A Delphi consensus on diagnosis, management, and treatment with allergen immunotherapy of polysensitized children in Spain: CAPP study, Part 2
Main Article Content
Keywords
allergen immunotherapy, children, consensus, Delphi method, diagnosis, polysensitization
Abstract
Background: The study aimed to evaluate the level of agreement between specialists in pediatric allergology regarding the diagnosis and indications for allergen immunotherapy (AIT) for dust mites, molds, animal dander, and Hymenoptera venom allergen, as well as mixtures of several allergen sources in polysensitized children in Spain.
Materials and Methods: A Delphi study was performed using an online survey designed by a committee of pediatric AIT experts: 46 and 44 panelists participated in Rounds 1 and 2, respectively. In Round 1, 204 statements on 8 dimensions were evaluated (Diagnosis, Therapeutic management, and Pollens - Part I; Mites, molds, animals, hymenoptera venom, and mixtures - Part II). A total of 148 statements were finally accepted after Round 2. Panel members rated their level of agreement with assessments on a 9-point Likert scale based on acceptance by ≥ 66.7 of them.
Results: Panel experts recommended molecular diagnosis for dust mite allergy diagnosis in polysensitized pediatrics and mixtures of nonhomologous mites (Dermatophagoides and Lepidoglyphus) for optimal AIT management. Subcutaneous AIT with mold extracts is recommended, but no agreement was reached on mixing different mold types. Panel experts agreed that Fel d 1 and Can f 1 sIgE are better predictors for animal dander allergy , but no agreement exists on the acceptance of AIT with dander mixtures. Panelists accepted that Api m 2 (hyaluronidase) sIgE indicates Vespid and Apis mellifera cross-reactivity in children; and Api m 4 (melittin) sIgE is a marker of risk for systemic reaction with AIT in Apis mellifera allergy. According to the consensus, SCIT is more suitable for allergen mixtures than SLIT. and agreement was reached for pollen allergens and Alternaria alternata mixtures if stability, safety, and efficacy have been demonstrated.
Conclusions: This Delphi study provides, where evidence is lacking, current expert-based opinions on clinical decision-making for managing polysensitized children.
References
1. Demoly P, Passalacqua G, Pfaar O, Sastre J, Wahn U. Management of the polyallergic patient with allergy immunotherapy: A practice-based approach. Allergy Asthma Clin Immunol. 2016;12:2. 10.1186/s13223-015-0109-6
2. Arbes SJ, Jr., Gergen PJ, Elliott L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the US population: Results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 2005;116(2):377–83. 10.1016/j.jaci.2005.05.017
3. Bousquet PJ, Castelli C, Daures JP, Heinrich J, Hooper R, Sunyer J, et al. Assessment of allergen sensitization in a general population-based survey (European Community Respiratory Health Survey I). Ann Epidemiol. 2010;20(11):797–803. 10.1016/j.annepidem.2010.05.012
4. Vidal C, Enrique E, Gonzalo A, Moreno C, Tabar AI. Diagnosis and allergen immunotherapy treatment of polysensitised patients with respiratory allergy in Spain: An allergist’s consensus. Clin Transl Allergy. 2014;4:36. 10.1186/2045-7022-4-36
5. Ojeda P, Sastre J, Olaguibel JM, Chivato T. Alergológica 2015: A national survey on allergic diseases in the adult Spanish population. J Investig Allergol Clin Immunol. 2018;28(3):151–64. 10.18176/jiaci.0264
6. Ha EK, Baek JH, Lee S-Y, Park YM, Kim WK, Sheen YH, et al. Association of polysensitization, allergic multimorbidity, and allergy severity: A cross-sectional study of school children. Int Arch Allergy Immunol. 2017;171(3–4):251–60. 10.1159/000453034
