Standard Allergens Research Articles

Food allergen ladders: A need for standardization.

The process of gradually reintroducing food allergens into an individual's diet is referred to as food allergen "ladders". There remain many questions regarding the foods chosen, structure and composition of the ladder, and medical and safety considerations. The COVID-19 pandemic has propelled us into an era where medicine is increasingly practiced via online platforms, highlighting the need for standardized food allergen ladder approaches for successful and safe introduction of food allergens. We performed a search of currently published food allergen ladders and obtained published information and clinical expertise to summarize current knowledge and suggest future standardized approaches for using food allergen ladders. There are currently a limited number of published milk, egg, wheat, and soy ladders. We suggest the following points should be considered when developing food ladders: (1) Food allergen: dose, time, and temperature of heating of the food allergen, simplicity of the ladder and recipes, the possible role of the wheat matrix, and testing for allergenic protein levels to standardize doses; (2) Nutritional factors: health and nutritional value of the foods in the ladder, taste, texture, and cultural appropriateness of foods should be considered; and (3) Medical aspects: consideration of which patients are safe to undergo ladders outside of the clinical setting, other safety aspects and risk factors for severe reactions, number of days suggested per steps, and availability and provision of rescue medication. Written instructions and recipes should be provided to families who wish to use food allergen ladders. Food allergen ladders used for gradual reintroduction of food allergens into a food allergic individual's diet are increasingly being used internationally. Standardization regarding the foods included in the ladder and medical considerations are required to practice patient-centered care, best assist patients and families, and ensure safety.

Allergen Immunotherapy Extract Shortages and Their Effects on Clinical Care: A Work Group Report of the AAAAI Immunotherapy, Allergen Standardization, and Allergy Diagnostics Committee

Allergen immunotherapy (AIT) is the only disease-modifying therapy indicated for treatment of allergic asthma, rhinitis, conjunctivitis, and Hymenoptera hypersensitivity. Manufacturing of the extracts used in AIT involve multistep complex processes as well as regulatory oversight. Furthermore, some source materials are vulnerable to unexpected events of nature. Given these circumstances, allergen extract supply can be disrupted with a potential to adversely impact patient care. A group of members from the American Academy of Allergy, Asthma, and Immunology (AAAAI) Immunotherapy, Allergy Standardization and Allergy Diagnostic Committee formed a workgroup to assess the frequency and effects of allergen extract shortages and associated factors. This workgroup developed a survey that was distributed to a random 20% of the AAAAI membership. In addition, the group also performed a review of the scientific literature on allergen extract supply and shortage. Based on the findings of the survey study and literature review, the workgroup reports frequency and extent of shortages, potential ways to improve communication with suppliers, and need for further guidance in patient care during times of shortage.

The History, Present and Future of Allergen Standardization in the United States and Europe.

The topic of standardization in relation to allergen products has been discussed by allergists, regulators, and manufacturers for a long time. In contrast to synthetic medicinal products, the natural origin of allergen products makes the necessary comparability difficult to achieve. This holds true for both aspects of standardization: Batch-to-batch consistency (or product-specific standardization) and comparability among products from different manufacturers (or cross-product comparability). In this review, we focus on how the United States and the European Union have tackled the topic of allergen product standardization in the past, covering the early joint standardization efforts in the 1970s and 1980s as well as the different paths taken by the two players thereafter until today. So far, these two paths have been based on rather classical immunological methods, including the corresponding benefits like simple feasability. New technologies such as mass spectrometry present an opportunity to redefine the field of allergen standardization in the future.

Venom Immunotherapy: From Proteins to Product to Patient Protection.

In this review, we outline and reflect on the important differences between allergen-specific immunotherapy for inhalant allergies (i.e., aeroallergens) and venom-specific immunotherapy (VIT), with a special focus on Venomil® Bee and Wasp. Venomil® is provided as a freeze-dried extract and a diluent to prepare a solution for injection for the treatment of patients with IgE-mediated allergies to bee and/or wasp venom and for evaluating the degree of sensitivity in a skin test. While the materials that make up the product have not changed, the suppliers of raw materials have changed over the years. Here, we consolidate relevant historical safety and efficacy studies that used products from shared manufacture supply profiles, i.e., products from Bayer or Hollister–Stier. We also consider the characterization and standardization of venom marker allergens, providing insights into manufacturing controls that have produced stable and consistent quality profiles over many years. Quality differences between products and their impacts on treatment outcomes have been a current topic of discussion and further research. Finally, we review the considerations surrounding the choice of depot adjuvant most suitable to augmenting VIT.

