Clinical contraindications to allergen immunotherapy: an EAACI position paper.
Clinical indications for allergen immunotherapy (AIT) in respiratory and Hymenoptera venom allergy are well established; however, clinical contraindications to AIT are not always well documented. There are some discrepancies when classifying clinical contraindications for different forms of AIT as 'absolute' or 'relative'. EAACI Task Force on 'Contraindications to AIT' was created to evaluate and review current literature on clinical contraindications, and to update recommendations for both sublingual and subcutaneous AIT for respiratory and venom immunotherapy. An extensive review of the literature was performed on the use of AIT in asthma, autoimmune disorders, malignant neoplasias, cardiovascular diseases, acquired immunodeficiencies and other chronic diseases (including mental disorders), in patients treated with β-blockers, ACE inhibitors or monoamine oxidase inhibitors, in children under 5 years of age, during pregnancy and in patients with poor compliance. Each topic was addressed by the following three questions: (1) Are there any negative effects of AIT on this concomitant condition/disease? (2) Are more frequent or more severe AIT-related side-effects expected? and (3) Is AIT expected to be less efficacious? The evidence, for the evaluation of these clinical conditions as contraindications, was limited, and most of the conclusions were based on case reports. Based on an extended literature research, recommendations for each medical condition assessed are provided. The final decision on the administration of AIT should be based on individual evaluation of any medical condition and a risk/benefit assessment for each patient.
Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
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Pitsios
Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.|UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Universités, Paris, France.
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Demoly
Allergy Unit, Department of Internal Medicine, University Hospital, Ancona, Italy.
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Bilò
Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, The Netherlands.
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Gerth van Wijk
Center for Rhinology and Allergology, Wiesbaden, Germany.|Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Pfaar
Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
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Sturm
Allergy Section, Children's University Hospital "Niño Jesús", Madrid, Spain.
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Rodriguez del Rio
Centre for Respiratory Medicine and Allergy, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Tsoumani
Department of Internal Medicine, Allergy and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
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Gawlik
Allergy Outpatient Clinic, 401 General Military Hospital of Athens, Athens, Greece.
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Paraskevopoulos
Department of Dermatology and Allergology, Ludwig-Maximilians University, Munich, Germany.
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Ruëff
Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland.
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Valovirta
Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.|Center for Pediatrics & Child Health, Institute of Human Development, University of Manchester, Manchester, UK.
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Papadopoulos
Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute and Royal Brompton Hospital NHS, London, UK.
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Calderón
D000286:Administration, Sublingual; D000485:Allergens / Q000187:drug effects / Q000276:immunology*; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000276:immunology; D032921:Consensus; D003888:Desensitization, Immunologic / Q000009:adverse effects* / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy* / Q000276:immunology; D007279:Injections, Subcutaneous; D008297:Male; D061214:Patient Safety; D018570:Risk Assessment; D016896:Treatment Outcome
D000485:Allergens; D018926:Anti-Allergic Agents
allergen immunotherapy; contraindications