7. Migueres M, Dávila I, Frati F, Azpeitia A, Jeanpetit Y, Lhéritier-Barrand M, et al. Types of sensitization to aeroallergens: Definitions, prevalences and impact on the diagnosis and treatment of allergic respiratory disease. Clin Transl Allergy. 2014;4:16. 10.1186/2045-7022-4-16
8. Del-Río Camacho G, Montes Arjona AM, Fernández-Cantalejo Padial J, Rodríguez Catalán J. How molecular diagnosis may modify immunotherapy prescription in multi-sensitized pollen-allergic children. Allergol Immunopathol (Madr.). 2018;46(6):552–6. 10.1016/j.aller.2018.03.002
9. Sastre J, Sastre-Ibañez M. Molecular diagnosis and immunotherapy. Curr Opin Allergy Clin Immunol. 2016;16(6):565–70. 10.1097/ACI.0000000000000318
10. Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy. 2018;73(4):765–98. 10.1111/all.13317
11. Ciprandi G, Incorvaia C, Puccinelli P, Dell’Albani I, Frati F. What should drive the choice of allergen for immunotherapy in polysensitized patients? Ann Allergy Asthma Immunol. 2012;109(2):148–9. 10.1016/j.anai.2012.06.007
12. Calderón MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: Looking at the published evidence. J Allergy Clin Immunol. 2012;129(4):929–34. 10.1016/j.jaci.2011.11.019
13. Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol. 2021;11(4):116–29. 10.5662/wjm.v11.i4.116
14. Niederberger M, Spranger J. Delphi technique in health sciences: A map. Front Public Health. 2020;8:457. 10.3389/fpubh.2020.00457
15. Veugelers R, Gaakeer MI, Patka P, Huijsman R. Improving design choices in Delphi studies in medicine: The case of an exemplary physician multi-round panel study with 100% response. BMC Med Res Methodol. 2020;20(1):156. 10.1186/s12874-020-01029-4
16. Posa D, Perna S, Resch Y, Lupinek C, Panetta V, Hofmaier S, et al. Evolution and predictive value of IgE responses toward a comprehensive panel of house dust mite allergens during the first 2 decades of life. J Allergy Clin Immunol. 2017;139(2):541–9.e8. 10.1016/j.jaci.2016.08.014
17. Resch Y, Michel S, Kabesch M, Lupinek C, Valenta R, Vrtala S. Different IgE recognition of mite allergen components in asthmatic and nonasthmatic children. J Allergy Clin Immunol. 2015;136(4):1083–91. 10.1016/j.jaci.2015.03.024
18. Zidarn M, Robič M, Krivec A, Šilar M, Resch-Marat Y, Vrtala S, et al. Clinical and immunological differences between asymptomatic HDM-sensitized and HDM-allergic rhinitis patients. Clin Exp Allergy. 2019;49(6):808–18. 10.1111/cea.13361
19. Curin M, Huang HJ, Garmatiuk T, Gutfreund S, Resch-Marat Y, Chen KW, et al. IgE epitopes of the house dust mite allergen Der p 7 are mainly discontinuous and conformational. Front Immunol. 2021;12:687294. 10.3389/fimmu.2021.687294
20. Alvaro-Lozano M, Akdis CA, Akdis M, Alviani C, Angier E, Arasi S, et al. EAACI allergen immunotherapy user’s guide. Pediatr Allergy Immunol. 2020;31 Suppl 25(Suppl 25):1–101. 10.1111/pai.13189
21. Rodinkova VV, Yuriev SD, Kryvopustova MV, Mokin VB, Kryzhanovskyi YM, Kurchenko AI. Molecular profile sensitization to house dust mites as an important aspect for predicting the efficiency of allergen immunotherapy. Front Immunol. 2022;13:848616. 10.3389/fimmu.2022.848616
22. Rodríguez-Domínguez A, Berings M, Rohrbach A, Huang HJ, Curin M, Gevaert P, et al. Molecular profiling of allergen-specific antibody responses may enhance success of specific immunotherapy. J Allergy Clin Immunol. 2020;146(5):1097–108. 10.1016/j.jaci.2020.03.029
