Bénéfices précoces de l'immunothérapie allergénique sublinguale (ITSL) dans la rhinite allergique : résultats du Patient Benefit Index dans l'étude PRACTIS

Introduction (contexte de la recherche) Les allergies respiratoires touchent 25 à 30 % de la population générale en France, se présentant ainsi comme un problème majeur de santé publique. Objectif Évaluer le bénéfice précoce de l'ITSL chez les patients souffrant d'une rhinite allergique (RA). Méthodes Étude observationnelle prospective et longitudinale menée chez des médecins spécialistes de l'allergie en France. Les symptômes de patients souffrant de RA ont été évalués avant ITSL (visite V1) et 6 à 12 mois après (V2). Le critère d'évaluation principal était les bénéfices précoces de l'ITSL ressentis par les patients à V2 en fonction des modalités d'utilisation et du type d'allergène, à partir des questionnaires PNQ (patient needs questionnaire) et PBQ (patient benefit questionnaire). Le score global du Patient Benefit Index (PBI) a été calculé à partir de ces deux questionnaires. Ce questionnaire comporte les mêmes 25 questions posées avant (PNQ évaluant à V1 l'aide attendue) et après ITSL (PBQ à V2 évaluant l'aide apportée) ;le seuil de significativité du PBI a été calculé ≥1. Résultats L'analyse a porté sur 1587 patients, 66 % d'entre eux (n=1047) ont réalisé la V2, malgré le contexte de l'épidémie COVID. L'ITSL a été bénéfique (PBI ≥ 1) pour 88,5 % des patients (PBI moyen 2,39±0,98) avec une amélioration des symptômes [RA 80,3 %, conjonctivite allergique (CA) 77,5 %, asthme allergique (AA) 68,0 %], et une diminution ou arrêt du recours aux médicaments symptomatiques de la RA (73 %), de la CA (81 %) et dans une moindre mesure de l'AA (67 %). Les principaux domaines améliorés par rapport aux précédents traitements symptomatiques concernent la qualité de vie (pouvoir rester en plein air, ne plus avoir le nez bouché ou qui coule et d'être soulagé de l'ensemble des symptômes). L'amélioration du bénéfice pour le patient ne diffère pas entre les deux formes galéniques de l'ITSL. Conclusions Première étude française utilisant le PBI pour évaluer les bénéfices précoces ressentis 6 à 12 mois après traitement par ITSL et répondant ainsi aux attentes des patients notamment diminution des symptômes et médicaments de la RA et amélioration de la qualité de vie.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in COVID-19 patients: A systematic review

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening drug-induced condition presenting with skin rash, fever, lymphadenopathy, systemic involvement and hematological (eosinophilia, atypical lymphocytes) findings. Although DRESS syndrome is frequently associated with reactivation of herpesviruses, the link between DRESS and COVID-19 has not been systematically analyzed. Method(s): A systematic search using PubMed and Google Scholar was conducted following the PRISMA guidelines to identify all reported DRESS cases associated with COVID-19 published between January 2020 and January 2022 using the keywords "COVID-19" AND "DRESS syndrome" OR "drug reaction with eosinophilia and systemic symptoms" OR "drug-induced hypersensitivity syndrome" OR "eosinophilia" AND "SARS-CoV- 2" OR "coronavirus". The identified DRESS cases were evaluated using the Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scoring system [Kardaun et al, 2007]. Result(s): We identified twelve published DRESS cases associated with COVID-19 (Table 1). Eleven patients presented with severe COVID-19 disease complicated by DRESS syndrome that developed several days after initial COVID-19 clinical presentation (ARDS n5;multiorgan failure n1;pneumonia requiring mechanical ventilation, n4), one patient was asymptomatic. The culprit drugs included piperacillin-tazobactam (n4), hydroxychloroquine (n5), vancomycin (n2), ceftriaxone (n1), midazolam (n1), sulphasalazine (n1), azithromycin (n1), esomeprazole (n1), cefepime (n1), levofloxacin (n1), and meropenem (n1). The latency between the onset of treatment with culprit drug(s) and the onset of symptoms ranged from 9 to 42 days. All patients presented with widespread maculopapular rash, affecting > 50% of body surface area;five patients also had facial edema. Systemic involvement included liver (n8), renal abnormalities (n8), and heart involvement (n4). All patients had elevated body temperature (fever > = 38.5degreeC, n6) and blood eosinophilia, five patients had lymphadenopathy. Atypical lymphocytes were a rare laboratory finding (n2). Systemic corticosteroids were used in all patients;three patients received benralizumab for DRESS syndrome. Nine patients recovered, two patients died and the outcome was not reported in one case Conclusion(s): DRESS syndrome in COVID-19 patients is associated with multiple drugs, most notably with hydroxychloroquine and a variety of antibiotics. An early recognition may improve management of DRESS syndrome in COVID-19 patients.

