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Diagnosis and allergen immunotherapy treatment of polysensitised patients with respiratory allergy in Spain: an Allergists' Consensus.

Vidal C, Enrique E, Gonzalo A, Moreno C, Tabar AI, Expert Clinical Participan - Clin Transl Allergy (2014)

Bottom Line: Selection of the best allergen immunotherapy (AIT) is difficult in polysensitised patients.A detailed medical history (clinical symptoms and medication) together with a profound knowledge of allergens present in the patient's environment are essential for diagnosis.Some criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.

View Article: PubMed Central - PubMed

Affiliation: Allergy Departments of Complejo Hospitalario Universitario de Santiago, Rúa Ramón Baltar s/n, Santiago de Compostela, 15706 Spain.

ABSTRACT

Background: Polysensitisation is common in patients with respiratory allergy in Spain. Selection of the best allergen immunotherapy (AIT) is difficult in polysensitised patients. The present study was designed to help allergists better identify relevant allergens in these patients and to improve the selection of AIT in Spain.

Methods: Sixty-two Spanish allergists answered a survey containing 88 items divided into four groups: 1) general approach to polysensitised subjects; 2) sensitisation profile involving mite, animal dander and moulds; 3) grass and olive pollen co-sensitisation, and 4) other pollen polysensitisation profile (weed and tree pollen). The Delphi method was used.

Results: A consensus was achieved for 83% of items (92%, 81%, 83% and 73% of the four groups analysed, respectively). Only polysensitised patients with clinical relevance should be considered polyallergic. A detailed medical history (clinical symptoms and medication) together with a profound knowledge of allergens present in the patient's environment are essential for diagnosis. Skin prick tests (SPTs) are not adequate to decide the clinical relevance of each allergen. Serum specific IgE against allergen sources adds value to SPT but molecular diagnosis, when possible, is strongly recommended, especially in pollen-allergic patients. Specific allergen challenge tests are difficult to perform and not recommended for daily practice. Regarding AIT composition, up to three allergens can be used in the same vaccine, but only related allergens may be mixed. In some cases more than one vaccine may be needed.

Conclusion: Some criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.

No MeSH data available.


Related in: MedlinePlus

Valuation scale of professional criteria or clinical recommendations proposed to be judged. 1–3: I disagree with the assertion (a lower score indicates greater level of disagreement); 4–6: Neither agree nor disagree with the assertion; I do not have fully defined criteria about the question (choose 4 or 6 if closer to disagreement or to agreement, respectively); 7–9: I agree with the assertion (a greater score indicates greater level of agreement).
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Fig2: Valuation scale of professional criteria or clinical recommendations proposed to be judged. 1–3: I disagree with the assertion (a lower score indicates greater level of disagreement); 4–6: Neither agree nor disagree with the assertion; I do not have fully defined criteria about the question (choose 4 or 6 if closer to disagreement or to agreement, respectively); 7–9: I agree with the assertion (a greater score indicates greater level of agreement).

Mentions: Once the second round was finished, the results were analysed. The median position of scores and the “level of agreement or disagreement” [16] achieved was measured according to the following criteria: an item is considered to have consensus when no more than a third of the scores are found outside of the region of three points (1–3),(4–6),(7–9) where the median is located. In this case, the value of the median score determines the group consensus reached: “agreement” majority with medians ≥7; “disagreement” majority with medians ≤3; “no consensus” items with medians in the region 4–6 and when the scores of a third or more of the participants are in the region 1–3, and another third or more in the region 7–9. Also considered for reassessment were the items where a high dispersion of opinions (interquartile-range ≥ 4points) (Figure 2) was observed.Figure 2


Diagnosis and allergen immunotherapy treatment of polysensitised patients with respiratory allergy in Spain: an Allergists' Consensus.

Vidal C, Enrique E, Gonzalo A, Moreno C, Tabar AI, Expert Clinical Participan - Clin Transl Allergy (2014)

Valuation scale of professional criteria or clinical recommendations proposed to be judged. 1–3: I disagree with the assertion (a lower score indicates greater level of disagreement); 4–6: Neither agree nor disagree with the assertion; I do not have fully defined criteria about the question (choose 4 or 6 if closer to disagreement or to agreement, respectively); 7–9: I agree with the assertion (a greater score indicates greater level of agreement).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4334589&req=5

Fig2: Valuation scale of professional criteria or clinical recommendations proposed to be judged. 1–3: I disagree with the assertion (a lower score indicates greater level of disagreement); 4–6: Neither agree nor disagree with the assertion; I do not have fully defined criteria about the question (choose 4 or 6 if closer to disagreement or to agreement, respectively); 7–9: I agree with the assertion (a greater score indicates greater level of agreement).
Mentions: Once the second round was finished, the results were analysed. The median position of scores and the “level of agreement or disagreement” [16] achieved was measured according to the following criteria: an item is considered to have consensus when no more than a third of the scores are found outside of the region of three points (1–3),(4–6),(7–9) where the median is located. In this case, the value of the median score determines the group consensus reached: “agreement” majority with medians ≥7; “disagreement” majority with medians ≤3; “no consensus” items with medians in the region 4–6 and when the scores of a third or more of the participants are in the region 1–3, and another third or more in the region 7–9. Also considered for reassessment were the items where a high dispersion of opinions (interquartile-range ≥ 4points) (Figure 2) was observed.Figure 2

Bottom Line: Selection of the best allergen immunotherapy (AIT) is difficult in polysensitised patients.A detailed medical history (clinical symptoms and medication) together with a profound knowledge of allergens present in the patient's environment are essential for diagnosis.Some criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.

View Article: PubMed Central - PubMed

Affiliation: Allergy Departments of Complejo Hospitalario Universitario de Santiago, Rúa Ramón Baltar s/n, Santiago de Compostela, 15706 Spain.

ABSTRACT

Background: Polysensitisation is common in patients with respiratory allergy in Spain. Selection of the best allergen immunotherapy (AIT) is difficult in polysensitised patients. The present study was designed to help allergists better identify relevant allergens in these patients and to improve the selection of AIT in Spain.

Methods: Sixty-two Spanish allergists answered a survey containing 88 items divided into four groups: 1) general approach to polysensitised subjects; 2) sensitisation profile involving mite, animal dander and moulds; 3) grass and olive pollen co-sensitisation, and 4) other pollen polysensitisation profile (weed and tree pollen). The Delphi method was used.

Results: A consensus was achieved for 83% of items (92%, 81%, 83% and 73% of the four groups analysed, respectively). Only polysensitised patients with clinical relevance should be considered polyallergic. A detailed medical history (clinical symptoms and medication) together with a profound knowledge of allergens present in the patient's environment are essential for diagnosis. Skin prick tests (SPTs) are not adequate to decide the clinical relevance of each allergen. Serum specific IgE against allergen sources adds value to SPT but molecular diagnosis, when possible, is strongly recommended, especially in pollen-allergic patients. Specific allergen challenge tests are difficult to perform and not recommended for daily practice. Regarding AIT composition, up to three allergens can be used in the same vaccine, but only related allergens may be mixed. In some cases more than one vaccine may be needed.

Conclusion: Some criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.

No MeSH data available.


Related in: MedlinePlus