The American Contact Dermatitis Society Core Allergen Series

ABSTRACT Allergic contact dermatitis has been increasing in prevalence with the growing complexity of the ingredients in commercial products. The gold standard for the diagnosis of allergic contact dermatitis is patch testing. Patch testing allows for identification of relevant allergens that can then guide treatment with targeted avoidance. Although patch testing initially required clinicians to handpick suspected allergens, the development of a standard allergen panel in 1995 called the Thin-Layer Rapid Epicutaneous Test transformed the way patch testing is performed. In recent years, more comprehensive series have been developed, including the American Contact Dermatitis Society (ACDS) Core Allergen Series, which tests for 80 allergens rather than 36 allergens. The benefits of using the ACDS Series include (a) a greater likelihood of detecting relevant allergen(s), (b) a decreased need for repeat testing and subsequently fewer clinic appointments and less patient travel, and (c) an ability to update and modify the series of allergens based on consumer trends and patient data. Important/relevant allergens found in the ACDS Series but not the Thin-Layer Rapid Epicutaneous Test include many preservatives, adhesives, fragrances, and propylene glycol. We propose that patch testing with extended series of allergens be considered for first-line use when evaluating patients with suspected allergic contact dermatitis.

Trend in the variation of sensitization of the European standard battery allergens over 26 years

<p class="abstract"><strong>Background:</strong> Epidemiological monitoring of sensitization rates to common allergens and identification of emerging allergens are needed to assess preventive measures. The aim of this study was to assess trends in the frequencies of sensitization to the different allergens in the European standard battery over a 26 year period from 1989 to 2015.</p><p class="abstract"><strong>Methods:</strong> It’s a descriptive study of the trend of sensitization to BSE allergens over a period of 26 years, at the dermato-allergology unit of occupational medicine department of Farhat Hached university hospital-Sousse (Tunisia), based on the results of patch tests of all patients who consulted the unit between 1989 and 2015.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the study period, 1716 patients were patch tested, 48048 patch tests were performed with 886 positive tests to at least one allergen (51.6%). Between 1989 and 2015, the number of positive patch tests has shown a significantly positive trend with an annual percentage change (APC) of 10.03% (p<10<sup>-3</sup>). However, the overall frequency of sensitization to BSE allergens decreased with an APC of -0.87%, p=0.2. The APC of chromium sensitization was -2.57% (p<10<sup>-3</sup>). The frequency of cobalt sensitization showed a non-significant decrease (APC=-0.28%, p=0.9). The frequency of nickel sensitization increased with an APC of +2.7%, p=0.1). Overall, there was a statistically significant growth between 1989 and 2015 in the BSE preservatives sensitization trend with an APC of +5.54% per year (p<10<sup>-3</sup>). The frequency of sensitization to mix fragrances increased from 2004 to 2015, with a significantly positive trend (APC=+24.33%, p<10<sup>-3</sup>).</p><p class="abstract"><strong>Conclusions:</strong> Although the frequency of some BSE allergens sensitization tends to decrease, it remains high. Consistent preventive measures should be focused, mainly on sensitization to perfumes and preservatives used in the cosmetic industry.</p>

Allergic rhinitis in Samara: clinical and allergological aspects

The aim of the study was to study the dynamics of clinical and allergic characteristics of patients with allergic rhinitis (AR) in Samara over the past 5 years. Clinical and allergological examination was performed in 1526 patients from 2012 to 2018. For skin prick testing, 16 names of standard allergens were used. In 2018, the most common forms of AR were seasonal – 40.7 % and combined (seasonal and perennial) forms of AR – 39.8 %. Over the past 5 years, there has been a 1.5-fold increase in seasonal forms of AR (pollinosis). The structure of sensitization revealed an increase in pollen allergy from 39.2 % to 50.6 %, and a decrease in the level of hypersensitivity to epidermal allergens from 29.9 % to 14.5 %. Sensitization to weeds remains dominant in patients with pollinosis and ranges from 82.8 % to 75.2 % in 2012 and 2018, respectively. The predominance of polysensitization to different groups of allergens over monosensitization remains: 55.8 % and 44.2 %, respectively.