Practices of French and Francophones allergists in the management of allergic risks and complications of anti-SARS- COV- 2 vaccination

Background: The SARS-COV- 2 vaccination campaign has massively mobilized the allergists' community to screen patients deemed at risk for the SARS-COV- 2 vaccines. To describe data regarding the management of medical calls regarding the allergic risk for the SARS-COV- 2 vaccination, amongst French allergists. Method(s): A questionnaire-based survey was launched on the AdviceMedica platform (a platform of medical advice exchange between peers) between July and October 2021 (including two reminders). Result(s): Fifty-four allergists answered the survey. Three quarters of the responders were full-time allergists. Overall, 42% and 35% had an exclusive hospital or private practice, respectively. Allergists were mostly contacted by telephone (96.3%) and e-mail (79.6%), by general practitioners (92.6%) or physicians practicing in vaccination centers (88.8%) (median of vaccine related medical calls: 10 per week (Q25-Q75: 7-20, range (2-300). Allergists favored in-person visits rather than teleconsultations (85.2% vs. 61.1%). Allergy testing was prescribed for suspicions of allergy to polyethylene glycol (84.4%) or other vaccines and non-identified drugs (64.4%). Half of the responders (29, 53.7%) could perform vaccination and four (13.7%) declared reactions during vaccination. The responders used several tools in taking their clinical decision: exchanges with peers from the AdviceMedica platform (40.4%), advice from tertiary university hospital allergy units (25%), recommendations of the French Society of Allergy (17.3%). The three most frequent drawbacks that the allergists encountered were: having a hard time adding supplementary patient visits within optimal delays (three quarters of the responders), the reluctance expressed by the physicians requiring the advice and by the patients (two thirds) and the fact that the learnt society recommendations were deemed not to cover many on-field situations (one third). The major benefits from screening were estimated to be the lack of allergy contraindication to vaccination (88.7%) and the increased visibility of the allergist's role (69.8%). Conclusion(s): This survey put numbers on the management of screening patients deemed at risk for the SARS-COV- 2 vaccination amongst French allergists. Peer exchange was the most frequent tool in taking a clinical decision.

Anaphylactic shock induced by a depot corticosteroid: Reflections on a clinical case

