Task force on “Contraindications of SIT”Coordinator: Constantinos Pitsios
Start date: 2011
Finish date: 2013
Rationale for establishing a 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.
1. To collect and compare clinical data on the effect of SIT in the known contraindications. A literature research will be performed.
2. AID and neoplasia should be considered as heterogeneous groups and the effect of SIT should be 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 will be proposed, 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.
Outcomes and possible benefits to EAACI: Revision of the guidelines regarding contraindications in SIT.
Participants: Beatrice Biló, Constantinos Pitsios, Erkka Valovirta, Franzisca Ruëf, Giannis Paraskevopoulos, Gunter Sturm, Marina Tsoumani, Moises Calderon, Oliver Pfaar, Pablo Rodríguez del Río, Pascal Demoly and Radoslaw Gawlik.
First meeting of this Group: ATHENS 24th of March, 2012Some of the members made a summary of the most relevant findings after reviewing literature concerning Autoimmune Diseases, Mastocytosis, HIV, Cancer, children below 5 y.o., elderly, intake of drugs considered as contraindications (ie: betablockers) and other topics concerning this group. An outline of the following steps and an action plan was depicted.
New meetings have been conducted in London on 2nd of June and Geneve on 18th of June 2012 to mature the methodology to be used to adress the issues of the TF by an evidence based medicine approach.