Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement

Marek L Kowalski 1, Ignacio Ansotegui 2, Werner Aberer 3, Mona Al-Ahmad 4, Mubeccel Akdis 5, Barbara K Ballmer-Weber 6, Kirsten Beyer 7, Miguel Blanca 8, Simon Brown 9, Chaweewan Bunnag 10, Arnaldo Capriles Hulett 11, Mariana Castells 12, Hiok Hee Chng 13, Frederic De Blay 14, Motohiro Ebisawa 15, Stanley Fineman 16, David B K Golden 17, Tari Haahtela 18, Michael Kaliner 19, Connie Katelaris 20, Bee Wah Lee 21, Joanna Makowska 22, Ulrich Muller 23, Joaquim Mullol 24, John Oppenheimer 25, Hae-Sim Park 26, James Parkerson 27, Giovanni Passalacqua 28, Ruby Pawankar 29, Harald Renz 30, Franziska Rueff 31, Mario Sanchez-Borges 32, Joaquin Sastre 33, Glenis Scadding 34, Scott Sicherer 35, Pongsakorn Tantilipikorn 10, James Tracy 36, Vera van Kempen 37, Barbara Bohle 38, G Walter Canonica 39, Luis Caraballo 40, Maximiliano Gomez 41, Komei Ito 42, Erika Jensen-Jarolim 43, Mark Larche 44, Giovanni Melioli 45, Lars K Poulsen 46, Rudolf Valenta 47, Torsten Zuberbier 48

Affiliations

10 December 2016

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doi: 10.1186/s40413-016-0122-3

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.

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