Introduction (contexte de la recherche): IgE-mediated reactions to systemic corticosteroids (CSs) are rare. Hydrocortisone and methylprednisolone succinate ester are the most frequent elicitors. Excipients of depot corticosteroids (like carmellose or macrogol) may also be involved. The involvement of the dipropionate form of betamethasone (present in the depot Diprostene) has not been studied. Objectif: To describe the case of a 40-year-old woman, who presented an anaphylactic shock reaction upon intra-articular administration of Diprostene (Betamethasone sodium phosphate and betamethasone dipropionate), associated with an iodinated radiocontrast media (ICM, Xenetix). Methodes: An allergy work-up was performed, according to recommendations for severe immediate reactions. Nine months after the reaction [hypotension (7/5 mmHg), erythema and desaturation at 94%, treated with adrenalin, methylprednisolone hemisuccinate, dexchlorpheniramine] the patient underwent skin prick tests (SPT) and intradermal tests (IDT) with ICM, bethamethasone and Diprostene (commercial molecules). Latex and chlorexidine were also studied. Resultats: The tests resulted negative for ICM, latex and chlorexidine (including serum specific IgE ImmunoCAP ThermoFisher Scientific), bethametasone phosphate (IDT 0.4 mg/mL) and carmellose (IDT 0.5 mg/mL). SPT elicited a positive reaction towards Diprostene in immediate reading, (for 5, 0.5, 0.05 mg/mL) with an erythema (10, 8, 5 mm respectively) and a wheal (of at least 3 mm for each SPT). We performed an oral drug challenge to bethametasone phosphate for a total of 8 mg and it was well tolerated. The basal tryptase was 5.5 microg/mL. Tryptasemia 30 minutes after the reaction was 26.8 microg/mL. Conclusion(s): We describe an anaphylactic reaction to Diprostene, proven by positive ST. The hypothesis of allergy to betamethasone dipropionate is under investigation. The hypothesis of allergy to macrogol, the other excipient of (which was not tested separately) is less likely, since the patient received Commirnaty SARS-CoV-2 vaccine 3 months after the reaction. The allergy work-up is ongoing (tests are programmed for betamethasone dipropionate alone).Copyright © 2023

Allergist coorporation, the COVID-19 vaccination's keystone

Background: The French vaccination campaign against COVID-19 was accompanied by an overwhelming increase in allergists work load highlighting our key role in the stratification of the allergy risk prior to vaccination. Method(s): In order to describe our triage and testing experience for the COVID-19 vaccination all requests were analysed in a standardized way prospectively. Our final goal was to filter the requests and avoid any delay in the vaccination process. We first set up and validated locally a questionnaire (completed by the requesting practitioner) allowing to evaluate the risk of allergy to the vaccine, based on the clinical history of the patient. Questionnaire-based allergy advices were delivered (regular vaccination or allergy testing prior to vaccination). Result(s): From January 2021 to January 2022, we addressed 1047 requests. Forty-one patients (4%) were tested. 96% had allergies to other compounds, not increasing the risk of reacting to the covid vaccines and were vaccinated safely. Half of the tested patients experienced an immediate reaction to the vaccine and the other half had a history of allergy to the vaccine's components. We identified 3 groups of patients: -Suspicions of polyethylene glycol (PEG) containing laxative allergy comprised 8 patients (26%), including 2 cases with proven IgE-mediated allergy to PEG. They were 63% (5) women, 63% (5) atopic (average age of 49 +/-10 yrs). Two thirds (63%, 5 patients) had an immediate reaction to PEG, including 3 and 2 patients with anaphylaxis with and without shock, respectively. The two allergic patients refused vaccination and received a certificate of contraindication to PEG-containing vaccines (as per French law). -Reactions to the covid vaccine comprised 21 patients: most were women (86%, 18 patients) and 29% (6) were atopic (average age was 51 +/-19 yrs). Three quarters (76%, 16 patients) presented a reaction within 1 hour after the vaccination, considered as potential anaphylaxis in 12 patients (8 patients with and 5 without shock). 100% (21 patients) were tested negative. Twenty patients (95%) were further vaccinated without reaction. One required H1 antihistamine. -Suspicions of allergy to PEG or polysorbate as excipients included 12 patients (29%). Most clinical histories were anaphylactic (42% without and 33% with shock). Following negative excipient skin testing, regular vaccination was authorized. Conclusion(s): Overall, only 4% of the initial requests were deemed eligible for allergy testing. We did not diagnose any allergy in patients who reacted to the vaccines and we delivered two certificates of contraindication to mRNA COVID-19 PEG-containing vaccines in two cases of confirmed IgE-mediated allergy to PEG.