23. Nony E, Martelet A, Jain K, Moingeon P. Allergen extracts for immunotherapy: To mix or not to mix? Expert Rev Clin Pharmacol. 2016; 9(3):401–8. 10.1586/17512433.2015.1131122
24. Daigle BJ, Rekkerth DJ. Practical recommendations for mixing allergy immunotherapy extracts. Allergy Rhinol (Providence). 2015;6(1):1–7. 10.2500/ar.2015.6.0111
25. De Kam PJ, Kramer MF, Shamji MH, Oluwayi K, Heath MD, Jensen-Jarolim E, et al. Dogmas, challenges, and promises in Phase III allergen immunotherapy studies. World Allergy Organ J. 2021;14(9):100578. 10.1016/j.waojou.2021.100578
26. Gabriel MF, Postigo I, Tomaz CT, Martínez J. Alternaria alternata allergens: Markers of exposure, phylogeny and risk of fungi-induced respiratory allergy. Environ Int. 2016;89–90:71–80. 10.1016/j.envint.2016.01.003
27. Pozzan M, Milani M. Efficacy of sublingual specific immunotherapy in patients with respiratory allergy to Alternaria alternata: A randomised, assessor-blinded, patient-reported outcome, controlled 3-year trial. Curr Med Res Opin. 2010;26(12):2801–6. 10.1185/03007995.2010.532201
28. Cortellini G, Spadolini I, Patella V, Fabbri E, Santucci A, Severino M, et al. Sublingual immunotherapy for Alternaria-induced allergic rhinitis: A randomized placebo-controlled trial. Ann Allergy Asthma Immunol. 2010;105(5):382–6. 10.1016/j.anai.2010.08.007
29. Di Bona D, Frisenda F, Albanesi M, Di Lorenzo G, Caiaffa MF, Macchia L. Efficacy and safety of allergen immunotherapy in patients with allergy to molds: A systematic review. Clin Exp Allergy. 2018;48(11):1391–401. 10.1111/cea.13242
30. Tabar AI, Prieto L, Alba P, Nieto A, Rodríguez M, Torrecillas M, et al. Double-blind, randomized, placebo-controlled trial of allergen-specific immunotherapy with the major allergen Alt a 1. J Allergy Clin Immunol. 2019;144(1):216–23.e3. 10.1016/j.jaci.2019.02.029
31. Rodríguez D, Tabar AI, Castillo M, Martínez-Gomariz M, Dobski IC, Palacios R. Changes in the sensitization pattern to Alternaria alternata allergens in patients treated with Alt a 1 immunotherapy. J Fungi (Basel). 2021;7(11):974. 10.3390/jof7110974
32. Bozek A, Pyrkosz K. Immunotherapy of mold allergy: A review. Hum Vaccin Immunother. 2017;13(10):2397–401. 10.1080/21645515.2017.1314404
33. Niesler A, Ścigała G, Łudzeń-Izbińska B. Cat (Fel d 1) and dog (Can f 1) allergen levels in cars, dwellings and schools. Aerobiologia (Bologna). 2016;32(3):571–80. 10.1007/s10453-016-9433-7
34. Curtin-Brosnan J, Matsui EC, Breysse P, McCormack MC, Hansel NN, Tonorezos ES, et al. Parent report of pests and pets and indoor allergen levels in inner-city homes. Ann Allergy Asthma Immunol. 2008;101(5):517–23. 10.1016/S1081-1206(10)60291-8
35. Mattsson L, Lundgren T, Everberg H, Larsson H, Lidholm J. Prostatic kallikrein: A new major dog allergen. J Allergy Clin Immunol. 2009;123(2):362–8. 10.1016/j.jaci.2008.11.021
36. Suzuki S, Nwaru BI, Ekerljung L, Sjölander S, Mincheva R, Rönmark EP, et al. Characterization of sensitization to furry animal allergen components in an adult population. Clin Exp Allergy. 2019;49(4):495–505. 10.1111/cea.13355
37. Asarnoj A, Hamsten C, Wadén K, Lupinek C, Andersson N, Kull I, et al. Sensitization to cat and dog allergen molecules in childhood and prediction of symptoms of cat and dog allergy in adolescence: A BAMSE/MeDALL study. J Allergy Clin Immunol. 2016;137(3):813–21.e7. 10.1016/j.jaci.2015.09.052
38. Dávila I, Domínguez-Ortega J, Navarro-Pulido A, Alonso A, Antolín-Amerigo D, González-Mancebo E, et al. Consensus document on dog and cat allergy. Allergy. 2018;73(6):1206–22. 10.1111/all.13391
39. Smith DM, Coop CA. Dog allergen immunotherapy: Past, present, and future. Ann Allergy Asthma Immunol. 2016;116(3):188–93. 10.1016/j.anai.2015.12.006
