Abstract
Allergen Immunotherapy (AIT) is a well-established, efficient, and safe way to treat respiratory and insect-venom allergies. After determining the diagnosis of the clinically relevant culprit allergen, AIT can be prescribed. However, not all patients are eligible for AIT, since some diseases/conditions represent contraindications to AIT use, as described in several guidelines. Allergists are often preoccupied on whether an extensive workup should be ordered in apparently healthy AIT candidates in order to detect contra-indicated diseases and conditions. These preoccupations often arise from clinical, ethical and legal issues. The aim of this article is to suggest an approach to the workup and assessment of the presence of any underlying diseases/conditions in patients with no case history before the start of AIT. Notably, there is a lack of published studies on the appropriate evaluation of AIT candidates, with no globally accepted guidelines. It appears that Allergists are mostly deciding based on their AIT training, as well as their clinical experience. Guidance is based mainly on experts’ opinions; the suggested preliminary workup can be divided into mandatory and optional testing. The evaluation for possible underlying neoplastic, autoimmune, and cardiovascular diseases, primary and acquired immunodeficiencies and pregnancy, might be helpful but only in subjects for whom the history and clinical examination raise suspicion of these conditions. A workup without any reasonable correlation with potential contraindications is useless. In conclusion, the evaluation of each individual candidate for possible medical conditions should be determined on a case-by-case basis.
Highlights
Introduction iationsAllergen Immunotherapy (AIT) is a well-established treatment option for respiratory and insect-venom allergies, as well as the only etiology-based and disease-modifying treatment for allergic diseases [1,2,3,4]
The administration of AIT is indicated for the treatment of allergic rhinitis, allergic rhinoconjunctivitis and allergic asthma, and is efficacious when directed at the specific allergen-driving symptoms [1,3,4,5,6]
A history of severe Hymenoptera-venom anaphylaxis in patients with clonal-mast-cell-activation syndrome (c-MCAS) is predictive of a future severe systemic sting reaction, and Venom immunotherapy (VIT) is the appropriate therapeutic option regardless of the level of tryptase
Summary
Skin tests are the cornerstone of allergy diagnostic evaluation. Is a cheap, quick and easy-to-perform method of diagnosis for IgE-mediated sensitivity to aeroallergens and Hymenoptera venoms [12]. In the case of Hymenoptera-venom allergy, the SPT is followed by the performance of intradermal tests [13]. Regarding the respiratory allergy evaluation, the SPT is performed using a panel of standard allergen extracts, including the local major aeroallergens [12]. In the case of venom hypersensitivity, skin tests are performed with the use of locally offending insects. In Europe, Apis melifera, Vespula, Polistes and Dolichovespula venom extracts are widely used [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