Réintroduction du vaccin COMIRNATY® chez une patiente présentant une allergie confirmée au PEG

Introduction (contexte de la recherche) Une allergie à l'un des composants du vaccin contre la Covid-19, comme le polyéthylène glycol (PEG), fait partie des contre-indications à la vaccination par COMIRNATY®. Un avis allergologique est nécessaire pour confirmer une éventuelle suspicion d'allergie au PEG. Objectif Présentation d'une proposition de prise en charge des patients ayant des antécédents de réaction allergique immédiate à l'un des composants du vaccin contre la Covid-19. Méthodes Nous présentons le cas d'une patiente travaillant dans le secteur médical, ayant présenté une réaction anaphylactique immédiate (nausée, vomissements, urticaire généralisée et céphalée) après avoir pris un laxatif contenant du PEG en tant que principe actif (MACROGOL®), 15 années auparavant, dans un contexte de constipation. Nous avons confirmé l'allergie au PEG par un test cutané (en prick) positif. Le prick test au vaccin COMIRNATY® était également positif. Après avoir évalué de façon stricte la balance bénéfice-risque individuelle de la vaccination, nous avons vacciné la patiente en hôpital de jour d'allergologie selon un protocole de réintroduction progressive et sous surveillance clinique rapprochée. Résultats La patiente a bénéficié de la réintroduction de ce vaccin (sans prémédication) selon un protocole en 4 étapes (dose totale 0,3 mL). Le protocole a été réalisé en milieu sécurisé dans le service d'allergologie et après avoir obtenu le consentement de la patiente. Une surveillance clinique classique d'un test de réintroduction à risque a été réalisée. Les résultats du test de réadministration du vaccin n'ont montré aucune réaction allergique après une surveillance prolongée (2 heures après la dernière dose). Conclusions En présence d'une balance bénéfice-risque favorable à la vaccination et avec une surveillance stricte, la réintroduction du vaccin COMIRNATY® chez les patients avec une allergie confirmée au PEG est possible, avec une bonne tolérance.

Enquête COMPac (Complications allergiques des vaccins de la Covid) : étude des pratiques des allergologues français et francophones

Déclaration de liens d’intérêts: Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts.

Modèle de stratification du risque allergique à la vaccination SARS-COV2 via un questionnaire (et bénéfice du bilan allergologique)

Déclaration de liens d’intérêts: Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts.

[Anaphylaxis and COVID-19 vaccines]. / L'anaphylaxie et les vaccins COVID-19.

Vaccines against COVID-19 are an essential global intervention to control the current pandemic situation. Anaphylactic reactions have rapidly been reported after SARS-CoV2 RNA vaccines. This risk is now measured at 2.5-11/1,000,000 in the context of vaccine safety surveillance programs and only one case was documented to be due to polyethylene glycol. Suggestions for its role are indirect. The COVID-19 vaccination is rolling out vastly and surveillance programs are key to monitor severe adverse reactions, such as anaphylaxis. It is important to restore confidence about vaccination with COVID-19 mRNA and other vaccines and current data confirm their safety with no greater mortality than previous vaccines. Anaphylaxis is a complication that should be recognized immediately, be treated with epinephrine and which is not limiting and allows re-vaccination of some patients with pre-medication. It is important to recognize populations at risk such as women, patients with a history of allergies and anaphylaxis and to recognize the rare patients who have mast cell activating diseases. Anaphylaxis due to vaccine is extremely rare and specific cases should receive individualized investigation and care, highlighting the key role of allergists in the vaccination programmes.

Use of teleconsultation by allergists: Results of the 2021 CNPA survey

Teleconsultation has been a reimbursed tool for monitoring patients since 2018 but which experienced a phenomenal boom with the COVID crisis of 2020. The National Professional Council of Allergology wanted to survey its members in this regard. 82.1% did not use this tool before the crisis but during it 86.4% of the doctors did it and 66.8% still do it in 2021. The teleconsultation is used mainly for the renewal of an allergen immunotherapy, symptomatic treatments and to announce a biological assessment. One in two allergists find it “interesting” to be able to receive new patients in this way, especially for patients in a medical desert, with a history of drug allergy or chronic urticaria. 57.3% think they save time thanks to teleconsultation. We note that this tool has become a habit of allergists who have known how to appropriate and adapt it to their practice.

