World Allergy Organization Journal (Jan 2016)
Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement
- Marek L. Kowalski,
- Ignacio Ansotegui,
- Werner Aberer,
- Mona Al-Ahmad,
- Mubeccel Akdis,
- Barbara K. Ballmer-Weber,
- Kirsten Beyer,
- Miguel Blanca,
- Simon Brown,
- Chaweewan Bunnag,
- Arnaldo Capriles Hulett,
- Mariana Castells,
- Hiok Hee Chng,
- Frederic De Blay,
- Motohiro Ebisawa,
- Stanley Fineman,
- David B.K. Golden,
- Tari Haahtela,
- Michael Kaliner,
- Connie Katelaris,
- Bee Wah Lee,
- Joanna Makowska,
- Ulrich Muller,
- Joaquim Mullol,
- John Oppenheimer,
- Hae-Sim Park,
- James Parkerson,
- Giovanni Passalacqua,
- Ruby Pawankar,
- Harald Renz,
- Franziska Rueff,
- Mario Sanchez-Borges,
- Joaquin Sastre,
- Glenis Scadding,
- Scott Sicherer,
- Pongsakorn Tantilipikorn,
- James Tracy,
- Vera van Kempen,
- Barbara Bohle,
- G Walter Canonica,
- Luis Caraballo,
- Maximiliano Gomez,
- Komei Ito,
- Erika Jensen-Jarolim,
- Mark Larche,
- Giovanni Melioli,
- Lars K. Poulsen,
- Rudolf Valenta,
- Torsten Zuberbier
Affiliations
- Marek L. Kowalski
- Department of Immunology, Rheumatology & Allergy, Medical University of Lodz, 251 Pomorska Str, 92-213 Lodz, Poland.; Correspondence:
- Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quiron Bizkaia, Bilbao, Spain.
- Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria.
- Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
- Mubeccel Akdis
- Swiss institute of Allergy & Asthma research, Davos, Switzerland.
- Barbara K. Ballmer-Weber
- Allergy Unit, Dermatology Clinic, University Hospital Zürich, University Zürich, Zürich, Switzerland.
- Kirsten Beyer
- Kirsten Beyer, Charité Universitätsmedizin Berlin, Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Berlin, Germany.
- Miguel Blanca
- Hospital Reg. Univ. Carlos Haya, Allergy Serv, Malaga, Spain.
- Simon Brown
- Royal Perth Hospital, Department of Emergency Medicine, Perth, WA, Australia.
- Chaweewan Bunnag
- Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- Arnaldo Capriles Hulett
- Allergology Unit, Hospital San Juan de Dios, Caracas, Venezuela.
- Mariana Castells
- Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA.
- Hiok Hee Chng
- Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore.
- Frederic De Blay
- Hôpitaux Universitaires de Strasbourg, Chest Diseases Department, Strasbourg, France.
- Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
- Stanley Fineman
- Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, Georgia.
- David B.K. Golden
- Johns Hopkins University, Baltimore, MD, USA.
- Tari Haahtela
- Helsinki University Central Hospital, Helsinki, Finland.
- Michael Kaliner
- Institute for Asthma & Allergy, Bethesda, MD, USA.
- Connie Katelaris
- Westmead Medical Centre, Westmead, NSW, Australia.
- Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Joanna Makowska
- CSK, Department of Allergy & Clinical Immunology, Lodz, Poland.
- Ulrich Muller
- Spitalnetz, Bern, Switzerland.
- Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, and CIBERES, Barcelona, Spain.
- John Oppenheimer
- UMDNJ – Rutgers Medical School, c/o Pulmonary and Allergy Associates, Summit, New Jersey, USA.
- Hae-Sim Park
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, South Korea.
- James Parkerson
- University of South Florida, Tampa, FL, USA.
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino Hospital IST, University of Genoa, Genoa, Italy.
- Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
- Harald Renz
- Universitatsklinikum GI & MR GmbH, Institut fur Laboratoriumsmedizin & Path, Standort Marburg, Marburg, Germany.
- Franziska Rueff
- Klinikum der Ludwig-Maximilians-Universitat, Klinik & Poliklinik fur Dermatologie & Allergologie, Munchen, Germany.
- Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidadad, Caracas, Venezuela.
- Joaquin Sastre
- Allergy Department, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Institute Carlos III, Madrid, Spain.
- Glenis Scadding
- RNTNE Hospital, London, UK.
- Scott Sicherer
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Pongsakorn Tantilipikorn
- Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- James Tracy
- University of Nebraska, Omaha, NE, USA.
- Vera van Kempen
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany.
- Barbara Bohle
- Division of Experimental Allergology, Department of Pathophysiology, Allergy Research Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria.
- G Walter Canonica
- Allergy & Respiratory Disease Clinic, DIMI – Department Int Med, University of Genoa, IRCCS AOU, San Martino – IST, Genoa, Italy.
- Luis Caraballo
- Immunology Department, Universidad De Cartagena, Cartagena, Colombia.
- Maximiliano Gomez
- Hospital San Bernardo, Salta, Argentina.
- Komei Ito
- Department of Allergy, Aichi Children’s Health and Medical Center, Aichi, Japan.
- Erika Jensen-Jarolim
- Messerli Research Institute, Medical University Vienna, University Vienna, Vienna, Austria.
- Mark Larche
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada.
- Giovanni Melioli
- Istituto Giannina Gaslini, Genoa, Italy.
- Lars K. Poulsen
- Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark.
- Rudolf Valenta
- Department of Pathophysiology, AKH, Wien, Austria.
- Torsten Zuberbier
- Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany.
- Journal volume & issue
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Vol. 9
Abstract
One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation.Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures.Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended.This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.
