The online version of this article (doi:10.1186/2045-7022-4-36) contains supplementary material, which is available to authorized users.
All authors and participants took part in the study as members of the Spanish Society of Allergology and Clinical Immunology. The study was supported by ALK-Abelló Laboratory, Madrid, Spain.
CV, EE, Mª AG, CM and AIT designed the study. They belong to the steering committee who reviewed the medical literature on the topic and discussed the main items to be included in the structured questionnaire. They selected the remaining 57 allergists who took part in the study. They analysed all results and discussed main conclusions. All authors actively worked on the elaboration of the manuscript. All authors read and approved the final manuscript.
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.
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.
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.
Some criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.
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- Diagnosis and allergen immunotherapy treatment of polysensitised patients with respiratory allergy in Spain: an Allergists’ Consensus
Ana I Tabar
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