Utilisation de la téléconsultation par les allergologues : résultats de l’enquête du CNPA de 2021

Résumé La téléconsultation est un acte médical pris en charge par la sécurité sociale pour le suivi des patients depuis 2018 mais qui a connu un essor phénoménal avec la crise COVID de 2020. Le Conseil National Professionnel d’Allergologie a souhaité enquêter auprès de ses membres à ce propos. 82,1 % n’utilisait pas cet outil avant la crise mais pendant celle-ci 86,4 % des médecins l’ont fait et 66,8 % le font encore en 2021. La téléconsultation leur sert principalement pour le renouvellement d’une immunothérapie allergénique, de traitements symptomatiques et pour annoncer un bilan biologique. Un allergologue sur deux trouve “intéressant” le fait de pouvoir recevoir ainsi des nouveaux patients, notamment pour des patients dans un désert médical, une histoire d’allergie médicamenteuse ou une urticaire chronique. 57,3 % pensent gagner du temps grâce à la téléconsultation. On note ainsi que cet exercice de la médecine à distance est rentré dans les habitudes des allergologues qui ont su se l’approprier et l’adapter à leur pratique. Teleconsultation has been a reimbursed tool for monitoring patients since 2018 but which experienced a phenomenal boom with the COVID crisis of 2020. The National Professional Council of Allergology wanted to survey its members in this regard. 82.1% did not use this tool before the crisis but during it 86.4% of the doctors did it and 66.8% still do it in 2021. The teleconsultation is used mainly for the renewal of an allergen immunotherapy, symptomatic treatments and to announce a biological assessment. One in two allergists find it “interesting” to be able to receive new patients in this way, especially for patients in a medical desert, with a history of drug allergy or chronic urticaria. 57.3% think they save time thanks to teleconsultation. We note that this tool has become a habit of allergists who have known how to appropriate and adapt it to their practice.

Real life report of allergen immunotherapy management during the COVID-19 outbreak in France and Spain, a CHOICE project

Background: The COVID-19 pandemic represents a challenging global crisis. Guidelines have provided recommendations on allergen immunotherapy (AIT) practice, but very few real-life data have been reported on how AIT has been managed. In the framework of an ongoing project on AIT (The CHOICE project) in France and Spain, we developed a sub-study to evaluate the impact of COVID-19 in AIT clinical practice. The objective was to assess how the pandemic crisis affected aeroallergen AIT prescription patterns during the first hard lockdown and the following period. The survey was open for 30 days and was closed on November 4th, 2020. Method: An online questionnaire gathering information on physicians' profile and a questionnaire on possible issues concerning AIT, related to COVID-19, were developed and run among participants Results: 95 doctors participated to the survey: 62.1% were Spanish and 37.9% French, 72.7% females, with a mean age 48.2 years (±SD10.2). During the lockdown phase, 70.9% of participants received significantly less respiratory patients, than in 2019. Besides, 90.7% of physicians acknowledged a reduction in AIT prescriptions, with a median reduction of 75% [0-100], which was significantly beyond the decrease in examined patients (median 50% [0-100], p < 0.001). For new prescriptions, 57.6% of participants reported qualitative changes, with more sublingual immunotherapy (SLIT) than usual, especially in Spain (26.9% vs. 5.9% in France, p = 0.021). For SCIT on maintenance, 54.5% of doctors applied modifications, mainly temporarily pausing the treatment. After the lockdown, clinic normalization was only partially achieved, and still 32.6% of physicians (p = 0.001) reported a maintained decrease in the number of patients. The reduction in new AIT prescriptions was still very marked (52.6%). Also, qualitative changes were less frequent (23.5%), but prescribing more SLIT remained the most common modification (18.9%). Conclusion: Our novel real-life data show that the COVID-19 pandemic correlates to a reduction in respiratory patients consulting allergy specialists, and in new AIT prescription, with changes in qualitative prescription patterns. Our results are highly relevant to understand how AIT has been handled in real life, have insights on the amplitude of the impact of the crisis, and implement new strategies to ensure a quality and timely healthcare not only for those who missed their consultations, but also for future patients.