Associated positive patch test reactions to standard contact allergens: 10-year data from the Slovenian E-Surveillance System.

A considerable share of patients tested with a baseline patch test series respond with a positive reaction to more than one allergen, and some associations between synchronous positive reactions to distinct baseline patch allergens have been described in the literature. To evaluate the prevalence of sensitization to haptens of the European baseline series as well as the prevalence of oligosensitization and polysensitization and the most significant associated positive patch test reactions in Slovenia. Patch testing data collected by the Slovenian E-Surveillance System from January 2008 to December 2017 were retrospectively analysed. Of a total of 15 171 patients analysed, 39.29% showed at least one positive reaction. The highest prevalences were noted for metals (nickel[II]sulfate hexahydrate: 16.33%) and fragrances (fragrance mix I: 6.70%). The correlation analysis showed the strongest correlation between mercapto mix and 2-mercaptobenzothiazole (61.2%), fragrance Mix II and hydroxyisohexyl 3-cyclohexene carboxaldehyde (50.5%), and potassium dichromate and cobalt(II) chloride hexahydrate (33.3%). Sensitization prevalences to the most common haptens were described, and their strongest correlations on a national level quantified. A comparison with other European results confirms already known associations between allergens in terms of cross-reactivity.

Targeted micronutrition via holo-BLG based on the farm effect in house dust mite allergic rhinoconjunctivitis patients – first evaluation in a standardized allergen exposure chamber

Abstract Purpose Evaluation of a lozenge for targeted micronutrition (holo-BLG), a new invention based on the farm effect, in house dust mite (HDM) allergic rhinoconjunctivitis (ARC) patients in a standardized allergen exposure chamber (AEC). Methods Eligible HDM allergic patients were exposed to HDM raw material in an AEC for 120 min before (V1) and after (V3) 3 months of holo-BLG supplementation. Nasal, conjunctival, bronchial and other symptoms were rated by the patients every 10 min and, wellbeing, peak nasal inspiratory flow (PNIF), and lung function parameters every 30 min. Primary endpoint was the change in median Total Nasal Symptom Score (TNSS) at V3 compared to V1 at 120 min of exposure. Secondary endpoints consisted of the exploratory analysis of the temporal evolution of symptom scores using linear mixed effects models. Results A total of 32 patients were included in the analysis. A significant improvement of 60% (p = 0.0034) in the primary endpoint TNSS (V1 2.5 [interquartile range, IQR 1–4], V3 1.0 [IQR 1–3]) was observed. 40% improvement was seen for the Total Symptom Score (V1 5.0 [IQR 3–9], V3 3.0 [IQR 2–4]; [Wilcoxon test: confidence interval 1.5–4.0, p < 0.0003]). The analysis of the temporal evolution of all symptom scores and the personal wellbeing revealed clinically meaningful improvement over time, manifested in a lower symptom increase during the final HDM exposure. No relevant differences were observed for PNIF and lung function parameters. Safety and tolerability were rated as excellent. Conclusions The effect of holo-BLG resulting in immune resilience might help to fight the allergy epidemic on a new front based on targeted micronutrition of immune cells. Trial registration The study was retrospectively registered at clinicaltrials.gov (NCT04477382).

Subcutaneous Allergen-Specific Immunotherapy Is Safe in Pediatric Patients with Allergic Rhinitis

Introduction: Subcutaneous allergen-specific immunotherapy (SCIT) is one of the main cornerstones in the treatment of allergic rhinitis in pediatric patients. It has demonstrated symptoms and quality of life improvement, but it is not exempt from adverse reactions (ADVrs). Nevertheless, there are a few reports that have evaluated their safety. Our objective was to evaluate the ADVr to SCIT in pediatric patients. Methods: We reviewed 786 clinical records with SCIT from 2005 to 2018, comparing the clinical characteristics of patients with ADVrs with SCIT versus a group of a similar number of patients who completed SCIT (control group, CG). The analysis of ADVrs was according to the World Allergy Organization (WAO) 2010 grading system by frequency analysis, survival curve, and log rank. Results: Of 786 patients, 106 (13.4%) presented ADVrs, and the patients with ADVr had sensitivity and immunotherapy with at least 2 allergens versus CG p < 0.001, containing a combination of standardized and nonstandardized allergens (p = 0.003). The ADVrs were in the buildup phase (p < 0.001). The survival curve showed that 50% had some reaction at 12 weeks of SCIT. The most frequent ADVr was grade 1 in 73/106 patients (68.8%) and grade 2 in 33/106 (31.1%). The log-rank analysis between the grades of the WAO grading system showed a statistically significant difference (p = 0.02). Conclusions: The SCIT is safe in pediatric patients. The ADVrs are infrequent, grade 1 being the most reported; however, at >12 weeks, the risk of ADVrs that involve 2 organs systems increases.