40. Jovanovic D, Peric-Popadic A, Djuric V, Stojanovic M, Lekic B, Milicevic O, et al. Molecular diagnostics and inhibition of cross-reactive carbohydrate determinants in Hymenoptera venom allergy. Clin Transl Allergy. 2023;13(3):e12230. 10.1002/clt2.12230
41. Jakob T, Müller U, Helbling A, Spillner E. Component resolved diagnostics for hymenoptera venom allergy. Curr Opin Allergy Clin Immunol. 2017;17(5):363–72. 10.1097/ACI.0000000000000390
42. Pretre G, Asturias JA, Lizaso MT, Tabar AI. Dipeptidyl peptidase IV of the Vespa velutina nigrithorax venom is recognized as a relevant allergen. Ann Allergy Asthma Immunol. 2022;129(1):101–5. 10.1016/j.anai.2022.02.018
43. Ruiz B, Serrano P, Moreno C. IgE-Api m 4 is useful for identifying a particular phenotype of bee venom allergy. J Investig Allergol Clin Immunol. 2016;26(6):355–61. 10.18176/jiaci.0053
44. Nelson HS, Makatsori M, Calderon MA. Subcutaneous immunotherapy and sublingual immunotherapy: Comparative efficacy, current and potential indications, and warnings—United States versus Europe. Immunol Allergy Clin North Am. 2016;36(1):13–24. 10.1016/j.iac.2015.08.005
45. Nelson HS, Iklé D, Buchmeier A. Studies of allergen extract stability: The effects of dilution and mixing. J Allergy Clin Immunol. 1996;98(2):382–8. 10.1016/s0091-6749(96)70162-8
46. EMA. Allergen products: Production and quality issues—Scientific guideline. 2009.
47. González-Mancebo E, Domínguez-Ortega J, Blanco-Bermejo S, González-Seco E, Trujillo MJ, de la Torre F. Comparison of two diagnostic techniques, skin-prick test and component resolved diagnosis in the follow-up of a cohort of paediatric patients with pollinosis. Multicentre pilot study in a highly exposed allergenic area. Allergol Immunopathol. 2017;45:121–6. 10.1016/j.aller.2016.04.005
48. Barber D, Diaz-Perales A, Escribese MM, Kleine-Tebbe J, Matricardi PM, Ollert M, et al. Molecular allergology and its impact in specific allergy diagnosis and therapy. Allergy. 2021;76(12):3642–58. 10.1111/all.14969
49. Mahler V, Esch RE, Kleine-Tebbe J, Lavery WJ, Plunkett G, Vieths S, et al. Understanding differences in allergen immunotherapy products and practices in North America and Europe. J Allergy Clin Immunol. 2019;143(3):813–28. 10.1016/j.jaci.2019.01.024
50. Zimmer J, Bonertz A, Vieths S. Quality requirements for allergen extracts and allergoids for allergen immunotherapy. Allergol Immunopathol (Madr). 2017;45 Suppl 1:4–11. 10.1016/j.aller.2017.09.002
2. Arbes SJ, Jr., Gergen PJ, Elliott L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the US population: Results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 2005;116(2):377–83. 10.1016/j.jaci.2005.05.017
3. Bousquet PJ, Castelli C, Daures JP, Heinrich J, Hooper R, Sunyer J, et al. Assessment of allergen sensitization in a general population-based survey (European Community Respiratory Health Survey I). Ann Epidemiol. 2010;20(11):797–803. 10.1016/j.annepidem.2010.05.012
4. Vidal C, Enrique E, Gonzalo A, Moreno C, Tabar AI. Diagnosis and allergen immunotherapy treatment of polysensitised patients with respiratory allergy in Spain: An allergist’s consensus. Clin Transl Allergy. 2014;4:36. 10.1186/2045-7022-4-36
5. Ojeda P, Sastre J, Olaguibel JM, Chivato T. Alergológica 2015: A national survey on allergic diseases in the adult Spanish population. J Investig Allergol Clin Immunol. 2018;28(3):151–64. 10.18176/jiaci.0264
6. Ha EK, Baek JH, Lee S-Y, Park YM, Kim WK, Sheen YH, et al. Association of polysensitization, allergic multimorbidity, and allergy severity: A cross-sectional study of school children. Int Arch Allergy Immunol. 2017;171(3–4):251–60. 10.1159/000453034