Guidelines for the prescription of allergen immunotherapy and patient follow-up – Methods and recommendations list

Allergen immunotherapy (AIT) for respiratory allergens is currently the only curative treatment for allergies;it also has a preventive effect towards the appearance of new sensitizations, and the evolution of allergic rhinitis to asthma and it makes it possible to reduce the therapeutic burden not only in patients suffering from allergic rhinitis, but also in asthmatics. The French National Professional Council of Allergy and the French Society of Allergy asked to the National NPP (Named-Patient Products) group (“groupe APSI”) to write the French national Clinical Practice Guidelines for the prescription of AIT and for patients’ monitoring, with a clear focus on NPP. Based on published meta-analysis and main studies in this field, a list of recommendations was drawn up by a group of more than 50 French allergists and based on 50 clinical questions that meet specific needs of AIT prescribers. We have drawn up 135 recommendations, which focus on the main aspects of the initiation of this treatment and on the follow-up of the patient, in different clinical situations, also including the possibility and the indications of such a treatment during pandemic, such as the one related to SARS-CoV-2 infection.

Guidelines for the prescription of allergen immunotherapy and patient follow-up — Clinical questions and revision of the literature

Allergen immunotherapy (AIT) for respiratory allergens is the only curative treatment for allergies. We previously published the list of the French National Clinical Practice Guidelines for AIT prescription and patient's monitoring. To carry out this work, a group of more than 50 French allergists wrote an exhaustive text answering 50 clinical questions that meet the specific needs of AIT prescribers. These questions have been classified into 7 groups, to focus on patient's choice, the indications and modalities of AIT prescription, treatment regimens, the routes of administration of AIT, its efficacy and safety, the choice of the allergen, patients’ follow-up and on other practical aspects that allergists may wonder about when prescribing such treatment. Answers to the 50 questions are based on the results of studies published in the literature, and, if hard data could not be found, on experts’ advice. The main goal of this work is to provide prescribers a clear picture of the most recent data and to guide them in choosing the optimal treatment for their allergic patients, taking into account the practical questions, which also include a look to the current clinical context, due to the SARS-CoV-2 pandemic. © 2020 Elsevier Masson SAS

Recommandations pour la prescription de l’immunothérapie allergenique et le suivi du patient – méthodologie et liste des recommandations

Résumé L’immunothérapie allergénique (ITA) aux allergènes respiratoires est à ce jour le seul traitement curatif des allergies ;elle a aussi un effet préventif vis-à-vis de l’apparition de nouvelles sensibilisations, de l’évolution de la rhinite allergique vers l’asthme et elle permet de diminuer la charge thérapeutique non seulement chez les patients souffrant de rhinite allergique, mais aussi chez l’asthmatique. Le Conseil National Professionnel d’Allergologie et la Société française d’allergologie ont mandaté le groupe APSI pour rédiger des recommandations pour la pratique clinique (RPC) nationales pour la prescription de l’ITA et le suivi du patient, avec un focus sur les APSI. Sur la base des méta-analyses publiées dans la littérature et des principales études dans ce domaine, une liste de recommandations a été rédigée par un groupe de plus de 50 allergologues français et sont basées sur 50 questions cliniques répondant aux besoins spécifiques des prescripteurs d’ITA. Nous avons ainsi rédigé 135 recommandations, qui se focalisent sur les aspects principaux de la mise en route de ce traitement et sur le suivi du patient, dans différentes situations cliniques, en incluant aussi la possibilité et les indications d’un tel traitement lors d’une infection pandémique, telle que l’infection à SARS-CoV-2. Allergen immunotherapy (AIT) for respiratory allergens is currently the only curative treatment for allergies;it also has a preventive effect towards the appearance of new sensitizations, and the evolution of allergic rhinitis to asthma and it makes it possible to reduce the therapeutic burden not only in patients suffering from allergic rhinitis, but also in asthmatics. The French National Professional Council of Allergy and the French Society of Allergy asked to the National NPP (Named-Patient Products) group (“groupe APSI”) to write the French national Clinical Practice Guidelines for the prescription of AIT and for patients’ monitoring, with a clear focus on NPP. Based on published meta-analysis and main studies in this field, a list of recommendations was drawn up by a group of more than 50 French allergists and based on 50 clinical questions that meet specific needs of AIT prescribers. We have drawn up 135 recommendations, which focus on the main aspects of the initiation of this treatment and on the follow-up of the patient, in different clinical situations, also including the possibility and the indications of such a treatment during pandemic, such as the one related to SARS-CoV-2 infection.

