regionArea>
<wicri:noRegion>Genoa</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Pawankar, Ruby" sort="Pawankar, Ruby" uniqKey="Pawankar R" first="Ruby" last="Pawankar">Ruby Pawankar</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff29">Department of Pediatrics, Nippon Medical School, Tokyo, Japan</nlm:aff>
<country xml:lang="fr">Japon</country>
<wicri:regionArea>Department of Pediatrics, Nippon Medical School, Tokyo</wicri:regionArea>
<placeName>
<settlement type="city">Tokyo</settlement>
<region type="région">Région de Kantō</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Renz, Harald" sort="Renz, Harald" uniqKey="Renz H" first="Harald" last="Renz">Harald Renz</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff30">Universitatsklinikum GI & MR GmbH, Institut fur Laboratoriumsmedizin & Path, Standort Marburg, Marburg, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Universitatsklinikum GI & MR GmbH, Institut fur Laboratoriumsmedizin & Path, Standort Marburg, Marburg</wicri:regionArea>
<placeName>
<region type="land" nuts="1">Hesse (Land)</region>
<region type="district" nuts="2">District de Giessen</region>
<settlement type="city">Marbourg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Rueff, Franziska" sort="Rueff, Franziska" uniqKey="Rueff F" first="Franziska" last="Rueff">Franziska Rueff</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff31">Klinikum der Ludwig-Maximilians-Universitat, Klinik & Poliklinik fur Dermatologie & Allergologie, Munchen, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Klinikum der Ludwig-Maximilians-Universitat, Klinik & Poliklinik fur Dermatologie & Allergologie, Munchen</wicri:regionArea>
<wicri:noRegion>Munchen</wicri:noRegion>
<wicri:noRegion>Munchen</wicri:noRegion>
<wicri:noRegion>Munchen</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Sanchez Borges, Mario" sort="Sanchez Borges, Mario" uniqKey="Sanchez Borges M" first="Mario" last="Sanchez-Borges">Mario Sanchez-Borges</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff32">Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidadad, Caracas, Venezuela</nlm:aff>
<country xml:lang="fr">Venezuela</country>
<wicri:regionArea>Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidadad, Caracas</wicri:regionArea>
<wicri:noRegion>Caracas</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Sastre, Joaquin" sort="Sastre, Joaquin" uniqKey="Sastre J" first="Joaquin" last="Sastre">Joaquin Sastre</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff33">Allergy Department, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Institute Carlos III, Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Allergy Department, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Institute Carlos III, Madrid</wicri:regionArea>
<placeName>
<settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Scadding, Glenis" sort="Scadding, Glenis" uniqKey="Scadding G" first="Glenis" last="Scadding">Glenis Scadding</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff34">RNTNE Hospital, London, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>RNTNE Hospital, London</wicri:regionArea>
<placeName>
<settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Sicherer, Scott" sort="Sicherer, Scott" uniqKey="Sicherer S" first="Scott" last="Sicherer">Scott Sicherer</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff35">Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA</nlm:aff>
<country>États-Unis</country>
<placeName>
<region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Tantilipikorn, Pongsakorn" sort="Tantilipikorn, Pongsakorn" uniqKey="Tantilipikorn P" first="Pongsakorn" last="Tantilipikorn">Pongsakorn Tantilipikorn</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff10">Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Tracy, James" sort="Tracy, James" uniqKey="Tracy J" first="James" last="Tracy">James Tracy</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff36">University of Nebraska, Omaha, NE USA</nlm:aff>
<country>États-Unis</country>
<placeName>
<region type="state">Nebraska</region>
</placeName>
<wicri:cityArea>University of Nebraska, Omaha</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Van Kempen, Vera" sort="Van Kempen, Vera" uniqKey="Van Kempen V" first="Vera" last="Van Kempen">Vera Van Kempen</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff37">Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum</wicri:regionArea>
<wicri:noRegion>Bochum</wicri:noRegion>
<wicri:noRegion>Bochum</wicri:noRegion>
<wicri:noRegion>Bochum</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Bohle, Barbara" sort="Bohle, Barbara" uniqKey="Bohle B" first="Barbara" last="Bohle">Barbara Bohle</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff38">Division of Experimental Allergology, Department of Pathophysiology, Allergy Research Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea>Division of Experimental Allergology, Department of Pathophysiology, Allergy Research Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna</wicri:regionArea>
<placeName>
<settlement type="city">Vienne (Autriche)</settlement>