Clinical evaluation of rush immunotherapy using house dust mite allergen in Japanese asthmatics.

BackgroundAllergen immunotherapy (AIT) is a specific treatment of administering clinically important allergens to patients who have allergic diseases. In Japan, the standardized house dust mite (HDM) allergen for subcutaneous immunotherapy (SCIT) was approved in 2015, and we then introduced rush-immunotherapy (rush-IT) using the standardized HDM allergen for HDM-sensitive asthmatics. However, little data are available on the safety and effectiveness of rush-HDM-IT, especially for Japanese asthmatics.ObjectiveThe objective of this study was to examine the safety and clinical effectiveness of rush-IT using the standardized HDM for HDM-sensitive Japanese asthmatics.MethodsThirteen HDM-sensitive asthmatics who received rush-HDM-IT and 12 HDM-sensitive asthmatic controls were enrolled. To evaluate the safety, the number of systemic reaction (SR) events, including anaphylaxis, was assessed. To evaluate the effectiveness, changes in the treatment step, dose of inhaled corticosteroid, and asthma control after rush-HDM-IT and the subsequent maintenance SCIT were assessed. Changes in the HDM-induced production of type 2 cytokines from peripheral blood mononuclear cells were also evaluated.ResultsAmong the 12 patients who received rush-IT, 4 (30.7%) experienced a SR and 3 (23.1%) experienced anaphylaxis. However, the anaphylaxis was not severe (grade 3) in all cases, and they recovered in a short time. The treatment step of asthma was better and the dose of inhaled corticosteroid was lower in the rush-HDM-IT group than in the control group. The HDM-induced production of both interleukin (IL)-5 and IL-13 from peripheral blood mononuclear cells was significantly lower in the rush-HDM-IT group than in the control group.ConclusionRush-HDM-IT can be performed relatively safely in Japanese asthmatics. Furthermore, rush-HDM-IT and the subsequent maintenance SCIT provided clinical improvement in asthma patients, and was accompanied by the suppression of HDM-specific Th2-mediated systemic immune responses.

Evaluation of skin prick test reactivity in children with allergic diseases: A cross sectional study

Allergic diseases are developed through complex interaction between exposure to environmental substances and genetic susceptibility. The prevalence of allergic diseases has increased during last decade globally. The present cross sectional study was designed to evaluate the skin prick test reactivity in children with allergic diseases. A total of 400 children between age group 1-12 years were recruited. The Skin prick tests (SPT) using 14 standardized allergen extracts were conducted in the volar surface of forearm. Majority children had asthma (52.5%), followed by atopic dermatitis (22.75%) and allergic rhinitis (15.75%). Food habits triggering allergic conditions in 76% children, environmental factors in 4.75% children, pets in 8.25% and indoor conditions in 11% children. Skin prick test was positive to egg (13.5%), milk (22%), wheat (9.75%), apple (4.5%), cereals (6.5%), cat (18%), dog (6%), blatella (9.5%), aspergillus fumigatus (9.5%), fungi (12.75%), Dermatophytes farina (24.75%), Dermatophytes pteromyssinus (23.75%), Blomia tropicalis (9.5%) and Bermuda grass (13.75%). Determination of allergen sensitization patterns in children with atopic disease is crucial for selecting proper preventive and therapeutic strategies which helps to improve quality of life of in children.

Seasonal Variation in Patch Test Results with European Baseline Series.

