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Specific Immunotherapy
Indications, contraindications, interactions

Essential facts about indications and contraindications to allergen-specific immunotherapy and interactions that may occur

Indications

Allergen-specific immunotherapy (SIT) is the only accepted causal treatment for IgE-mediated allergic diseases. Therefore, SIT is primarily indicated in patients with established, clinically relevant IgE-mediated sensitisation to allergens if allergen avoidance is not (sufficiently) possible. This is typically the case with inhalational allergies of the upper and lower respiratory tract [1;2;3].

As SIT interferes with the immunologic process of allergy (see: How it works ), it should be administered as early as possible in the course of the disease process – before irreversible organ changes have occurred [1;2]. Results from controlled trials suggest that early institution of SIT in patients with allergic rhinitis can prevent both the development of allergic bronchial asthma and further sensitisations [1;2].

Contraindications and interactions

General contraindications to allergen-specific immunotherapy include irreversible target organ changes, inflammatory/febrile disorders, severe acute or chronic diseases (especially cardiovascular disease), and severe psychiatric disorders where the necessary patient cooperation is not ensured. Important contraindications to SIT include in particular inadequately controlled asthma and/or irreversible airway obstruction – these patients should have regular peak flow measurements. SIT is not recommended for patients with conditions where causal or concomitant involvement of the immune system cannot be ruled out (severe autoimmune diseases, immunodeficiency syndromes, malignant neoplastic diseases).

SIT should not be started and not usually be continued during pregnancy. Potential interactions may occur with concomitant use of beta blockers (also in eye drops), immunosuppressant agents and ACE inhibitors [1;2;3].

Read more on the next page: "Outcome assessment, duration of treatment, dosage"


REFERENCES:
[1] Bousquet J, Lockey RF, Malling HJ. WHO Position Paper - Allergen immunotherapy: therapeutic vaccines for allergic diseases - Geneva, January 27-29,1997. Allergy 1998;53(Suppl.44):4-42.
[2] Kleine-Tebbe J, Bufe A, Ebner C, Eigenmann P, Friedrichs F, Fuchs T, et al. Die spezifische Immuntherapie (Hyposensibilisierung) bei IgE-vermittelten allergischen Erkrankungen. Leitlinie der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI), des Ärzteverbandes Deutscher Allergologen (ÄDA), der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA), der Österreichischen Gesellschaft für Allergologie und Immunologie (ÖGAI) und der Schweizerischen Gesellschaft für Allergologie und Immunologie (SGAI). Allergo J 2009;18:508-37.
[3] Sennekamp J, Fuchs T, Hornung B, Kersten W, Klimek L, Leupold W, et al. Empfehlungen zur praktische Durchführung der spezifischen Immuntherapie mit Allergenen (Hyposensibilisierung). Ärzteverband Deutscher Allergologen e.V. (ÄDA). Aktualisierte Fassung 2002. Abgestimmt mit der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAI). Allergo J 2002;11:332-8.

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