Patient with comorbid pathology: is ASIT possible?

Introduction. ASIT is characterized by a high safety profile, however, when prescribing ASIT, indications and certain contraindications should be taken into account, knowledge of which is mandatory for every practicing allergist. In recent years, clinical contraindications to ASIT have been revised due to the publication of the Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI). The decision to prescribe ASIT is based on an assessment of the individual patient’s condition, analysis of indications, consideration of contraindications to ASIT, assessment of concomitant diseases, and their pharmacotherapy. The doctor must make the final decision when prescribing allergen treatment, weighing the risk-benefit ratio. Refusal to perform ASIT on a patient with must be clearly reasoned and justified.

Presentation of a clinical case. A child aged 11 years was observed with a diagnosis of allergic bronchial asthma, mild intermittent course. Allergic rhinitis, persistent course. Allergy to trees, cereals, weeds. Cross food allergy (peas, melon) with clinical manifestations in the form of oral allergic syndrome, acute urticaria, angioedema of the lips and tongue. Asperger’s syndrome. Congenital cataract. Despite the annual progression of respiratory allergies and the expansion of the spectrum of sensitization, the patient was not offered ASIT for a long time if there were indications for its implementation due to the presence of comorbid pathology. The presence of mental illness, according to the Position Document, is a relative contraindication to ASIT. ASIT with the therapeutic allergen Grazax is not accompanied by side effects and is characterized by high compliance, which led to a significant therapeutic effect.

Conclusion. This clinical observation clearly demonstrates a situation where the initial refusal to administer ASIT to a patient with an indication for this type of treatment was unfounded. Even in the case of complex comorbid pathology, ASIT can be performed effectively and safely.

1. Peredkova EV, Sebekina OV, Nenasheva NM. Reasons for the ineffectiveness of allergen-specific immunotherapy. Prakticheskaya allergologiya. 2021; 2: 30–38. (In Russ.) URL: https://doi.org/10.46393/2712-9667_2021_2_30_38

2. Allergologiya. Federal’nye klinicheskie rekomendacii. Allergology. Federal clinical guidelines. Moscow: Farmarus Print Media, 2014. 126 s. (In Russ.) URL: https://raaci.ru/dat/pdf/allerg_klinrek.pdf

3. Kurbacheva OM, Pavlova KS, Galickaya MA. Clinical contraindications to ASIT. Rossijskij allergologicheskij zhurnal. 2017; 2 (14): 10–21. (In Russ.) URL: https://asitru.ru/article/6.html

4. Pitsios C, Demoly P, Bilo MB et al. Clinical contraindications to allergen immunotherapy: an EAACI position paper. Allergy. 2015; 70 (8): 897–909. URL: https://doi.org/10.1111/all.12638

5. Allergen-specific immunotherapy in children (as a guide). Soglasitel’nyj dokument Associacii detskih allergologov i immunologov Rossii. Moscow: ADAIR, 2021. 198 s. (In Russ.) URL: https://adair.ru/soglasitelnyy-dokument/allergen-spetsificheskaya-immunoterapiya-u-detey/

6. Senna GE, Makatsori M, Schiappoli M, et al. Subcutaneous allergen specific immunotherapy: best clinical practice as corner-stone for future development. Eur Ann Allergy Clin Immunol. 2011; 43 (5): 135–140. URL: https://pubmed.ncbi.nlm.nih.gov/22145249/

7. Alvaro-Lozano М, Akdis СA, Akdis М. et al. EAACI Allergen Immunotherapy User’s Guide — Pediatr. Allergy Immunol. 2020; 31 (25): 1–101. URL: https://doi.org/10.1111/pai.13189

8. Orlova EA. Modern principles of allergen-specific immunotherapy: a guide for doctors. Moscow: GEOTAR-Media, 2023. 256 s. (In Russ.) URL: https://www.rosmedlib.ru/book/ISBN9785970477816.html