Aim To study the influence of season on patch tests results. Methods We conducted a retrospective epidemiological study which concerned all the patients of the Tunisian center, who consulted in the Dermato-Allergology Unit of Occupational Medicine Department of Farhat Hached University Hospital-Sousse (Tunisia) over a period of 07 years. All the patients were tested by the European Standard Battery allergens (BSE). Results The data of 1000 patch tests were analyzed during the study period. More than half of the patch tests (58.6%) was positive. In winter, 63% of patch tests showed a positive reaction versus 52% of patch tests in summer without a statistically significant association. However, results of lanolin alcohols, epoxy resin, and Sesquiterpene lactone mix varied significantly with season. Atopy was significantly associated with 18.8% of positive reactions in winter and only with 5.2% of positive reactions in summer (p = 0.015). Conclusion Seasonal variations in patch tests results were more significant with some allergens of European Standard Battery and in atopic patients.

Changes in Chinese patch testing practices over 13 years: Updated cross-sectional survey and possible international implications.

Patch testing, the standard method for diagnosing allergic contact dermatitis, has been utilized for over 30 years in China. A 2006 survey found that patch testing was widespread among Chinese dermatologists, but the practice and perceptions were unsatisfactory. To evaluate the current situation of patch testing practice and perception, we resurveyed Chinese dermatologists. A cross-sectional survey of Chinese dermatologists was conducted by electronic questionnaires at the 15th National Congress of Dermatology in November 2019. There were 2199 valid questionnaires collected. About 75% of dermatologists performed patch testing; the majority (59.2%) utilized the baseline (standard) allergen series made in China; others used TRUE Test or the Chemotechnique Diagnostics series, a greater share compared with 2006. Most (92.8%) performed only one single reading, more than 2006. About two-thirds offered patient education after patch testing, but only 27% were executed by trained dermatologists. Dermatologists from regional hospitals more likely performed patch testing and had better perception of patch testing. The majority (88.1%) had received patch testing training, which however did not significantly improve dermatologists' perception. There was an insignificant improvement in practice and perception of dermatologists compared with 2006. Further education and studies should be conducted. Similar surveys in other countries would be of interest.

Fluorescence-based quantitative platform for ultrasensitive food allergen detection: From immunoassays to DNA sensors.

Food allergies are global health issue with an increasing prevalence that affect food safety; hence, food allergen detection, labeling, and management are considered to be important priorities in the food industry. In this critical review, we provide a comprehensive overview of several fluorescence-based platforms based on different biorecognition ligands, such as antibodies, DNA, aptamers, and cells, for food allergen quantification. Traditional analytical methods are generally unsuitable for food manufacturers to accomplish the real-time identification of food allergens in food products. Therefore, it is important to develop simple, rapid, inexpensive, accurate, and sensitive methods to improve user accessibility. A fluorescence-based quantitative platform provides an excellent detection platform for food allergens because of its high sensitivity. This review summarizes the traditional antibody-based fluorescent techniques for food allergen detection, such as the time-resolved fluoroimmunoassay , immunofluorescence imaging, fluorescence enzyme-linked immune sorbent assay, flow injection fluoroimmunoassay, and fluorescence immunosensors. However, these methods suffer from disadvantages such as the significant rate of false-positive and false-negative results due to antibody cross-reactivity with nontarget food components in the complex food matrix and epitope degradation during food processing. Hence, different types of fluorescence-based immunoassays are suitable for standardization and quantification of allergens in fresh foods. In addition, we summarize new fluorescence-based quantitative platforms, including fluorescence genosensors, fluorescence cell sensors, and fluorescence aptamer sensors. With the advantages of high sensitivity and simple operation, fluorescence biosensors will have great potential in the future and could provide portable methods for multiallergen real-time detection in complex food systems.

Sensitization to inhalation allergens in patients with psoriasis and atopic dermatitis

