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.

Palomares O, Yaman G, Azkur AK, Akkoc T, Akdis M, Akdis CA: Role of T regulatory cells in immune regulation of allergic diseases. Eur J Immunol 2010;40:1–9.
Bohle B, Kinaciyan T, Gerstmayr M, Radakovics A, Jahn-Schmid B, Ebner C: Sublingual immunotherapy induces IL-10-producing T regulatory cells, allergen-specific T-cell tolerance, and immune deviation. J Allergy Clin Immunol 2007;120:707–713.
Kinaciyan T, Jahn-Schmid B, Radakovics A, Zwolfer B, Schreiber C, Francis JN, et al: Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1 homolog Mal d 1. J Allergy Clin Immunol 2007;119:937–943.
Mahnke K, Schonfeld K, Fondel S, Ring S, Karakhanova S, Wiedemeyer K, et al: Depletion of CD4+CD25+ human regulatory T cells in vivo: kinetics of Treg depletion and alterations in immune functions in vivo and in vitro. Int J Cancer 2007;120:2723–2733.
Kleine-Tebbe J, Bufe A, Ebner C, Eigenmann P, Friedrichs F, Fuchs T, et al: Die spezifische Immuntherapie (Hyposensibilisierung) bei IgE-vermittelten allergischen Erkrankungen. Allergo J 2009;18:508–537.
Ruëff F, Bergmann KC, Brockow K, Fuchs T, Grübl A, Jung K, et al: Hauttests zur Diagnostik von allergischen Soforttypreaktionen. Allergo J 2010;19:402–415.
Wöhrl S, Gamper S, Hemmer W, Heinze G, Stingl G, Kinaciyan T: Premedication with montelukast reduces local reactions of allergen immunotherapy. Int Arch Allergy Immunol 2007;144:137–142.
Mueller HL: Maintenance of protection in patients treated for stinging insect hypersensitivity: a booster injection program. Pediatrics 1977;59:773–777.
Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, et al: Staging system for breast cancer: revisions for the 6th edition of the AJCC Cancer Staging Manual. Surg Clin North Am 2003;83:803–819.
Valent P, Akin C, Escribano L, Fodinger M, Hartmann K, Brockow K, et al: Standards and standardization in mastocytosis: consensus statements on diagnostics, treatment recommendations and response criteria. Eur J Clin Invest 2007;37:435–453.
Detterbeck FC, Boffa DJ, Tanoue LT: The new lung cancer staging system. Chest 2009;136:260–271.
Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, et al: Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline. Eur J Cancer 2010;46:270–283.
Kleine-Tebbe J, Bergmann KC, Friedrichs F, Fuchs T, Jung K, Klimek L, et al: Die spezifische Immuntherapie (Hyposensibilisierung) bei IgE-vermittelten allergischen Erkrankungen. Allergologie 2006;29:135–156.
Cox L, Li JT, Nelson H, Lockey R: Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol 2007;120:S25–S85.
Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al: Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA2LEN and AllerGen). Allergy 2008;63(suppl 86):8–160.
Sublingual immunotherapy: World Allergy Organization position paper 2009. Allergy 2009;64:1–59.
Fricker M, Helbling A, Schwartz L, Müller U: Hymenoptera sting anaphylaxis and urticaria pigmentosa: clinical findings and results of venom immunotherapy in ten patients. J Allergy Clin Immunol 1997;100:11–15.
Ruëff F, Przybilla B, Biló MB, Müller U, Scheipl F, Aberer W, et al: Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase-a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. J Allergy Clin Immunol 2009;124:1047–1054.
Ruëff F, Wenderoth A, Przybilla B: Patients still reacting to a sting challenge while receiving conventional Hymenoptera venom immunotherapy are protected by increased venom doses. J Allergy Clin Immunol 2001;108:1027–1032.
Jensen-Jarolim E, Achatz G, Turner MC, Karagiannis S, Legrand F, Capron M, et al: AllergoOncology: the role of IgE-mediated allergy in cancer. Allergy 2008;63:1255–1266.
Talbot-Smith A, Fritschi L, Divitini ML, Mallon DFJ, Knuiman MW: Allergy, atopy, and cancer: a prospective study of the 1981 Busselton cohort. Am J Epidemiol 2003;157:606–612.
Turner MC, Chen Y, Krewski D, Ghadirian P, Thun MJ, Calle EE: Cancer mortality among US men and women with asthma and hay fever. Am J Epidemiol 2005;162:212–221.
Schabath MB, Gorlova OY, Spitz MR: Reply: ‘Cancer mortalitiy among US men and women with asthma and hay fever’. Am J Epidemiol 2006;163:394–395.
Castaing M, Youngson J, Zaridze D, Szeszenia-Dabrowska N, Rudnai P, Lissowska J, et al: Is the risk of lung cancer reduced among eczema patients? Am J Epidemiol 2005;162:542–547.
Wang H, Rothenbacher D, Low M, Stegmaier C, Brenner H, Diepgen TL: Atopic diseases, immunoglobulin E and risk of cancer of the prostate, breast, lung and colorectum. Int J Cancer 2006;119:695–701.
Bakos N, Schöll I, Szalai K, Kundi M, Untersmayr E, Jensen-Jarolim E: Risk assessment in elderly for sensitization to food and respiratory allergens. Immunol Lett 2006;107:15–21.
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