7. Migueres M, Dávila I, Frati F, Azpeitia A, Jeanpetit Y, Lhéritier-Barrand M, et al. Types of sensitization to aeroallergens: Definitions, prevalences and impact on the diagnosis and treatment of allergic respiratory disease. Clin Transl Allergy. 2014;4:16. 10.1186/2045-7022-4-16
8. Del-Río Camacho G, Montes Arjona AM, Fernández-Cantalejo Padial J, Rodríguez Catalán J. How molecular diagnosis may modify immunotherapy prescription in multi-sensitized pollen-allergic children. Allergol Immunopathol (Madr.). 2018;46(6):552–6. 10.1016/j.aller.2018.03.002
9. Sastre J, Sastre-Ibañez M. Molecular diagnosis and immunotherapy. Curr Opin Allergy Clin Immunol. 2016;16(6):565–70. 10.1097/ACI.0000000000000318
10. Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy. 2018;73(4):765–98. 10.1111/all.13317
11. Ciprandi G, Incorvaia C, Puccinelli P, Dell’Albani I, Frati F. What should drive the choice of allergen for immunotherapy in polysensitized patients? Ann Allergy Asthma Immunol. 2012;109(2):148–9. 10.1016/j.anai.2012.06.007
12. Calderón MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: Looking at the published evidence. J Allergy Clin Immunol. 2012;129(4):929–34. 10.1016/j.jaci.2011.11.019
13. Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol. 2021;11(4):116–29. 10.5662/wjm.v11.i4.116
14. Niederberger M, Spranger J. Delphi technique in health sciences: A map. Front Public Health. 2020;8:457. 10.3389/fpubh.2020.00457
15. Veugelers R, Gaakeer MI, Patka P, Huijsman R. Improving design choices in Delphi studies in medicine: The case of an exemplary physician multi-round panel study with 100% response. BMC Med Res Methodol. 2020;20(1):156. 10.1186/s12874-020-01029-4
16. Posa D, Perna S, Resch Y, Lupinek C, Panetta V, Hofmaier S, et al. Evolution and predictive value of IgE responses toward a comprehensive panel of house dust mite allergens during the first 2 decades of life. J Allergy Clin Immunol. 2017;139(2):541–9.e8. 10.1016/j.jaci.2016.08.014
17. Resch Y, Michel S, Kabesch M, Lupinek C, Valenta R, Vrtala S. Different IgE recognition of mite allergen components in asthmatic and nonasthmatic children. J Allergy Clin Immunol. 2015;136(4):1083–91. 10.1016/j.jaci.2015.03.024
18. Zidarn M, Robič M, Krivec A, Šilar M, Resch-Marat Y, Vrtala S, et al. Clinical and immunological differences between asymptomatic HDM-sensitized and HDM-allergic rhinitis patients. Clin Exp Allergy. 2019;49(6):808–18. 10.1111/cea.13361
19. Curin M, Huang HJ, Garmatiuk T, Gutfreund S, Resch-Marat Y, Chen KW, et al. IgE epitopes of the house dust mite allergen Der p 7 are mainly discontinuous and conformational. Front Immunol. 2021;12:687294. 10.3389/fimmu.2021.687294
20. Alvaro-Lozano M, Akdis CA, Akdis M, Alviani C, Angier E, Arasi S, et al. EAACI allergen immunotherapy user’s guide. Pediatr Allergy Immunol. 2020;31 Suppl 25(Suppl 25):1–101. 10.1111/pai.13189
21. Rodinkova VV, Yuriev SD, Kryvopustova MV, Mokin VB, Kryzhanovskyi YM, Kurchenko AI. Molecular profile sensitization to house dust mites as an important aspect for predicting the efficiency of allergen immunotherapy. Front Immunol. 2022;13:848616. 10.3389/fimmu.2022.848616
22. Rodríguez-Domínguez A, Berings M, Rohrbach A, Huang HJ, Curin M, Gevaert P, et al. Molecular profiling of allergen-specific antibody responses may enhance success of specific immunotherapy. J Allergy Clin Immunol. 2020;146(5):1097–108. 10.1016/j.jaci.2020.03.029
