Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2797_Библиотеки_им_академика_М_И_Перельмана

The majority of patients in both the U.S. and Europe presenting to an allergy clinic for evaluation of an allergic respiratory condition are sensitized to multiple aeroallergens. (Nelson 2016). There is no difference in the response to AIT with a single allergen, whether they are sensitive to only the allergen being used for treatment or to multiple unrelated allergens (Nelson 2013). There is, however, a major disagreement between the majority of European and American allergists regarding the appropriate treatment of patients presenting with multiple allergies, as opposed to multiple positive skin tests most of which may not be clinically important. The US practice parameters recommend that patients be treated with a mixture(s) containing all clinically relevant allergen extracts (Cox 2011). European guidelines, however, do not recommend the use of mixtures of unrelated allergens (Demoly 2016; Roberts 2018). Instead, they recommend that only the most clinically important allergen extract be administered or if two extracts containing unrelated allergens are of equal importance, they are to be given on alternate days or during the same visit in the left and right arm with at least a 30-minute interval between injections. Support for the US practice is primarily provided by the studies of Lowell and Franklin who demonstrated, in two randomized placebo-controlled trials, that reduction or elimination of ragweed extract in a mixture of unrelated allergen extracts caused loss of protection against symptoms of allergic rhinitis during the ragweed pollen season, thus proving that ragweed pollen extract was clinically effective when administered in a mixture of unrelated pollen extracts.