2019 ARIA Care pathways for allergen immunotherapy.

Authors:
Jean Bousquet
Jean Bousquet
Université Laval
Canada
Oliver Pfaar
Oliver Pfaar
University Hospital Mannheim
Germany
Alkis Togias
Alkis Togias
Johns Hopkins University School of Medicine
United States
Ignacio Ansotegui
Ignacio Ansotegui
University of Genoa
Italy
Nikolaos G Papadopoulos
Nikolaos G Papadopoulos
2nd Pediatric Clinic
Toronto | Canada
Ioanna Tsiligianni
Ioanna Tsiligianni
University Medical Center Groningen
Greece
Ioana Agache
Ioana Agache
Transylvania University
Romania

Allergy 2019 Apr 7. Epub 2019 Apr 7.

Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GA2LEN, Humboldt-Uniersität zu Berlin, Berlin, Germany.

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 healthcare 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 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.

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http://dx.doi.org/10.1111/all.13805DOI Listing

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April 2019
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