Safety Evaluation of a Multiallergen Immunotherapy Treatment in Polyallergic Patients. APOLO Observational Study

Abstract

Aim: Assessment of safety, tolerability and changes in global clinical impression with an multiallergen immunotherapy treatment without dilutional effect in polyallergic patients. Patients & methods: This observational prospective study included patients with allergic rhinitis-rhinoconjunctivitis with or without asthma between 5 and 60 years old receiving immunotherapy treatment with a mixture of two allergenic sources. All adverse events were recorded. Global clinical impression, tolerability subjective assessment and satisfaction were also assessed. Results: 130 patients were analyzed. Nine clinically relevant local adverse reactions were reported in six patients (4.6%). Six systemic reactions (grades 0–I) occurred in four patients (3.1%). Patients improved significantly in their global clinical impression. Good tolerability subjective assessment and satisfaction values were also observed. Conclusion: This multiallergen immunotherapy treatment without dilutional effect can be considered as a potential therapeutic alternative for polyallergic patients suffering from allergic rhinitis.

Adverse events in children and adolescents undergoing allergen immunotherapy for respiratory allergies—Report from the Allergen Immunotherapy Adverse Events Registry (ADER), a European Academy of Allergy and Clinical Immunology taskforce

“…30 Although there was no difference in the rate of AE in our population between those receiving mixtures or single allergen, it is still controversial whether treatment with mixtures can be approximately safe. 35,36 We found no significant differences between natural and allergoid preparations or in regard to different adjuvants, probably reflecting the small number of overall AEs, and possibly, the fact that our population consisted of children and adolescents. The adult population will be analyzed separately in the forthcoming papers.…”

“…Even though more than 50% of the patients were polysensitized, the majority (90%) received single allergen immunotherapy, reflecting the ‘European’ approach to AIT, in contrast to the US approach of prescribing mixtures 30 . Although there was no difference in the rate of AE in our population between those receiving mixtures or single allergen, it is still controversial whether treatment with mixtures can be approximately safe 35,36 …”

“…Among patients with AE, 60% (n = 51) were males, the majority (53%) had allergic rhinitis only and 56.5% (n = 48) were polysensitized. Most were receiving AIT with mites (43.5%) followed by AIT with grass pollen extract in35.3% (n = 30). Atopic dermatitis was present in 9.4% (n = 8) of the cases with AE and none of them had reported a previous history of anaphylaxis.…”

Polysensitisation is associated with more severe symptoms: The reality of patients with allergy

“…Although most patients consulting allergologists are polysensitised, 1 polysensitisation does not necessarily indicate polyallergy which is defined as a causal relationship between exposure to two or more specific sensitising allergens and the subsequent occurrence of clinical symptoms. Although not all positive SPTs in polysensitised patients are associated with clinical symptoms, 3 polysensitisation can affect the clinical disease presentation and is a risk factor for the age‐dependent development of more severe allergic symptoms 4,5 . A better understanding of the sensitisation patterns, along with clinical information and the predictive value of IgE or other biomarkers, may help determine which allergens are relevant for the effective management of the diverse symptoms and individual treatment needs 6–8 .…”

“…development of more severe allergic symptoms. 4,5 A better understanding of the sensitisation patterns, along with clinical information and the predictive value of IgE or other biomarkers, may help determine which allergens are relevant for the effective management of the diverse symptoms and individual treatment needs. [6][7][8] Componentresolved diagnostics (CRD) identifying IgE sensitisation to allergenic molecules/components improves diagnostic accuracy [9][10][11] and can distinguish allergens causing clinically relevant allergic symptoms (genuine sensitisations) from cross-reactive sensitisations, which is particularly important in polysensitised patients.…”