Recommandations pour la prescription de l’immunothérapie allergénique et le suivi du patient — Questions développées et revue de la littérature

Résumé L’immunothérapie allergénique (ITA) aux allergènes respiratoires est à ce jour le seul traitement curatif des allergies. Nous avons précédemment publié la liste des recommandations pour la pratique cliniques (RPC) nationales pour la prescription de l’ITA et le suivi du patient. Pour la réalisation de ce travail, un groupe de plus de 50 allergologues français a rédigé un texte exhaustif basé sur 50 questions cliniques pratiques pour les prescripteurs d’ITA. Ces questions ont été classées en 7 groupes, pour focaliser l’attention sur le choix du patient, les indications et modalité de prescription d’une ITA, les schémas thérapeutiques, les voies d’administration de l’ITA, son efficacité et sécurité, le choix de l’allergène, le suivi du patient et sur d’autres aspects pratiques sur lesquels les allergologues peuvent s’interroger lors de la prescription d’un tel traitement. Les réponses aux 50 questions sont basées sur les résultats des études publiées dans la littérature, et, en cas d’impossibilité à repérer des données solides, sur l’avis des experts. Le but principal de ce travail est de donner aux prescripteurs un tableau clair des données les plus récentes et de les guider dans le choix du traitement optimal pour leur patients allergiques, en tenant compte de l’utilité pratique des questions, qui incluent aussi un regard sur le contexte clinique actuel de pandémie à SARS-CoV-2. Allergen immunotherapy (AIT) for respiratory allergens is the only curative treatment for allergies. We previously published the list of the French National Clinical Practice Guidelines for AIT prescription and patient's monitoring. To carry out this work, a group of more than 50 French allergists wrote an exhaustive text answering 50 clinical questions that meet the specific needs of AIT prescribers. These questions have been classified into 7 groups, to focus on patient's choice, the indications and modalities of AIT prescription, treatment regimens, the routes of administration of AIT, its efficacy and safety, the choice of the allergen, patients’ follow-up and on other practical aspects that allergists may wonder about when prescribing such treatment. Answers to the 50 questions are based on the results of studies published in the literature, and, if hard data could not be found, on experts’ advice. The main goal of this work is to provide prescribers a clear picture of the most recent data and to guide them in choosing the optimal treatment for their allergic patients, taking into account the practical questions, which also include a look to the current clinical context, due to the SARS-CoV-2 pandemic.

[The allergist facing the COVID-19 pandemic: What impact and what precautions should be taken?] / L'allergologue face à l'épidémie de COVID-19 : quel impact et quelles précautions prendre ?

In the unusual health environment of the COVID 19 pandemic, allergists must adapt their exercise and their office or clinic, by strengthening hygiene and distancing precautions. In case of sanitary containment telehealth can, in many cases, replace face-to-face visits. Nevertheless, each practitioner must define the contingency planning and the priorities according to his own practice and the epidemic context.