<region nuts="2" type="province">Vienne (Autriche)</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Canonica, G Walter" sort="Canonica, G Walter" uniqKey="Canonica G" first="G Walter" last="Canonica">G Walter Canonica</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff39">Allergy & Respiratory Disease Clinic, DIMI – Department Int Med, University of Genoa, IRCCS AOU, San Martino – IST, Genoa, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Allergy & Respiratory Disease Clinic, DIMI – Department Int Med, University of Genoa, IRCCS AOU, San Martino – IST, Genoa</wicri:regionArea>
<wicri:noRegion>Genoa</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Caraballo, Luis" sort="Caraballo, Luis" uniqKey="Caraballo L" first="Luis" last="Caraballo">Luis Caraballo</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff40">Immunology Department, Universidad De Cartagena, Cartagena, Colombia</nlm:aff>
<country xml:lang="fr">Colombie</country>
<wicri:regionArea>Immunology Department, Universidad De Cartagena, Cartagena</wicri:regionArea>
<wicri:noRegion>Cartagena</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Gomez, Maximiliano" sort="Gomez, Maximiliano" uniqKey="Gomez M" first="Maximiliano" last="Gomez">Maximiliano Gomez</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff41">Hospital San Bernardo, Salta, Argentina</nlm:aff>
<country xml:lang="fr">Argentine</country>
<wicri:regionArea>Hospital San Bernardo, Salta</wicri:regionArea>
<wicri:noRegion>Salta</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Ito, Komei" sort="Ito, Komei" uniqKey="Ito K" first="Komei" last="Ito">Komei Ito</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff42">Department of Allergy, Aichi Children’s Health and Medical Center, Aichi, Japan</nlm:aff>
<country xml:lang="fr">Japon</country>
<wicri:regionArea>Department of Allergy, Aichi Children’s Health and Medical Center, Aichi</wicri:regionArea>
<wicri:noRegion>Aichi</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Jensen Jarolim, Erika" sort="Jensen Jarolim, Erika" uniqKey="Jensen Jarolim E" first="Erika" last="Jensen-Jarolim">Erika Jensen-Jarolim</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff43">Messerli Research Institute, Medical University Vienna, University Vienna, Vienna, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea>Messerli Research Institute, Medical University Vienna, University Vienna, Vienna</wicri:regionArea>
<placeName>
<settlement type="city">Vienne (Autriche)</settlement>
<region nuts="2" type="province">Vienne (Autriche)</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Larche, Mark" sort="Larche, Mark" uniqKey="Larche M" first="Mark" last="Larche">Mark Larche</name>
<affiliation wicri:level="4">
<nlm:aff id="Aff44">Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton</wicri:regionArea>
<orgName type="university">Université McMaster</orgName>
<placeName>
<settlement type="city">Hamilton (Ontario)</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Melioli, Giovanni" sort="Melioli, Giovanni" uniqKey="Melioli G" first="Giovanni" last="Melioli">Giovanni Melioli</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff45">Istituto Giannina Gaslini, Genoa, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Istituto Giannina Gaslini, Genoa</wicri:regionArea>
<wicri:noRegion>Genoa</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Poulsen, Lars K" sort="Poulsen, Lars K" uniqKey="Poulsen L" first="Lars K." last="Poulsen">Lars K. Poulsen</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff46">Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark</nlm:aff>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup</wicri:regionArea>
<wicri:noRegion>Hellerup</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Valenta, Rudolf" sort="Valenta, Rudolf" uniqKey="Valenta R" first="Rudolf" last="Valenta">Rudolf Valenta</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff47">Department of Pathophysiology, AKH, Wien, Austria</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea>Department of Pathophysiology, AKH, Wien</wicri:regionArea>
<placeName>
<settlement type="city">Vienne (Autriche)</settlement>
<region nuts="2" type="province">Vienne (Autriche)</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Zuberbier, Torsten" sort="Zuberbier, Torsten" uniqKey="Zuberbier T" first="Torsten" last="Zuberbier">Torsten Zuberbier</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff48">Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin</wicri:regionArea>
<placeName>
<region type="land" nuts="3">Berlin</region>
<settlement type="city">Berlin</settlement>
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</affiliation>
</author>
</analytic>
<series>
<title level="j">The World Allergy Organization Journal</title>
<idno type="eISSN">1939-4551</idno>
<imprint>
<date when="2016">2016</date>
</imprint>
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<textClass></textClass>
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</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation.</p>
<p>Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures.</p>
<p>Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended.</p>
<p>This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.</p>
</div>
</front>
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<name sortKey="Cardona, V" uniqKey="Cardona V">V Cardona</name>
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<name sortKey="Dunngalvin, A" uniqKey="Dunngalvin A">A DunnGalvin</name>
