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Contraindications to immunotherapy: a global approach.

C Pitsios1, M Tsoumani2, M B Bilò3

  • 11Medical School, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus.

Clinical and Translational Allergy
|September 19, 2019
PubMed
Summary
This summary is machine-generated.

Allergen immunotherapy (AIT) contraindications vary significantly across guidelines, with common exclusions including pregnancy and beta-blocker use. Future evidence may allow AIT for patients on ACE inhibitors and beta-blockers, and those with comorbidities.

Keywords:
ACE-inhibitorAllergen immunotherapyAsthmaAutoimmunityBeta-blockerContraindicationsMalignancyPregnancyVenom hypersensitivity

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Area of Science:

  • Allergy and Immunology
  • Clinical Practice Guidelines

Background:

  • Current allergen immunotherapy (AIT) contraindications lack robust evidence, relying on expert opinion and case reports.
  • National and international societies have developed independent AIT contraindication recommendations.
  • Limited evidence-based information exists for AIT contraindications.

Purpose of the Study:

  • To review existing guidelines on contraindications to AIT.
  • To identify and highlight discrepancies among AIT contraindication guidelines.
  • To inform future evidence-based AIT practice.

Main Methods:

  • Comprehensive literature review on AIT contraindications for respiratory allergy and venom hypersensitivity.
  • Inquiry to World Allergy Organization and EAACI registered societies for additional information.
  • Inclusion of only AIT guidelines published under official auspices.

Main Results:

  • Significant heterogeneity observed in AIT contraindication recommendations across guidelines.
  • Common contraindications identified: lack of adherence, pre-AIT pregnancy, beta-blocker use, specific age groups, uncontrolled asthma, autoimmune diseases, and malignancies.
  • Varied recommendations exist regarding patient populations like the elderly and those with comorbidities.

Conclusions:

  • Revisions to AIT contraindication guidelines are anticipated with emerging data.
  • Potential future AIT eligibility for patients on ACE inhibitors, beta-blockers, elderly patients, and those with stable autoimmune diseases/neoplasias.
  • Development of globally accepted guidelines is needed to aid allergologists in AIT decision-making.