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Allergy. 2019 Apr 7. doi: 10.1111/all.13805. [Epub ahead of print]

2019 ARIA Care pathways for allergen immunotherapy.

Author information

1
MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France.
2
INSERM U 1168, VIMA : Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France, Euforea, Brussels, Belgium, and Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and AllergyBerlin, Germany.
3
Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Germany.
4
Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, US.
5
Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada.
6
Hospital Quirónsalud Bizkaia, Bilbao, Spain.
7
Division of Infection, Immunity& Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK, and Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou," University of Athens, Athens, Greece.
8
Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece.
9
Faculty of Medicine, Transylvania University, Brasov, Romania.
10
ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
11
IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
12
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
13
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
14
Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium.
15
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, member of GA2LEN, Berlin, Germany.
16
Woolcock Institute of Medical Research, University of Sydney and Woolcock Emphysema Centre and Local Health District, Glebe, NSW, Australia.
17
Allergist, La RochelleFrance.
18
Quebec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada.
19
Calderon. Imperial College London - National Heart and Lung Institute, Royal Brompton Hospital NHS, London, UK.
20
Personalized Medicine Clinic Asthma & Allergy, Humanitas University, Humanitas Research Hospital, Rozzano, Milan, Italy.
21
Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Colombia, and Foundation for the Development of Medical and Biological Sciences (Fundemeb)Cartagena, Colombia.
22
Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL research network, Barcelona, Spain.
23
Division of Allergy/Immunology, University of South Florida, Tampa, USA.
24
SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
25
UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork), University of Porto, Portugal.
26
Medical Consulting Czarlewski, Levallois, France.
27
ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Brasil and WHO GARD Planning Group, Brazil.
28
Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, UK.
29
Guy's and st Thomas' NHS Trust, Kings College London, UK.
30
Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
31
Clinical Reserch Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.
32
Unité de pneumo-allergologie de l'enfant, pôle pédiatrique, CHU de Clermont-Ferrand-Estaing, Clermont-Ferrand, France.
33
Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
34
Department of Otorhinolaryngology, Academic Medical Centres, AMC, Amsterdam, the Netherlands.
35
CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto; and Medida, Lda Porto, Portugal.
36
Allergist, Reims, France.
37
Department of Internal Medicine, section of Allergology, Erasmus MC, Rotterdam, the Netherlands.
38
Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki,, Helsinki, Finland.
39
Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
40
Dept of Otorhinolaryngology, Univ Hospitals Leuven, and Academic Medical Center, Univ of Amsterdam, The Netherlands and Euforea, Brussels, Belgium.
41
Dept of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan.
42
Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
43
Allergy Learning and Consulting, Copenhagen, Denmark.
44
Department of Clinical Immunology, Wrocław Medical University, Poland.
45
Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
46
National Research Center, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology, Moscow, Russian Federation.
47
Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey.
48
Allergy& Asthma Center Westend, Berlin, Germany.
49
Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Poland, Sach's Childrend and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
50
Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland.
51
Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, and Institute of Clinical medicine, Clinic of Chest diseases and Allergology, faculty of Medicine, Vilnius University, Vilnius, Lithuania.
52
Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy.
53
Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
54
Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany.
55
KYomed INNOV, Montpellier, France.
56
University of Medicine and Pharmacy, Hochiminh City, Vietnam.
57
Oslo University Hospital, Department of Paediatrics, and University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.
58
Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
59
Danish Allergy Centre, University of Copenhagen, Copenhagen, Denmark.
60
EUFOREA, Bussels, Belgium.
61
CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.
62
Unité Médico-Economie, Département de l'Information Médicale, University Hospital, Montpellier, France.
63
Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Spain.
64
Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
65
Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, and Central Clinical School, Monash University, Melbourne, Victoria, Australia.
66
Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.
67
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
68
Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
69
Allergy and Respiratory Diseases, Ospedale Policlino San Martino -University of Genoa, Italy.
70
Allergy department, Pasteur Institute, Paris, France.
71
David Hide Centre, St Mary's Hospital, Isle of Wight, and University of Southampton, Southampton, UK.
72
Association Asthme et Allergie, Paris, France.
73
Hospital de Clinicas, University of Parana, Brazil.
74
Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Edinburgh, UK.
75
Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Poland.
76
Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela.
77
The Royal National TNE Hospital, University College London, UK.
78
Immunomodulation and Tolerance Group, Imperial College London, and Allergy and Clinical Immunology, Imperial College London, London, UK.
79
The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
80
Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria and Outpatient Allergy Clinic Reumannplatz, Vienna Austria.
81
Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Portugal.
82
Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
83
Allergist, MontevideoUruguay.
84
Vilnius University Institute of Clinical Medicine, Clinic of Children's Diseases, and Institute of Health Sciences, Department of Public Health, Vilnius, Lithuania.
85
European Academy of Paediatrics, (EAP/UEMS-SP), Brussels, Belgium.
86
Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo allergy clinic, Turku, Finland.
87
University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy.
88
Pediatric Department, Charité, Berlin, Germany.
89
Asthma, Mansell street, London UK.
90
Nova Southeastern University, Fort Lauderdale, Florida, USA.

Abstract

Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including health professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as on the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow up of patients. This article is protected by copyright. All rights reserved.

KEYWORDS:

Allergen immunotherapy; asthma; children; mHealth; rhinitis; stratification

PMID:
30955224
DOI:
10.1111/all.13805

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