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<name sortKey="Harada, L" uniqKey="Harada L">L Harada</name>
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</author>
<author>
<name sortKey="Niggemann, B" uniqKey="Niggemann B">B Niggemann</name>
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<author>
<name sortKey="Rueff, F" uniqKey="Rueff F">F Ruëff</name>
</author>
<author>
<name sortKey="Timmermans, F" uniqKey="Timmermans F">F Timmermans</name>
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<author>
<name sortKey="Vlieg Boerstra, Bj" uniqKey="Vlieg Boerstra B">BJ Vlieg-Boerstra</name>
</author>
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</author>
<author>
<name sortKey="Dhami, S" uniqKey="Dhami S">S Dhami</name>
</author>
<author>
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<author>
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<author>
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<author>
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<author>
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<li>Espagne</li>
<li>Finlande</li>
<li>France</li>
<li>Géorgie (pays)</li>
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<li>Japon</li>
<li>Koweït</li>
<li>Pologne</li>
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<li>Angleterre</li>
<li>Berlin</li>
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<li>Canton de Zurich</li>
<li>Catalogne</li>
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<li>District de Giessen</li>
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<li>New Jersey</li>
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<li>Hamilton (Ontario)</li>
<li>Londres</li>
<li>Madrid</li>
<li>Marbourg</li>
<li>Strasbourg</li>
<li>Tokyo</li>
<li>Vienne (Autriche)</li>
<li>Zurich</li>
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<li>Université McMaster</li>
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<name sortKey="Valenta, Rudolf" sort="Valenta, Rudolf" uniqKey="Valenta R" first="Rudolf" last="Valenta">Rudolf Valenta</name>
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<name sortKey="Zuberbier, Torsten" sort="Zuberbier, Torsten" uniqKey="Zuberbier T" first="Torsten" last="Zuberbier">Torsten Zuberbier</name>
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<name sortKey="Castells, Mariana" sort="Castells, Mariana" uniqKey="Castells M" first="Mariana" last="Castells">Mariana Castells</name>
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<name sortKey="Lee, Bee Wah" sort="Lee, Bee Wah" uniqKey="Lee B" first="Bee Wah" last="Lee">Bee Wah Lee</name>
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<country name="France">
<region name="Grand Est">
<name sortKey="De Blay, Frederic" sort="De Blay, Frederic" uniqKey="De Blay F" first="Frederic" last="De Blay">Frederic De Blay</name>
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<country name="Géorgie (pays)">
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<country name="Australie">
<region name="Nouvelle-Galles du Sud">
<name sortKey="Katelaris, Connie" sort="Katelaris, Connie" uniqKey="Katelaris C" first="Connie" last="Katelaris">Connie Katelaris</name>
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<noRegion>
<name sortKey="Park, Hae Sim" sort="Park, Hae Sim" uniqKey="Park H" first="Hae-Sim" last="Park">Hae-Sim Park</name>
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<name sortKey="Passalacqua, Giovanni" sort="Passalacqua, Giovanni" uniqKey="Passalacqua G" first="Giovanni" last="Passalacqua">Giovanni Passalacqua</name>
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<name sortKey="Canonica, G Walter" sort="Canonica, G Walter" uniqKey="Canonica G" first="G Walter" last="Canonica">G Walter Canonica</name>
<name sortKey="Melioli, Giovanni" sort="Melioli, Giovanni" uniqKey="Melioli G" first="Giovanni" last="Melioli">Giovanni Melioli</name>
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<region name="Région de Kantō">
<name sortKey="Pawankar, Ruby" sort="Pawankar, Ruby" uniqKey="Pawankar R" first="Ruby" last="Pawankar">Ruby Pawankar</name>
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<name sortKey="Ito, Komei" sort="Ito, Komei" uniqKey="Ito K" first="Komei" last="Ito">Komei Ito</name>
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<region name="Angleterre">
<name sortKey="Scadding, Glenis" sort="Scadding, Glenis" uniqKey="Scadding G" first="Glenis" last="Scadding">Glenis Scadding</name>
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<country name="Colombie">
<noRegion>
<name sortKey="Caraballo, Luis" sort="Caraballo, Luis" uniqKey="Caraballo L" first="Luis" last="Caraballo">Luis Caraballo</name>
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<name sortKey="Gomez, Maximiliano" sort="Gomez, Maximiliano" uniqKey="Gomez M" first="Maximiliano" last="Gomez">Maximiliano Gomez</name>
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<country name="Canada">
<region name="Ontario">
<name sortKey="Larche, Mark" sort="Larche, Mark" uniqKey="Larche M" first="Mark" last="Larche">Mark Larche</name>
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<country name="Danemark">
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<name sortKey="Poulsen, Lars K" sort="Poulsen, Lars K" uniqKey="Poulsen L" first="Lars K." last="Poulsen">Lars K. Poulsen</name>
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