title: Diagnosis and allergen immunotherapy treatment of polysensitised patients with respiratory allergy in Spain: an Allergists' Consensus.
abstract: BACKGROUND
  Polysensitisation 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.
  
  
  METHODS
  Sixty-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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Some criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.
authors.affiliation: Allergy Departments of Complejo Hospitalario Universitario de Santiago, Rúa Ramón Baltar s/n, Santiago de Compostela, 15706 Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vidal
authors.affiliation: Allergy Departments of Hospital de Sagunto, Valencia, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Enrique
authors.affiliation: Allergy Departments of Hospital Universitario Infanta Cristina, Badajoz, Spain.
authors.forename: Angeles
authors.initials: A
authors.lastname: Gonzalo
authors.affiliation: Allergy Departments of Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Moreno
authors.affiliation: Allergy Departments of Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tabar
keywords: Allergen immunotherapy; Consensus; Delphi method; Diagnosis; Polysensitisation; Respiratory allergy