Management of the polyallergic patient with allergy immunotherapy: a practice-based approach
Identifieur interne : 000002 ( France/Analysis ); précédent : 000001; suivant : 000003Management of the polyallergic patient with allergy immunotherapy: a practice-based approach
Auteurs : Pascal Demoly [France] ; Giovanni Passalacqua [Italie] ; Oliver Pfaar [Allemagne] ; Joaquin Sastre [Espagne] ; Ulrich Wahn [Allemagne]Source :
- Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology [ 1710-1484 ] ; 2016.
Abstract
The great majority (60–80 %) of patients consulting specialist physicians for allergic respiratory disease are polysensitized and thus may be potentially clinically polyallergic. However, management approaches to allergen immunotherapy (AIT) in polysensitized and polyallergic patients are not standardized.
An international group of clinicians with in-depth expertise in AIT product development, clinical trials and clinical practice met to generate up-to-date, unambiguous, pragmatic guidance on AIT in polysensitized and polyallergic patients. The guidance was developed after reviewing (1) the current stance of regulatory bodies and learned societies, (2) the literature data on single- and multi-AIT and (3) the members’ confirmed clinical experience with polysensitized patients.
AIT is safe and effective in polysensitized and polyallergic patients, and should always be based on the identification of one or more clinically relevant allergens (based on the type and severity of symptoms, the duration of induced symptoms, the impact on quality of life and how difficult an allergen is to avoid). Single-AIT is recommended in polyallergic patients in whom one of the relevant allergens is nevertheless clearly responsible for the most intense and/or bothersome symptoms. Parallel 2-allergen immunotherapy or mixed 2-allergen immunotherapy is indicated in polyallergic patients in whom two causal relevant allergens have a marked clinical and QoL impact. In parallel 2-allergen immunotherapy (whether subcutaneous or sublingual), high-quality, standardized, single-allergen formulations must be administered with an interval of 30 min. Mixing of allergen extracts may be considered, as long as (1) the mixture is technically feasible, (2) the mixture is allowed from a regulatory standpoint, (3) the allergen doses are reduced in proportion to the number of components but are still at concentrations with demonstrated efficacy.
Physicians can prescribe AIT (preferably with high-quality, standardized, single-allergen formulations) with confidence in polysensitized and polyallergic patients by focusing on clinical/QoL relevance and safety.
Url:
DOI: 10.1186/s13223-015-0109-6
PubMed: 26759555
PubMed Central: 4709898
Affiliations:
- Allemagne, Espagne, France, Italie
- Bade-Wurtemberg, Berlin, Communauté de Madrid, District de Karlsruhe, Languedoc-Roussillon, Occitanie (région administrative), Île-de-France
- Berlin, Madrid, Mannheim, Montpellier, Paris
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PMC:4709898Le document en format XML
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Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff2">Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></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="Aff3">Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Pfaar, Oliver" sort="Pfaar, Oliver" uniqKey="Pfaar O" first="Oliver" last="Pfaar">Oliver Pfaar</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Center for Rhinology and Allergology, Wiesbaden, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Center for Rhinology and Allergology, Wiesbaden</wicri:regionArea><wicri:noRegion>Wiesbaden</wicri:noRegion><wicri:noRegion>Wiesbaden</wicri:noRegion><wicri:noRegion>Wiesbaden</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff5">Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Universitatsmedizin Mannheim, Heidelberg University, Mannheim, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Universitatsmedizin Mannheim, Heidelberg University, Mannheim</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></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="Aff6">Allergy Division, Fundación Jimenez Díaz, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Allergy Division, Fundación Jimenez Díaz, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Wahn, Ulrich" sort="Wahn, Ulrich" uniqKey="Wahn U" first="Ulrich" last="Wahn">Ulrich Wahn</name><affiliation wicri:level="3"><nlm:aff id="Aff7">Department of Paediatric Pulmonology and Immunology, Charité Virchow-Klinikum, Humboldt University, Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Paediatric Pulmonology and Immunology, Charité Virchow-Klinikum, Humboldt University, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author></analytic><series><title level="j">Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology</title><idno type="ISSN">1710-1484</idno><idno type="eISSN">1710-1492</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The great majority (60–80 %) of patients consulting specialist physicians for allergic respiratory disease are polysensitized and thus may be potentially clinically polyallergic. However, management approaches to allergen immunotherapy (AIT) in polysensitized and polyallergic patients are not standardized.