title: Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement.
abstract: One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation. Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures. Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended. This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.
authors: Department of Immunology, Rheumatology & Allergy, Medical University of Lodz, 251 Pomorska Str, 92-213 Lodz, Poland.
authors: Marek L
authors: ML
authors: Kowalski
authors: Department of Allergy and Immunology, Hospital Quiron Bizkaia, Bilbao, Spain.
authors: Ignacio
authors: I
authors: Ansotegui
authors: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors: Werner
authors: W
authors: Aberer
authors: Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
authors: Mona
authors: M
authors: Al-Ahmad
authors: Swiss institute of Allergy & Asthma research, Davos, Switzerland.
authors: Mubeccel
authors: M
authors: Akdis
authors: Allergy Unit, Dermatology Clinic, University Hospital Zürich, University Zürich, Zürich, Switzerland.
authors: Barbara K
authors: BK
authors: Ballmer-Weber
authors: Kirsten Beyer, Charité Universitätsmedizin Berlin, Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Berlin, Germany.
authors: Kirsten
authors: K
authors: Beyer
authors: Hospital Reg. Univ. Carlos Haya, Allergy Serv, Malaga, Spain.
authors: Miguel
authors: M
authors: Blanca
authors: Royal Perth Hospital, Department of Emergency Medicine, Perth, WA Australia.
authors: Simon
authors: S
authors: Brown
authors: Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Chaweewan
authors: C
authors: Bunnag
authors: Allergology Unit, Hospital San Juan de Dios, Caracas, Venezuela.
authors: Arnaldo Capriles
authors: AC
authors: Hulett
authors: Brigham & Women's Hospital, Harvard Medical School, Boston, MA USA.
authors: Mariana
authors: M
authors: Castells
authors: Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore.
authors: Hiok Hee
authors: HH
authors: Chng
authors: Hôpitaux Universitaires de Strasbourg, Chest Diseases Department, Strasbourg, France.
authors: Frederic
authors: F
authors: De Blay
authors: Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan.
authors: Motohiro
authors: M
authors: Ebisawa
authors: Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, Georgia.
authors: Stanley
authors: S
authors: Fineman
authors: Johns Hopkins University, Baltimore, MD USA.
authors: David B K
authors: DB
authors: Golden
authors: Helsinki University Central Hospital, Helsinki, Finland.
authors: Tari
authors: T
authors: Haahtela
authors: Institute for Asthma & Allergy, Bethesda, MD USA.
authors: Michael
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authors: Kaliner
authors: Westmead Medical Centre, Westmead, NSW Australia.
authors: Connie
authors: C
authors: Katelaris
authors: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Bee Wah
authors: BW
authors: Lee
authors: CSK, Department of Allergy & Clinical Immunology, Lodz, Poland.
authors: Joanna
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authors: Makowska
authors: Spitalnetz, Bern, Switzerland.
authors: Ulrich
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authors: Muller
authors: Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, and CIBERES, Barcelona, Spain.
authors: Joaquim
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authors: Mullol
authors: UMDNJ - Rutgers Medical School, c/o Pulmonary and Allergy Associates, Summit, New Jersey, USA.
authors: John
authors: J
authors: Oppenheimer
authors: Department of Internal Medicine, Ajou University School of Medicine, Suwon, South Korea.
authors: Hae-Sim
authors: HS
authors: Park
authors: University of South Florida, Tampa, FL USA.
authors: James
authors: J
authors: Parkerson
authors: Allergy and Respiratory Diseases, IRCCS San Martino Hospital IST, University of Genoa, Genoa, Italy.
authors: Giovanni
authors: G
authors: Passalacqua
authors: Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
authors: Ruby
authors: R
authors: Pawankar
authors: Universitatsklinikum GI & MR GmbH, Institut fur Laboratoriumsmedizin & Path, Standort Marburg, Marburg, Germany.
authors: Harald
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authors: Renz
authors: Klinikum der Ludwig-Maximilians-Universitat, Klinik & Poliklinik fur Dermatologie & Allergologie, Munchen, Germany.
authors: Franziska
authors: F
authors: Rueff
authors: Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidadad, Caracas, Venezuela.
authors: Mario
authors: M
authors: Sanchez-Borges
authors: Allergy Department, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Institute Carlos III, Madrid, Spain.
authors: Joaquin
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authors: Sastre
authors: RNTNE Hospital, London, UK.
authors: Glenis
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authors: Scadding
authors: Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA.
authors: Scott
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authors: Sicherer
authors: Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Pongsakorn
authors: P
authors: Tantilipikorn
authors: University of Nebraska, Omaha, NE USA.
authors: James
authors: J
authors: Tracy
authors: Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany.
authors: Vera
authors: V
authors: van Kempen
authors: Division of Experimental Allergology, Department of Pathophysiology, Allergy Research Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria.
authors: Barbara
authors: B
authors: Bohle
authors: Allergy & Respiratory Disease Clinic, DIMI - Department Int Med, University of Genoa, IRCCS AOU, San Martino - IST, Genoa, Italy.
authors: G Walter
authors: GW
authors: Canonica
authors: Immunology Department, Universidad De Cartagena, Cartagena, Colombia.
authors: Luis
authors: L
authors: Caraballo
authors: Hospital San Bernardo, Salta, Argentina.
authors: Maximiliano
authors: M
authors: Gomez
authors: Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan.
authors: Komei
authors: K
authors: Ito
authors: Messerli Research Institute, Medical University Vienna, University Vienna, Vienna, Austria.
authors: Erika
authors: E
authors: Jensen-Jarolim
authors: Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada.
authors: Mark
authors: M
authors: Larche
authors: Istituto Giannina Gaslini, Genoa, Italy.
authors: Giovanni
authors: G
authors: Melioli
authors: Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark.
authors: Lars K
authors: LK
authors: Poulsen
authors: Department of Pathophysiology, AKH, Wien, Austria.
authors: Rudolf
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authors: Valenta
authors: Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany.
authors: Torsten
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authors: Zuberbier