Contraindications to immunotherapy: a global approach.

BACKGROUND: Recommendations on contraindications to allergen immunotherapy (AIT) have been independently developed by National and International Societies/Academies. AIT contraindications are mainly based on case reports, case-series, or experts' opinion, while evidence-based information is limited. The aim of the present review was to describe existing guidelines on contraindications to AIT and to highlight differences between them. MAIN BODY: An extended review of the literature regarding contraindications to AIT for respiratory allergy and venom hypersensitivity was performed. Furthermore, Societies and Academies registered in the World Allergy Organization and EAACI databases, were asked for additional information. Only AIT guidelines published under official auspicies were included. A large heterogeneity among the various recommendations on contraindications was registered. Common contraindications to most of the guidelines were: lack of adherence, pregnancy before the start of AIT, the use of beta-blockers, certain age groups, uncontrolled asthma, autoimmune diseases and malignancies. CONCLUSION: As new data arise, revisions might soon be needed allowing AIT in the cases of patients treated with ACE inhibitors and beta-blockers, in elderly patients and in patients with concomitant autoimmune diseases and neoplasias in remission. The decision to prescribe AIT is always tailor-made, balancing risk vs benefit. Creating globally accepted guidelines would help Allergologists in their decision making.

Clinical contraindications to allergen immunotherapy: an EAACI position paper.

Clinical indications for allergen immunotherapy (AIT) in respiratory and Hymenoptera venom allergy are well established; however, clinical contraindications to AIT are not always well documented. There are some discrepancies when classifying clinical contraindications for different forms of AIT as 'absolute' or 'relative'. EAACI Task Force on 'Contraindications to AIT' was created to evaluate and review current literature on clinical contraindications, and to update recommendations for both sublingual and subcutaneous AIT for respiratory and venom immunotherapy. An extensive review of the literature was performed on the use of AIT in asthma, autoimmune disorders, malignant neoplasias, cardiovascular diseases, acquired immunodeficiencies and other chronic diseases (including mental disorders), in patients treated with ß-blockers, ACE inhibitors or monoamine oxidase inhibitors, in children under 5 years of age, during pregnancy and in patients with poor compliance. Each topic was addressed by the following three questions: (1) Are there any negative effects of AIT on this concomitant condition/disease? (2) Are more frequent or more severe AIT-related side-effects expected? and (3) Is AIT expected to be less efficacious? The evidence, for the evaluation of these clinical conditions as contraindications, was limited, and most of the conclusions were based on case reports. Based on an extended literature research, recommendations for each medical condition assessed are provided. The final decision on the administration of AIT should be based on individual evaluation of any medical condition and a risk/benefit assessment for each patient.

Successful treatment of mastocytic anaphylactic episodes with reduction of skin mast cells after anti-IgE therapy.

Mastocytosis is a clonal disease derived from hematopoietic bone marrow progenitor cells. Clinical manifestations of the disease vary greatly depending on tissue involvement. Omalizumab is a recombinant humanized monoclonal anti-IgE antibody licensed in the treatment of asthma with increasing reports of clinical eficiency in other allergic diseases. We describe a case of a patient with mastocytosis responsive clinically and patho-physiologically after anti-IgE treatment.

The effect of captopril on severe renin-dependent hypertension of uraemics on regular dialysis treatment.

The renin-dependent hypertension of uraemic patients on regular dialysis treatment (RDT), resistant to conventional therapy, is a major problem. In these cases, bilateral nephrectomy is effective but carries operative risks and also the possibility of worsening the patients' anaemia. Five uraemic patients on RDT, with severe renin-dependent hypertension resistant to medical therapy were treated with the oral angiotensin converting enzyme inhibitor captopril for 3 to 6 months and the effects of the drug were studied. The pretreatment blood pressure was lowered from 227 +/- 5.7/127 +/- 4.47 mmHg to 146 +/- 13.42/86 +/- 4.18 mmHg within a month of treatment with captopril and that result was maintained throughout the study. A transient loss of taste was seen in two cases, but no other serious side effects of the drug were observed. In conclusion, captopril is a very effective drug in treating the severe renin-dependent hypertensive uraemic patients on RDT.