Department of Internal Medicine, University Hospital San Martino, Genoa, Italy.
Expert Opin Biol Ther. 2011 Jun;11(6):715-22. doi: 10.1517/14712598.2011.576246. Epub 2011 Apr 8.
Polysensitization, that is, sensitization to more than one allergen family, is a common feature of patients with allergic rhinitis (AR) and significantly impairs their quality of life (QoL). Allergen-specific immunotherapy is the only causal treatment for AR. However, the polysensitization phenomenon may represent a crucial obstacle as far as it concerns the choice of the allergen extract to be used for immunotherapy.
A series of real-life based multi-center studies, named POLISMAIL (Polysensitization Impact on Allergen Immunotherapy), have been designed with the aim of evaluating the behavior of allergists in managing polysensitized AR patients. The effect of immunotherapy treatment in these patients was also evaluated. A single allergen extract was used in two-thirds of patients, whereas a mix of two allergens was chosen in the remaining. The severity grade of AR and the QoL were significantly improved by immunotherapy. Both outcomes confirmed that immunotherapy with one or two allergen extracts achieves a significant improvement in polysensitized patients.
In conclusion, POLISMAIL studies demonstrate that polysensitization should not represent a counter-indication for prescribing immunotherapy. The choice of limiting sublingual immunotherapy to one to two allergen extracts, preferably separated and at high dosages, is sufficient and effective in improving symptoms and QoL.
过敏症的多重致敏，即对一种以上过敏原家族的致敏，是过敏性鼻炎（AR）患者的常见特征，显著降低了他们的生活质量（QoL）。过敏原特异性免疫疗法是治疗 AR 的唯一病因。然而，多重致敏现象可能是一个关键的障碍，因为它涉及到选择用于免疫疗法的过敏原提取物。
一系列基于真实生活的多中心研究，命名为 POLISMAIL（多重致敏对过敏原免疫疗法的影响），旨在评估过敏症专家在管理多重致敏 AR 患者方面的行为。还评估了这些患者免疫治疗的效果。三分之二的患者使用单一过敏原提取物，而其余的患者选择两种过敏原的混合物。免疫疗法显著改善了 AR 的严重程度和 QoL。这两种结果都证实，用一种或两种过敏原提取物进行免疫疗法可显著改善多重致敏患者的情况。
总之，POLISMAIL 研究表明，多重致敏不应成为开具免疫疗法的禁忌症。选择将舌下免疫疗法限制在一种到两种过敏原提取物，最好是分开且高剂量，足以有效改善症状和 QoL。
