To mix or not to mix in allergy immunotherapy vaccines

Abstract

Purpose of reviewEuropean and US allergists generally do not agree on the approach to subcutaneous allergy immunotherapy in patients with multiple allergies. The North American approach is to treat with a mixture that contains all the allergen extracts to which the patient has evident clinical sensitivity, whereas the European approach is to select for treatment the one or at the most two allergens that are clinically most important for the patient. Recent findingsRecent society guidelines continue to recommend these differing practices of treating the polyallergic patient and reviews of prescribing practices indicate these divergent recommendations are followed in Europe and the USA.

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 .…”