Abstract
BackgroundPolysensitisation is common in patients with respiratory allergy in Spain. Selection of the best allergen immunotherapy (AIT) is difficult in polysensitised patients. The present study was designed to help allergists better identify relevant allergens in these patients and to improve the selection of AIT in Spain.MethodsSixty-two Spanish allergists answered a survey containing 88 items divided into four groups: 1) general approach to polysensitised subjects; 2) sensitisation profile involving mite, animal dander and moulds; 3) grass and olive pollen co-sensitisation, and 4) other pollen polysensitisation profile (weed and tree pollen). The Delphi method was used.ResultsA consensus was achieved for 83% of items (92%, 81%, 83% and 73% of the four groups analysed, respectively). Only polysensitised patients with clinical relevance should be considered polyallergic. A detailed medical history (clinical symptoms and medication) together with a profound knowledge of allergens present in the patient’s environment are essential for diagnosis. Skin prick tests (SPTs) are not adequate to decide the clinical relevance of each allergen. Serum specific IgE against allergen sources adds value to SPT but molecular diagnosis, when possible, is strongly recommended, especially in pollen-allergic patients. Specific allergen challenge tests are difficult to perform and not recommended for daily practice. Regarding AIT composition, up to three allergens can be used in the same vaccine, but only related allergens may be mixed. In some cases more than one vaccine may be needed.ConclusionSome criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.
Highlights
Polysensitisation is common in patients with respiratory allergy in Spain
The present study was designed to explore the medical opinion of a panel of 62 Spanish allergists in order to achieve consensus regarding diagnosis and treatment with allergen immunotherapy (AIT) in polysensitised patients, aiming to improve allergic treatment
Consensus was reached in 73/88 items (83%), 55 of them (63%) were in terms of agreement and the remaining 18 items (20%) in terms of disagreement with the assertion presented
Summary
Polysensitisation is common in patients with respiratory allergy in Spain. Selection of the best allergen immunotherapy (AIT) is difficult in polysensitised patients. While monoallergen AIT is preferred in European countries, the use of more than eight allergens in the same vaccine is common in the US [12] In this regard, the European Medicine Agency (EMA) recommends that allergists restrict the mixture of non-related allergens to a minimum and advises not to mix seasonal and perennial allergens, or allergens with proteolytic activity without justification [13]. The European Medicine Agency (EMA) recommends that allergists restrict the mixture of non-related allergens to a minimum and advises not to mix seasonal and perennial allergens, or allergens with proteolytic activity without justification [13] Taking these concepts together, define precisely the diagnosis seems important before prescribing AIT [14]. The present study was designed to explore the medical opinion of a panel of 62 Spanish allergists in order to achieve consensus regarding diagnosis and treatment with AIT in polysensitised patients, aiming to improve allergic treatment
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