Malignancy and Specific Allergen Immunotherapy: The Results of a Case Series

Abstract

Background: Specific immunotherapy with allergen is the only causative treatment for IgE-mediated allergies such as stinging insect allergy or hay fever and works by the induction of blocking antibodies and regulatory T lymphocytes. Objective: Does a hypothetical obstruction of tumor surveillance presupposing the induction of regulatory T cells really justify detaining immunotherapy to oncologic patients as suggested by recent guidelines? Methods: We report 6 patients (4 female, 2 male) suffering or having suffered from stage 1 cancer (4 melanomas, 1 lung cancer, 1 breast cancer) and concomitant IgE-mediated allergy. Four of them had a history of severe anaphylactic reactions to the insect yellow jacket, the 5th suffered from allergic rhinoconjunctivitis to dust mites, and the 6th to grass/rye pollen. Results: Between 2004 and 2010, subcutaneous immunotherapy was safely performed in 5 patients without signs of tumor reactivation. The cancer in 2 of them was diagnosed immediately after specific immunotherapy had been initiated and in another 2 the active cancer phase had already finished years before; the 5th suffered from a relapse around the time of the initiation of immunotherapy. At the time of the writing of the manuscript, 4 of them had already concluded 3 years of treatment, another one almost 1 year. The melanoma in the 6th patient was diagnosed 5 months after reaching the maintenance dose. Immunotherapy with grass/rye pollen was aborted in this patient based on current guidelines. Conclusions: Specific immunotherapy was safely administered in patients suffering concomitantly from IgE-mediated allergy and lower stage cancer.

Clinical contraindications to allergen immunotherapy: an EAACI position paper

“… Concomitant acute or clinically relevant malignant tumours are considered absolute contraindications for AIT with aeroallergens by some guidelines , while in others there is no mention of these disorders . No controlled studies about the effectiveness or risks of AIT in these patients are available . The increased risk of a disease exacerbation due to AIT in patients with malignant neoplastic diseases is theoretical and this contraindication has been established for safety and ethical reasons, as possible immunological interaction between the cancer and AIT cannot be ruled out. There is no published or documented theoretical interaction between (pharmaceutical or other) treatment of an underlying malignant disease and AIT, nor of interactions between drugs used to treat a possible anaphylactic reaction due to AIT and cancer treatments. In high‐risk venom‐allergic patients (e.g. mastocytosis or any previous life‐threatening reaction) with a concomitant neoplasia, VIT is indicated so as to prevent a fatal reaction in the case of a Hymenoptera sting. Conclusion : Malignant neoplasias are considered an absolute contraindication, but VIT is a highly advised option in high‐risk venom‐allergic patients (Table ).…”

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

“…34 No controlled studies are available relating to the risk or effectiveness of AIT in malignant neoplasias. …”

Hymenoptera Venom Allergy: Management of Children and Adults in Clinical Practice

“…Malignant neoplasms are considered absolute contraindications for specific immunotherapy with aeroallergens, although not all guidelines agree. This contraindication has been established for safety and ethical reasons [249], since the risk of an exacerbation of neoplastic disease by allergen immunotherapy is only theoretical, although a possible immunological interaction between neoplasm, cancer treatments, and allergen immunotherapy cannot be completely excluded. However, in patients allergic to hymenoptera venom with a high risk of severe reactions to subsequent stings (eg, previous life-threatening reaction or clonal mast cell diseases), VIT appears to prevent fatal events even in the presence of cancer [228,250] (strength of recommendation, D).…”