23. Nony E, Martelet A, Jain K, Moingeon P. Allergen extracts for immunotherapy: To mix or not to mix? Expert Rev Clin Pharmacol. 2016; 9(3):401–8. 10.1586/17512433.2015.1131122
24. Daigle BJ, Rekkerth DJ. Practical recommendations for mixing allergy immunotherapy extracts. Allergy Rhinol (Providence). 2015;6(1):1–7. 10.2500/ar.2015.6.0111
25. De Kam PJ, Kramer MF, Shamji MH, Oluwayi K, Heath MD, Jensen-Jarolim E, et al. Dogmas, challenges, and promises in Phase III allergen immunotherapy studies. World Allergy Organ J. 2021;14(9):100578. 10.1016/j.waojou.2021.100578
26. Gabriel MF, Postigo I, Tomaz CT, Martínez J. Alternaria alternata allergens: Markers of exposure, phylogeny and risk of fungi-induced respiratory allergy. Environ Int. 2016;89–90:71–80. 10.1016/j.envint.2016.01.003
27. Pozzan M, Milani M. Efficacy of sublingual specific immunotherapy in patients with respiratory allergy to Alternaria alternata: A randomised, assessor-blinded, patient-reported outcome, controlled 3-year trial. Curr Med Res Opin. 2010;26(12):2801–6. 10.1185/03007995.2010.532201
28. Cortellini G, Spadolini I, Patella V, Fabbri E, Santucci A, Severino M, et al. Sublingual immunotherapy for Alternaria-induced allergic rhinitis: A randomized placebo-controlled trial. Ann Allergy Asthma Immunol. 2010;105(5):382–6. 10.1016/j.anai.2010.08.007
29. Di Bona D, Frisenda F, Albanesi M, Di Lorenzo G, Caiaffa MF, Macchia L. Efficacy and safety of allergen immunotherapy in patients with allergy to molds: A systematic review. Clin Exp Allergy. 2018;48(11):1391–401. 10.1111/cea.13242
30. Tabar AI, Prieto L, Alba P, Nieto A, Rodríguez M, Torrecillas M, et al. Double-blind, randomized, placebo-controlled trial of allergen-specific immunotherapy with the major allergen Alt a 1. J Allergy Clin Immunol. 2019;144(1):216–23.e3. 10.1016/j.jaci.2019.02.029
31. Rodríguez D, Tabar AI, Castillo M, Martínez-Gomariz M, Dobski IC, Palacios R. Changes in the sensitization pattern to Alternaria alternata allergens in patients treated with Alt a 1 immunotherapy. J Fungi (Basel). 2021;7(11):974. 10.3390/jof7110974
32. Bozek A, Pyrkosz K. Immunotherapy of mold allergy: A review. Hum Vaccin Immunother. 2017;13(10):2397–401. 10.1080/21645515.2017.1314404
33. Niesler A, Ścigała G, Łudzeń-Izbińska B. Cat (Fel d 1) and dog (Can f 1) allergen levels in cars, dwellings and schools. Aerobiologia (Bologna). 2016;32(3):571–80. 10.1007/s10453-016-9433-7
34. Curtin-Brosnan J, Matsui EC, Breysse P, McCormack MC, Hansel NN, Tonorezos ES, et al. Parent report of pests and pets and indoor allergen levels in inner-city homes. Ann Allergy Asthma Immunol. 2008;101(5):517–23. 10.1016/S1081-1206(10)60291-8
35. Mattsson L, Lundgren T, Everberg H, Larsson H, Lidholm J. Prostatic kallikrein: A new major dog allergen. J Allergy Clin Immunol. 2009;123(2):362–8. 10.1016/j.jaci.2008.11.021
36. Suzuki S, Nwaru BI, Ekerljung L, Sjölander S, Mincheva R, Rönmark EP, et al. Characterization of sensitization to furry animal allergen components in an adult population. Clin Exp Allergy. 2019;49(4):495–505. 10.1111/cea.13355
37. Asarnoj A, Hamsten C, Wadén K, Lupinek C, Andersson N, Kull I, et al. Sensitization to cat and dog allergen molecules in childhood and prediction of symptoms of cat and dog allergy in adolescence: A BAMSE/MeDALL study. J Allergy Clin Immunol. 2016;137(3):813–21.e7. 10.1016/j.jaci.2015.09.052
38. Dávila I, Domínguez-Ortega J, Navarro-Pulido A, Alonso A, Antolín-Amerigo D, González-Mancebo E, et al. Consensus document on dog and cat allergy. Allergy. 2018;73(6):1206–22. 10.1111/all.13391
