Clinical contraindications to allergen immunotherapy: an EAACI position paper

Abstract

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 b-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.Allergen immunotherapy (AIT) has been used worldwide for over a century and is currently the only causative therapy for the treatment of respiratory allergies (1-3), and Hymenoptera venom allergy (4). Although clinical indications for AIT are specific and widely accepted, clinical contraindications to AIT differ between various guidelines (1, 2, 4, 5).Allergy 70 (2015) 897-909

The relationship between autoimmunity and specific immunotherapy for allergic diseases

“…This method has become a recognized treatment for selected allergic diseases, such as allergic rhinitis and conjunctivitis, bronchial asthma or allergy to Hymenoptera venom, and, more recently, for food allergies and atopic dermatitis. 1 A major advantage of SIT is its ability to modify the natural history of allergic disease, as well as to reduce the frequency of the occurrence of multivalent allergies in an attempt to stop the so-called "allergic march" in children. [2][3] A natural consequence of the widespread use of SIT is a continuous assessment of the short-and long-term safety of this type of therapy, with special observation of its interference with the immune system.…”

“…Due to a lack of available data, the authors propose there is a relative contraindication in autoimmune disorders in remission and absolute contraindications in active forms. 1 A less tolerant position for SIT and autoimmune disease was presented by Zuberbier T et al They suggest that all serious autoimmune diseases (without specifying their nature) are contraindications for SIT. 2 However, Linneberg et al are inclined to the view of Pistosis et al They consider that it seems reasonable to carefully evaluate the indication for SIT, that is, risks versus benefits, in patients with established autoimmune disease or a strong family history of autoimmune disease.…”

Allergen-Specific Immunotherapy in Children: Prospects of Prevention and Treatment

“…Результаты многочисленных исследований исполь-зования АСИТ как у взрослых, так и у детей дают воз-можность ведущим международным сообществам аллергологов и клинических иммунологов [Всемирная организация аллергии (World Allergy Organization, WAO), рабочая группа Американской академии аллергии, аст-мы и иммунологии (American Academy of Allergy Asthma and Immunology, AAAAI), Американская коллегия аллер-гии, астмы и иммунологии (American College of Allergy, Asthma and Immunology, ACAAI), Европейская академия аллергологии и клинической иммунологии (European Academy of Allergy, Asthma and Clinical Immunology, EAACI)] разрабатывать и своевременно пересматривать согла-сительные документы по терминологии, механизмам дозирования, схемам терапии, эффективности, безопас-ности и будущим направлениям развития специфической иммунотерапии [9,10].…”

“…АСИТ -это единственная патогенетическая этио-тропная общедоступная иммуномодулирующая терапия для пациентов, страдающих аллергическими заболева-ниями, обусловленными IgE-опосредованным иммунным воспалением [6][7][8][9][10][11].…”

“…Противопоказания, как абсолютные, так и относи-тельные, на сегодняшний день остаются одним из самых актуальных аспектов данной медицинской технологии: продолжают обсуждаться и формулируются по мере поступления новых доказательных данных с учетом воз-можных рисков развития нежелательных побочных эффектов [9,10].…”