</p></sec><sec><title>Methods</title><p>An international group of clinicians with in-depth expertise in AIT product development, clinical trials and clinical practice met to generate up-to-date, unambiguous, pragmatic guidance on AIT in polysensitized and polyallergic patients. The guidance was developed after reviewing (1) the current stance of regulatory bodies and learned societies, (2) the literature data on single- and multi-AIT and (3) the members’ confirmed clinical experience with polysensitized patients.</p></sec><sec><title>Results</title><p>AIT is safe and effective in polysensitized
and polyallergic patients, and should always be based on the identification of one or more clinically relevant allergens (based on the type and severity of symptoms, the duration of induced symptoms, the impact on quality of life and how difficult an allergen is to avoid). Single-AIT is recommended in polyallergic patients in whom one of the relevant allergens is nevertheless clearly responsible for the most intense and/or bothersome symptoms. Parallel 2-allergen immunotherapy or mixed 2-allergen immunotherapy is indicated in polyallergic patients in whom two causal relevant allergens have a marked clinical and QoL impact. In parallel 2-allergen immunotherapy (whether subcutaneous or sublingual), high-quality, standardized, single-allergen formulations must be administered with an interval of 30 min. Mixing of allergen extracts may be considered, as long as (1) the mixture is technically feasible, (2) the mixture is allowed from a regulatory standpoint, (3) the allergen doses are reduced in proportion to the number of components but are still at concentrations with demonstrated efficacy.</p></sec><sec><title>Conclusions</title><p>Physicians can prescribe AIT (preferably with high-quality, standardized, single-allergen formulations) with confidence in polysensitized and polyallergic patients by focusing on clinical/QoL relevance and safety.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bauchau, V" uniqKey="Bauchau V">V Bauchau</name></author><author><name sortKey="Durham, Sr" uniqKey="Durham S">SR Durham</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bousquet, J" uniqKey="Bousquet J">J Bousquet</name></author><author><name sortKey="Van, Cp" uniqKey="Van C">CP 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Horiot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bachert, C" uniqKey="Bachert C">C Bachert</name></author><author><name sortKey="Larche, M" uniqKey="Larche M">M Larché</name></author><author><name sortKey="Bonini, S" uniqKey="Bonini S">S Bonini</name></author><author><name sortKey="Canonica, Gw" uniqKey="Canonica G">GW Canonica</name></author><author><name sortKey="Kundig, T" uniqKey="Kundig T">T Kündig</name></author><author><name sortKey="Larenas Linnemann, D" uniqKey="Larenas Linnemann D">D Larenas-Linnemann</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li><li>Espagne</li><li>France</li><li>Italie</li></country><region><li>Bade-Wurtemberg</li><li>Berlin</li><li>Communauté de Madrid</li><li>District de Karlsruhe</li><li>Languedoc-Roussillon</li><li>Occitanie (région administrative)</li><li>Île-de-France</li></region><settlement><li>Berlin</li><li>Madrid</li><li>Mannheim</li><li>Montpellier</li><li>Paris</li></settlement></list><tree><country name="France"><region name="Occitanie (région administrative)"><name sortKey="Demoly, Pascal" sort="Demoly, Pascal" uniqKey="Demoly P" first="Pascal" last="Demoly">Pascal Demoly</name></region><name sortKey="Demoly, Pascal" sort="Demoly, Pascal" uniqKey="Demoly P" first="Pascal" last="Demoly">Pascal Demoly</name></country><country name="Italie"><noRegion><name sortKey="Passalacqua, Giovanni" sort="Passalacqua, Giovanni" uniqKey="Passalacqua G" first="Giovanni" last="Passalacqua">Giovanni Passalacqua</name></noRegion></country><country name="Allemagne"><noRegion><name sortKey="Pfaar, Oliver" sort="Pfaar, Oliver" uniqKey="Pfaar O" first="Oliver" last="Pfaar">Oliver Pfaar</name></noRegion><name sortKey="Pfaar, Oliver" sort="Pfaar, Oliver" uniqKey="Pfaar O" first="Oliver" last="Pfaar">Oliver Pfaar</name><name sortKey="Wahn, Ulrich" sort="Wahn, Ulrich" uniqKey="Wahn U" first="Ulrich" last="Wahn">Ulrich Wahn</name></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Sastre, Joaquin" sort="Sastre, Joaquin" uniqKey="Sastre J" first="Joaquin" last="Sastre">Joaquin Sastre</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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