39. Smith DM, Coop CA. Dog allergen immunotherapy: Past, present, and future. Ann Allergy Asthma Immunol. 2016;116(3):188–93. 10.1016/j.anai.2015.12.006
40. Jovanovic D, Peric-Popadic A, Djuric V, Stojanovic M, Lekic B, Milicevic O, et al. Molecular diagnostics and inhibition of cross-reactive carbohydrate determinants in Hymenoptera venom allergy. Clin Transl Allergy. 2023;13(3):e12230. 10.1002/clt2.12230
41. Jakob T, Müller U, Helbling A, Spillner E. Component resolved diagnostics for hymenoptera venom allergy. Curr Opin Allergy Clin Immunol. 2017;17(5):363–72. 10.1097/ACI.0000000000000390
42. Pretre G, Asturias JA, Lizaso MT, Tabar AI. Dipeptidyl peptidase IV of the Vespa velutina nigrithorax venom is recognized as a relevant allergen. Ann Allergy Asthma Immunol. 2022;129(1):101–5. 10.1016/j.anai.2022.02.018
43. Ruiz B, Serrano P, Moreno C. IgE-Api m 4 is useful for identifying a particular phenotype of bee venom allergy. J Investig Allergol Clin Immunol. 2016;26(6):355–61. 10.18176/jiaci.0053
44. Nelson HS, Makatsori M, Calderon MA. Subcutaneous immunotherapy and sublingual immunotherapy: Comparative efficacy, current and potential indications, and warnings—United States versus Europe. Immunol Allergy Clin North Am. 2016;36(1):13–24. 10.1016/j.iac.2015.08.005
45. Nelson HS, Iklé D, Buchmeier A. Studies of allergen extract stability: The effects of dilution and mixing. J Allergy Clin Immunol. 1996;98(2):382–8. 10.1016/s0091-6749(96)70162-8
46. EMA. Allergen products: Production and quality issues—Scientific guideline. 2009.
47. González-Mancebo E, Domínguez-Ortega J, Blanco-Bermejo S, González-Seco E, Trujillo MJ, de la Torre F. Comparison of two diagnostic techniques, skin-prick test and component resolved diagnosis in the follow-up of a cohort of paediatric patients with pollinosis. Multicentre pilot study in a highly exposed allergenic area. Allergol Immunopathol. 2017;45:121–6. 10.1016/j.aller.2016.04.005
48. Barber D, Diaz-Perales A, Escribese MM, Kleine-Tebbe J, Matricardi PM, Ollert M, et al. Molecular allergology and its impact in specific allergy diagnosis and therapy. Allergy. 2021;76(12):3642–58. 10.1111/all.14969
49. Mahler V, Esch RE, Kleine-Tebbe J, Lavery WJ, Plunkett G, Vieths S, et al. Understanding differences in allergen immunotherapy products and practices in North America and Europe. J Allergy Clin Immunol. 2019;143(3):813–28. 10.1016/j.jaci.2019.01.024
50. Zimmer J, Bonertz A, Vieths S. Quality requirements for allergen extracts and allergoids for allergen immunotherapy. Allergol Immunopathol (Madr). 2017;45 Suppl 1:4–11. 10.1016/j.aller.2017.09.002
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Mar 1, 2025
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How to Cite
Tabar, A. I., Larramona Cabrera, H., Rivas-Juesas, C., Canals Candela, F. J., Mar Folqué, M. del, Tortajada-Girbés, M., Martínez-Cañavate, A., Lucas Moreno, J. M., & Mesa-del-Castillo, M. (2025). A Delphi consensus on diagnosis, management, and treatment with allergen immunotherapy of polysensitized children in Spain: CAPP study, Part 2. Allergologia Et Immunopathologia, 53(2), 141-159. https://doi.org/10.15586/aei.v53i2.1221
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How to Cite
Tabar, A. I., Larramona Cabrera, H., Rivas-Juesas, C., Canals Candela, F. J., Mar Folqué, M. del, Tortajada-Girbés, M., Martínez-Cañavate, A., Lucas Moreno, J. M., & Mesa-del-Castillo, M. (2025). A Delphi consensus on diagnosis, management, and treatment with allergen immunotherapy of polysensitized children in Spain: CAPP study, Part 2. Allergologia Et Immunopathologia, 53(2), 141-159. https://doi.org/10.15586/aei.v53i2.1221