Selection of allergen extract for immunotherapy in polysensitized allergic rhinitis patients

Aim: To evaluate the criteria used by allergists in selecting an immunotherapy extract (allergen immunotherapy [AIT]-extract) in rhinitis patients with polysensitization. Methods: First, a cross-sectional study was carried out by evaluating different factors that influence the medical choice of AIT-extract. Second, a literature review was performed by evaluating the diagnostic performance of atopy tests. Results: A total of 419 patients were included (84 children, 149 adolescents and 186 adults). Anamnesis, atopy tests and exposure to pets were the main factors for choosing the AIT extract. The sensitivity and specificity of atopy tests were high for Dermatophagoides spp., (>80%), moderate for pets (60%) and indeterminate for Blomia tropicalis. Conclusion: NCTs could be necessary for AIT-extract selection in polysensitized allergic rhinitis patients.
Allergen immunotherapy is an effective treatment for patients with allergic rhinitis. Atopy tests are used to identify possible substances in the environment that cause symptoms. A patient may sometimes have multiple substances which could be causing their allergic reactions, which makes it difficult to choose the appropriate immunotherapy for the patient. In this study, we identified some factors that might help to guide the criteria used by allergists when selecting the extract for immunotherapy.
To the knowledge of the authors, this is the first study evaluating allergist criteria for the selection of an allergen immunotherapy (AIT)-extract in polysensitized patients.
The principal criteria for selection of AIT-extracts were atopy tests, local allergen prevalence, anamnesis and allergen exposure.
The selection of an AIT-extract based only on anamnesis and the presence of pets in homes has poor diagnostic performance.
According to the nasal challenge test (NCT), for the selection of the Dermatophagoides spp. AIT-extract, atopy tests have a high diagnostic performance.
According to the NCT, for the selection of the Blomia tropicalis AIT-extract, atopy tests have an indeterminate diagnostic performance.
According to the NCT, for the selection of pets (cat or dog), AIT-extract atopy tests have a moderate diagnostic performance.
A systematic review supports the use of the NCT for evaluating clinical relevance and choosing the AIT-extract in polysensitized AR patients.
Diagnosis by components can help improve the selection of the most appropriate extract for polysensitized patients; however, there is a lack of studies that evaluate the diagnostic performance of this test for some sources of allergens.