Ongoing Task Forces

Contraindications to Immunotherapy


The Task Force "Contraindications to Immunotherapy" was created by Immunotherapy IG and joined by Venom Allergy IG.

Rationale for establishing this Task Force: In position papers and in the guidelines of national committees, autoimmune diseases (AID) and neoplasia are referred as absolute contraindications for Specific Immunotherapy (SIT). It is not clear how and if the immunologic mechanisms of SIT is able to affect these concurrent diseases. As far as neoplasia are concerned, there are cases of Hymenoptera venom-treated allergic patients with an underlying malignancy that didn’t present any progress of the disease, offering food for thought on the possibility that SIT with aeroallergens can also be performed in such patients. Other contraindications include beta-blocker treatment, uncontrolled asthma and pregnancy at the start of immunotherapy. Age restrictions referring to age are also suggested. As far as HIV disease is concerned there is skepticism on whether an immunostimulation during SIT may affect the course of the disease and lead to a more severe stage. Since the introduction of HAART (highly active antiretroviral therapy), that extended the progression to AIDS to decades, patients have an excellent quality of life and a chronic moderate/severe rhinitis may result to be of major concern. It is, therefore, of general interest if it is safe and effective to treat such patients.


Main objectives of this TF have been:
1. To collect and compare clinical data on the effect of SIT in the known contraindications. A thorough literature research has be performed.
2. AID and neoplasia are heterogeneous groups, so the effect of SIT has been examined in each AID and in each form/stage/prognosis of neoplasia (at least the most frequent), defining if SIT can be performed in any of them.
3. A pathophysiology mechanism on SIT’s interference (or not) with AID, neoplasia, HIV has been investigated, as well as the affect of an underlying disease on the efficacy of SIT.
4. Confirmation (rejection if any) of the rest of the contraindications was studied.   
For this purpose TF-meetings took place in order to define methodology, create an online survey contacting Allergologists on their opinion (CONSIT survey), present findings and discuss them. A final meeting took place, leading to an 'Experts' Consensus'.
A position paper is currently on its way to be pubblished, while we also aim to pubblish a Review on Contraindications and the results of CONSIT.

Members of this Task Force were: Constantinos Pitsios (coordinator), Beatrice Bilò (secretary), Pascal Demoly, Marina Tsoumani, Erkka Valovirta, Radoslaw Gawlik, Pablo Rodriguez Del Rio, Gunter Sturm, Oliver Pfaar, Franziska Ruëff, Giannis Paraskevopoulos  and Moises Calderón.
Roy Gerth van Wijk and Nikolaos Papadopoulos NG have kindly joined the Consensus meeting and reviewed the draft of the Position Paper.
 
Last updated 12 February 2015