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Dealing with absolute and relative contraindications to specific immunotherapy using Hymenoptera venoms

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Abstract

Background

Acute infectious disorders, uncontrolled bronchial asthma, severe chronic inflammatory disorders, severe cardiovascular disorders, autoimmune or immunodeficiency disorders, active or progressive cancer, acquired immunodeficiency syndrome (AIDS), treatment initiation during pregnancy, as well as medication with β‑blockers and angiotensin-converting enzyme (ACE) inhibitors, among others, are considered either absolute or relative contraindications to specific immunotherapy using Hymenoptera venom (HV-SIT). Some of the contraindications listed above, however, are potential risk factors in the event of anaphylaxis, such that one regularly needs to challenge these contraindications on a case-by-case basis so as not to withhold HV-SIT from patients at particularly high risk.

Methods

Literature review.

Results and conclusion

Study data on a risk-increasing effect are available for only some of the contraindications to HV-SIT listed in the product information or guidelines. Moreover, these data are partially conflicting. Nevertheless, acute infectious disorders, active autoimmune disorders during flare-ups, active or progressive malignant disease, uncontrolled bronchial asthma, AIDS, and treatment during pregnancy are considered absolute contraindications to the initiation of HV-SIT. Some of these contraindications are, by their very nature, temporary. In other cases, therapy can be initiated once the underlying disease has been optimally treated. Relative contraindications to the initiation of HV-SIT include autoimmune disorders in remission, immune defects and immunosuppressive therapy, well-controlled chronic infectious diseases, category A and B HIV, partially controlled bronchial asthma, limited compliance, age below 5 years, cancer in remission, comedication with ACE inhibitors and β‑blockers, as well as treatment (continuation) during pregnancy. In the case of relative as well as absolute contraindications, it is essential to conduct a risk/benefit analysis prior to initiating or continuing HV-SIT.

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Abbreviations

ACE:

Angiotensin-converting enzyme

AIDS:

Acquired immunodeficiency syndrome

CI:

Confidence interval

EAACI:

European Academy of Allergy and Clinical Immunology

HAART:

Highly active retroviral therapy

HV:

Hymenoptera venom

HV-SIT:

Specific immunotherapy using Hymenoptera venom

HIV:

Human immunodeficiency virus

SIT:

Specific immunotherapy

SLE:

Systemic lupus erythematosus

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Authors and Affiliations

  1. Department and Outpatient Clinic for Dermatology, University Allergy Center, Carl Gustav Carus University Hospital at the Technical University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany

    Andrea Bauer MPH

  2. Department and Outpatient Clinic for Dermatology and Allergology, AllergieZENTRUM, Ludwig-Maximilian University, Munich, Germany

    Franziska Ruëff

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  1. Andrea Bauer MPH
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Correspondence to Andrea Bauer MPH.

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A. Bauer and F. Ruëff declare that they have no competing interests.

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Bauer, A., Ruëff, F. Dealing with absolute and relative contraindications to specific immunotherapy using Hymenoptera venoms. Allergo J Int 26, 122–128 (2017). https://doi.org/10.1007/s40629-017-0024-0

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