Table 2 Items included in the questionnaire about “Allergy to mites, animal dander and moulds” (2A) and results (2B)

Epidemiology

25- Knowledge of the predominant type of mites in a geographical area is useful in defining the composition of immunotherapy in an allergic patient.

26- The moulds with the most epidemiological importance in respiratory allergy are Aspergillus and Alternaria.

27- In patients with double sensitisation to mites and Alternaria, it is essential know if there is exposure to both sources

Clinical relevance

28- Skin-tests, by themselves, are sufficient for the diagnosis of mite allergy, epithelia and mould.

29- Skin-tests are sufficient for the immunotherapy prescription to mites, epithelium and mould.

30- Quantitation of specific IgE in serum against full mite extract adds additional value to the skin-test.

31- In order to know the true sensitisation profile of patients allergic to mites, molecular diagnosis is necessary.

32- The specific IgE determination in serum against Der p 1 and Der p 2 is useful if these components have been quantified in the vaccine.

33- The IgE specific quantification to Dermatophagoides and/or Lepidoglyphus and/or Blomia helps to decide AIT composition.

34- Alt a1 determination as primary sensitiser to Alternaria is recommended before AIT prescription with this mould.

35- Clinical relevance of double sensitisation to Alternaria and mites may be improved by symptom’s calendar.

Therapeutic strategy (AIT for mite sensitised patients)

36-Given the high cross-reactivity between Dermatophagoides pteronyssinus and farinae, the choice of the species present in the vaccine is irrelevant.

37- Quantification of major molecular components (Der p 1 and Der p 2) in the vaccine is mandatory

38- In case of sensitisation to Lepidoglyphus or Blomia in a patient allergic to Dermatophagoides, only after proving clinical relevance of these minor mites should a vaccine be indicated.

39- Vaccines containing minor mites should not be used until efficacy has been proven.

40- In case of true allergy to both a minor mite and Dermatophagoides, a vaccine containing both allergens could be used as a 50% mixture.

41- It is not advisable to mix mites with any other different allergenic source due to their proteolytic activity

Therapeutic strategy (patient allergic to moulds (one or more) and with/without mite allergy)

42- Patients allergic to Alternaria only should receive a vaccine containing this allergenic source.

43- Alternaria vaccine must have its major allergen quantified (Alt a 1)

44- Immunotherapy with mould mixtures is not indicated.

Therapeutic strategy (Regarding patients allergic to epithelia with/without other sensitivities)

45- There is not sufficient scientific evidence in immunotherapy to epithelia different from cat and dog

46- Studies with cat epithelium vaccine have shown clinical efficacy

47- In case of mite and epithelia sensitisation, both clinically relevant when animal avoidance is not possible, a mixture of both would be advisable.

48- In case of mite and epithelia sensitisation, both clinically relevant when animal avoidance is not possible, two vaccines should be used

49- In the same situation as previously described, the use of a vaccine containing one allergen could be recommended followed by the consideration for a second AIT

50- In patients allergic to horse epithelium , when occupational exposure and/or severe impact on quality of life is present, AIT could be considered