Background
Term | Definition |
---|---|
Allergen sources | Allergen sources are allergens from the same homologous group (e.g. Dermatophagoides pteronyssinus and Dermatophagoides farinae) |
Monosensitization | Sensitization (according to standardized SPTs or ssIgE assays) to only one of the allergens tested in the patient to date. A single “allergen” is defined in allergists’ terms, i.e. grass pollen, tree pollen, house dust mite, cat dander (even though extracts of these extracts contain tens, hundreds or even thousands of different polypeptides) |
Polysensitization | Sensitization (according to standardized SPTs or ssIgE assays) to two or more allergens |
Monoallergy | Clinically confirmed allergy to a single, sensitizing allergen (i.e. a causal relationship between exposure to the sensitizing allergen and clinical allergy symptoms) |
Polyallergy | Clinically confirmed allergy to two or more sensitizing allergens (i.e. causal relationships between exposure to two or more sensitizing allergens and clinical allergy symptoms) |
Homologous group | A group of allergens with (1) comparable physicochemical and biological properties of the source material, (2) cross-reactivity/structural homology of the allergens, (3) identical formulation of the finished product, and (4) identical production process of the allergen extract and of the finished product, as defined by the European Medicines Agency |
Allergen mixture | A single formulation containing a mixture of several allergen sources (e.g. a grass pollen source mixed with a birch pollen source) |
Single-allergen immunotherapy | Administration of an allergen immunotherapy formulation containing a single allergen source In the cases of sequential administration of two consecutive single-allergen immunotherapies.(e.g. 3 years of treatment with a house dust mite source, followed by 3 years of treatment with a grass pollen source) this does not constitute multi-allergen immunotherapy (see below) |
Multi-allergen immunotherapy | Administration of different allergen sources Multi-allergen immunotherapy can be administered either in parallel (see below) or on a mixed formulation (see below) |
Parallel multi-allergen immunotherapy | The separate administration of two or more single-allergen immunotherapy formulations in parallel during the same course of treatment
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Mixed multi-allergen immunotherapy | The administration of an allergen mixture (i.e. a single formulation containing several allergen sources) |
Methods
Treatment of the polyallergic patient: a high-priority topic
What is the regulatory authorities’ current stance on the composition of AIT formulations?
Homologous groups | No homologous groups | ||
---|---|---|---|
Tree pollen | |||
1. Suggested homologous group: birch/fagales | Non-grouped species: justification for mixing required | ||
Betula verrucosa = B. pendula* = B. alba
| European white birch |
Fagus sylvatica
| European beech |
Alnus glutinosa
| Alder |
Acer sp. | Maple |
Carpinus betulus
| Hornbeam |
Platanus sp. | Plane tree |
Corylus avellana
| Hazel |
Populus sp. | Poplar |
Quercus alba
| Oak |
Robinia pseudoacacia
| False acacia, locust tree |
Castanea sativa
| Sweet chestnut |
Salix sp. | Sallow/willow |
Tilia sp. | Lime | ||
Ulmus sp. | Elm | ||
Cryptomeria japonica
| Japanese cedar | ||
2. Suggested homologous group: Oleaceae
| |||
Olea europaea
| Olive | ||
Fraxinus excelsior
| Ash | ||
Ligustrum vulgare
| Privet | ||
Syringa vulgaris
| Lilac | ||
3. Suggested homologous group: Cupressaceae
| |||
Juniperus sp. | Juniper | ||
Cupressus sp. | Cypress | ||
Grass and cereal pollen | |||
4. Suggested homologous group: sweet grasses, the Poaceae (Gramineae) family, Pooideae subfamily | Non-grouped species: justification for mixing required | ||
Anthoxanthum odoratum
| Sweet vernal grass |
Cynodon dactylon
| Bermuda grass |
Avena sativa
| Oat |
Cynosurus cristatus
| Dogstail |
Dactylis glomerata
| Orchard grass/cocksfoot | ||
Festuca sp. | Meadow fescue | ||
Holcus lanatus
| Velvet grass/Yorkshire fog | ||
Hordeum vulgare
| Barley | ||
Lolium perenne
| Perennial ryegrass | ||
Phleum pratense
| Timothy grass | ||
Poa pratensis
| Kentucky bluegrass | ||
Secale cereale
| Cultivated rye | ||
Triticum aestivum
| Cultivated wheat | ||
Additional Pooideae grass species, with reservations: | |||
Agropyron sp. | Couch grass/crested wheatgrass | ||
Agrostis sp. | Bent grass | ||
Alopecurus pratensis
| Meadow foxtail | ||
Arrhenatherum elatius
| False oat | ||
Bromus sp. | Brome grass | ||
Weed pollen | |||
5. Suggested homologous group: weed pollen species | Non-grouped species: justification for mixing required | ||
Ambrosia artemisiifolia, Ambrosia trifida
| Ragweed |
Plantago sp. | Plantain |
Artemisia vulgaris
| Mugwort | ||
Parietaria judaica, Parietaria officinalis
| Pellitory | ||
MITES | |||
6. Suggested homologous group: house dust mites of the Dermatophagoides genus | Non-grouped species: justification for mixing required | ||
Dermatophagoides pteronyssinus
| European house dust mite |
Acarus siro
| Flour mite |
Dermatophagoides farinae
| American house dust mite |
Glycyphagus domesticus
| House mite |
Lepidoglyphus destructor
| Storage mite | ||
Thyreophagus entomophagus
| Flour mite | ||
Tyrophagus putrescentiae
| Storage mite | ||
Insect venoms | Non-grouped species: justification for mixing required | ||
No homologous groups | All species | ||
Allergen extracts derived from vertebrates (extracts such as animal epithelia, hair, dander) | Non-grouped species: justification for mixing required | ||
No homologous groups |
Canis familiaris
| Dog | |
Felis domesticus
| Cat | ||
Cavia porcellus
| Guinea pig | ||
Cricetus cricetus
| Hamster | ||
Equus caballus
| Horse | ||
Mus musculus
| Mouse | ||
Oryctolagus cuniculus
| Rabbit | ||
Rattus sp. | Rat | ||
Moulds | Non-grouped species: justification for mixing required | ||
All species | |||
No homologous groups | In case of justification of grouping of mould species, special emphasis on similar stability is necessary |