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I saw a 16 year-old girl with Ehlers Danlos syndrome and postural tachycardia hypotension. She has severe allergic rhinitis to seasonal and perennial allergens and pollen food syndrome manifested by oropharyngeal itching and urticarial. Is there any contraindication to allergen immunotherapy in this patient?


Based upon the information that you provided, I see no contraindications for allergen immunotherapy in this patient. Given that the patient has POTS, it would be prudent for the patient to be well hydrated prior to administration of IT, and seated or supine during the injection with a gradual return to standing afterwards. I would also recommend checking blood pressure and pulse pre/post IT administration. I have provided a reference that provides a comprehensive list of concerns and contraindications to allergen immunotherapy.

Pitsios C, Demoly P et al. Clinical contraindications to allergen immunotherapy: an EAACI position paper. Allergy 2015;70:897-909
I hope this information is helpful.
Jacqueline A. Pongracic, MD, FAAAAI

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