Vidal Carmen, Enrique Ernesto, Gonzalo Angeles, Moreno Carmen, Tabar Ana I
Allergy Departments of Complejo Hospitalario Universitario de Santiago, Rúa Ramón Baltar s/n, Santiago de Compostela, 15706 Spain.
Allergy Departments of Hospital de Sagunto, Valencia, Spain.
Clin Transl Allergy. 2014 Nov 7;4:36. doi: 10.1186/2045-7022-4-36. eCollection 2014.
Polysensitisation is common in patients with respiratory allergy in Spain. Selection of the best allergen immunotherapy (AIT) is difficult in polysensitised patients. The present study was designed to help allergists better identify relevant allergens in these patients and to improve the selection of AIT in Spain.
Sixty-two Spanish allergists answered a survey containing 88 items divided into four groups: 1) general approach to polysensitised subjects; 2) sensitisation profile involving mite, animal dander and moulds; 3) grass and olive pollen co-sensitisation, and 4) other pollen polysensitisation profile (weed and tree pollen). The Delphi method was used.
A consensus was achieved for 83% of items (92%, 81%, 83% and 73% of the four groups analysed, respectively). Only polysensitised patients with clinical relevance should be considered polyallergic. A detailed medical history (clinical symptoms and medication) together with a profound knowledge of allergens present in the patient's environment are essential for diagnosis. Skin prick tests (SPTs) are not adequate to decide the clinical relevance of each allergen. Serum specific IgE against allergen sources adds value to SPT but molecular diagnosis, when possible, is strongly recommended, especially in pollen-allergic patients. Specific allergen challenge tests are difficult to perform and not recommended for daily practice. Regarding AIT composition, up to three allergens can be used in the same vaccine, but only related allergens may be mixed. In some cases more than one vaccine may be needed.
Some criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.
在西班牙，呼吸道过敏患者中多重致敏现象很常见。对于多重致敏患者而言，选择最佳的变应原免疫疗法（AIT）颇具难度。本研究旨在帮助过敏症专科医生更好地识别这些患者中的相关变应原，并改进西班牙的AIT选择。
62名西班牙过敏症专科医生回答了一项包含88个项目的调查问卷，这些项目分为四组：1）对多重致敏受试者的一般处理方法；2）涉及螨虫、动物皮屑和霉菌的致敏情况；3）草和橄榄花粉共同致敏情况，以及4）其他花粉多重致敏情况（杂草和树花粉）。采用了德尔菲法。
83%的项目达成了共识（分别为所分析的四组项目中的92%、81%、83%和73%）。只有具有临床相关性的多重致敏患者才应被视为多过敏患者。详细的病史（临床症状和用药情况）以及对患者环境中存在的变应原的深入了解对于诊断至关重要。皮肤点刺试验（SPT）不足以确定每种变应原的临床相关性。针对变应原来源的血清特异性IgE为SPT增添了价值，但强烈建议在可能的情况下进行分子诊断，尤其是对于花粉过敏患者。特异性变应原激发试验难以实施，不建议用于日常实践。关于AIT的组成，同一疫苗中可使用多达三种变应原，但只能混合相关变应原。在某些情况下，可能需要不止一种疫苗。
已确立了一些标准，以改善多重致敏患者的诊断和AIT处方。
