Management of polysensitized patient: from molecular diagnostics to biomolecular immunotherapy

Abstract

A panel of Italian allergists gathered to discuss the issue concerning the management of polysensitized patients. The main conclusions were as follows: polysensitization is a relevant clinical characteristic as it affects about 70–80% of the global allergic population; the diagnostic pathway needs the use of an adequate and thorough methodology, based on the demonstration of consistency between history and documented sensitization; polysensitization and polyallergy are not synonymous: true allergy should always be demonstrated; polysensitization does not constitute a limitation to allergen immunotherapy prescription, as 1–2 allergen extracts could be effective in polysensitized patients; the allergen immunotherapy product characteristics should include the following: high efficacy and optimal safety profile, standardized production, and documented presence and titration of the major allergen.

Keywords:

• allergy
• immunotherapy
• management
• molecular allergens
• polysensitization

Financial & competing interests disclosure

The meeting occurred in Bilbao (Spain) on 24–25 October 2014, and was sponsored by Stallergenes Italy. G Ciprandi and C Incorvaia are scientific consultants of Stallergenes Italy. F Frati is the scientific director of Stallergenes Italy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Polysensitization is a relevant clinical characteristic as it affects about 70–80% of the global allergic population.

• Diagnostic pathway needs the use of an adequate and thorough methodology, based on the demonstration of consistency between history and documented sensitization by skin prick test and/or serum allergen-specific IgE measurement. In selected patients, molecular diagnostics should be performed.

• Polysensitization and polyallergy are not synonymous: true allergy should always be demonstrated.

• Polysensitization does not constitute a limitation to AIT prescription. There is convincing evidence-based medicine literature supporting the concept that 1–2 allergen extracts could be effective in polysensitized patients.

• The AIT product characteristics should be: high efficacy and optimal safety profile (validated by evidence-based medicine trials for single allergen), standardized production, and documented presence and titration of major allergen.