Psoriasis is an autoimmune chronic inflammatory disease that affects various body organs and systems, mainly targeting the skin. In recent years, an association of autoimmune diseases with atopy has been actively debated. The published data aimed at examining relationship between atopy and psoriasis are very scarce and highly contradictory that account for importance of our study. Generation of transcutaneous sensitization due to potential invasion of allergens across impaired epidermal barrier in psoriasis is of special interest. We aimed at investigating a range of sensitization to pollen, fungal and indoor allergens in patients with psoriasis and atopic dermatitis and comparatively analyze our data. There were enrolled patients with psoriasis vulgaris (group 1, n = 27) aged 18 to 67 years (mean age 41.0±3.1 years). The comparison group consisted of patients with atopic dermatitis (group 2, n = 41) aged 18 to 57 (mean age 28.0±1.5 years). Allergen-specific examination was carried out (collection of allergic history, determining sensitization). Skin prick testing was performed by using standardized allergens (Allergopharma, Germany). Statistical data were analyzed by using the Statistica 6.0 software package. While conducting a comparative analysis regarding a range of sensitization to pollen allergens, it was found that sensitization to tree and weed pollen in patients with atopic dermatitis vs psoriasis was observed at significantly higher rate. Sensitization to indoor allergens in patients with atopic dermatitis vs psoriasis tended to increase. More than half of patients with psoriasis revealed sensitization to pollen derived from meadows, weeds, grasses and trees. Sensitization to Candida albicans tended to rise in patients with psoriasis vs atopic dermatitis. Moreover, we found that patients with psoriasis exerted much higher sensitization to Candida albicans, Cladosporium herbarum and indoor allergens was revealed. Hence, presence of damaged epidermal barrier in psoriasis likely contributes to increased invasion of inhalation allergens and formation of percutaneous sensitization. Therefore, further investigation of features related to the range of sensitization to various allergen groups in psoriasis seems promising and may lead to discovery of new therapeutic targets.

Prevalence of Contact Allergens in Best-Selling Ophthalmic Products.

Ophthalmic products are a common but often overlooked contributor to allergic contact dermatitis. Frequency of allergenic ingredients in over-the-counter ophthalmic products has not been well characterized. The purpose of this study was to determine the prevalence of allergenic ingredients in most commonly bought eye lubricants and contact lens solutions. A product list of Amazon.com's best-selling ophthalmic products was curated by searching for "Best Sellers in Eye Drops, Lubricants & Washes" and "Best Sellers in Contact Lens Care Products." For exploratory analysis, indication, price, consumer ratings, number of reviews, and US Food and Drug Administration approval status were recorded. The products' ingredients were compiled using NLM DailyMed, and products that had 1 or more allergens or relevant cross-reactors on either the 2018 American Contact Dermatitis Society Core Allergen Series or the 2015-2016 North American Contact Dermatitis Group Standard Allergen Series were noted. Forty-eight percent (n = 49) of the total products, (57.8% [n = 37] of eye lubricants, and 31.6% [n = 12] of contact lens solutions) had 1 or more allergens or associated cross-reactors. Identified allergens were benzalkonium chloride, propylene glycol, sorbic acid, amidoamine, sorbitan sesquioleate, chlorhexidine digluconate, lanolin alcohol, parabens, benzyl alcohol, and butylated hydroxytoluene. Awareness of potential allergens is crucial to diagnosing allergic contact dermatitis to ophthalmic products and helping patients navigate online pharmacological chaos.

Gaps in allergen immunotherapy administration and subcutaneous allergen immunotherapy dose adjustment schedules: Need for prospective data

Gaps in allergen immunotherapy administration and subcutaneous allergen immunotherapy dose adjustment schedules: Need for prospective data

Allergen-specific Immunotherapy for Inhalant Allergens in Children.

Allergen-specific immunotherapy (AIT) for aeroallergens consists of the administration of standardized allergen extracts to patients with respiratory IgE-mediated diseases to the same allergen in order to achieve immune tolerance to the allergen and prevent the onset of symptoms. AIT is usually delivered by sublingual (SLIT), subcutaneous (SCIT) route. AIT with one or multiple allergens currently represents the only causal treatment able to change the natural history of allergic airway diseases. Significant progresses have been made in terms of AIT efficacy and safety. In this paper, mechanisms of action, indication and side effects of allergen immunotherapy are reviewed. SLIT and SCIT have been found to be effective in the treatment of asthma and rhinoconjunctivitis due to inhalant allergens. The route of AIT administration should be selected on availability, cost (dependent from the local health system), tolerability (better for SLIT), patient's preference (injections are less accepted in young children), and adherence (higher for SCIT beyond pediatric age). However, it should be taken into account that metanalyses on AIT do not consider that effectiveness and safety depend upon the product chosen for treatment. Each product should be separately assessed to avoid generalization on administration routes or age group that may affect the decision.

Coronavirus disease 2019 and allergen immunotherapy: Theoretical benefits invite to adjustments in practice recommendations

Coronavirus disease 2019 and allergen immunotherapy: Theoretical benefits invite to adjustments in practice recommendations