2019 ARIA Care pathways for allergen immunotherapy

Jean Bousquet^{1

2

3

4

5

6}, Oliver Pfaar⁷, Alkis Togias⁸, Holger J Schünemann⁹, Ignacio Ansotegui¹⁰, Nikolaos G Papadopoulos^{11

12}, Ioanna Tsiligianni¹³, Ioana Agache¹⁴, Josep M Anto^{15

16

17

18}, Claus Bachert¹⁹, Anna Bedbrook¹, Karl-Christian Bergmann²⁰, Sinthia Bosnic-Anticevich²¹, Isabelle Bosse²², Jan Brozek⁹, Moises A Calderon²³, Giorgio W Canonica²⁴, Luigi Caraballo^{25

26}, Victoria Cardona²⁷, Thomas Casale²⁸, Lorenzo Cecchi²⁹, Derek Chu⁹, Elisio Costa³⁰, Alvaro A Cruz^{31

32}, Wienczyslawa Czarlewski³³, Stephen R Durham³⁴, George Du Toit³⁵, Mark Dykewicz³⁶, Motohiro Ebisawa³⁷, Jean Luc Fauquert³⁸, Montserrat Fernandez-Rivas³⁹, Wytske J Fokkens⁴⁰, João Fonseca^{41

42}, Jean-François Fontaine⁴³, Roy Gerth van Wijk⁴⁴, Tari Haahtela⁴⁵, Susanne Halken⁴⁶, Peter W Hellings^{47

48}, Despo Ierodiakonou¹³, Tomohisa Iinuma⁴⁹, Juan Carlos Ivancevich⁵⁰, Lars Jacobsen⁵¹, Marek Jutel⁵², Igor Kaidashev⁵³, Musa Khaitov⁵⁴, Omer Kalayci⁵⁵, Jörg Kleine Tebbe⁵⁶, Ludger Klimek⁵⁷, Marek L Kowalski^{58

59}, Piotr Kuna⁶⁰, Violeta Kvedariene^{61

62}, Stefania La Grutta⁶³, Désirée Larenas-Linemann⁶⁴, Susanne Lau⁶⁵, Daniel Laune⁶⁶, Lan Le⁶⁷, Karin Lodrup Carlsen^{68

69}, Olga Lourenço⁷⁰, Hans-Jørgen Malling⁷¹, Gert Marien⁴, Enrica Menditto⁷², Gregoire Mercier⁷³, Joaquim Mullol^{74

75}, Antonella Muraro⁷⁶, Robyn O'Hehir⁷⁷, Yoshitaka Okamoto⁴⁹, Giovanni B Pajno⁷⁸, Hae-Sim Park⁷⁹, Petr Panzner⁸⁰, Giovanni Passalacqua⁸¹, Nhan Pham-Thi⁸², Graham Roberts⁸³, Ruby Pawankar⁸⁴, Christine Rolland⁸⁵, Nelson Rosario⁸⁶, Dermot Ryan⁸⁷, Bolesław Samolinski⁸⁸, Mario Sanchez-Borges⁸⁹, Glenis Scadding⁹⁰, Mohamed H Shamji^{91

92}, Aziz Sheikh⁹³, Gunter J Sturm^{94

95}, Ana Todo Bom⁹⁶, Sanna Toppila-Salmi⁴⁵, Maryline Valentin-Rostan⁹⁷, Arunas Valiulis^{98

99

100}, Erkka Valovirta¹⁰¹, Maria-Teresa Ventura¹⁰², Ulrich Wahn¹⁰³, Samantha Walker¹⁰⁴, Dana Wallace¹⁰⁵, Susan Waserman¹⁰⁶, Arzu Yorgancioglu¹⁰⁷, Torsten Zuberbier²⁰; ARIA Working Group

Affiliations

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, France.
³ UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France.
⁴ Euforea, Brussels, Belgium.
⁵ Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
⁶ Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany.
⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
⁸ Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland.
⁹ Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Hospital Quirónsalud Bizkaia, Bilbao, Spain.
¹¹ Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK.
¹² Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece.
¹³ Department of Social Medicine, Faculty of Medicine, University of Crete and International Primary Care Respiratory Group, Crete, Greece.
¹⁴ Faculty of Medicine, Transylvania University, Brasov, Romania.
¹⁵ Centre for Research in Environmental Epidemiology (CREAL), ISGlobAL, Barcelona, Spain.
¹⁶ IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
¹⁷ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
¹⁸ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
¹⁹ ENT Department, Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium.
²⁰ 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.
²¹ Woolcock Institute of Medical Research, Woolcock Emphysema Centre and Local Health District, University of Sydney, Glebe, New South Wales, Australia.
²² Allergist, La Rochelle, France.
²³ Imperial College London - National Heart and Lung Institute, Royal Brompton Hospital NHS, London, UK.
²⁴ Personalized Medicine Clinic Asthma & Allergy, Humanitas Research Hospital, Humanitas University, Milan, Italy.
²⁵ Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Cartagena, Colombia.
²⁶ Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia.
²⁷ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain.
²⁸ Division of Allergy/Immunology, University of South Florida, Tampa, Florida.
²⁹ SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
³⁰ UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork), University of Porto, Porto, Portugal.
³¹ ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil.
³² WHO GARD Planning Group, Salvador, Brazil.
³³ Medical Consulting Czarlewski, Levallois, France.
³⁴ Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK.
³⁵ Guy's and st Thomas' NHS Trust, Kings College London, London, UK.
³⁶ Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri.
³⁷ Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.
³⁸ Unité de pneumo-allergologie de l'enfant, pôle pédiatrique, CHU de Clermont-Ferrand-Estaing, Clermont-Ferrand, France.
³⁹ Allergy Department, IdISSC, Hospital Clinico San Carlos, Madrid, Spain.
⁴⁰ Department of Otorhinolaryngology, Academic Medical Centres, Amsterdam, The Netherlands.
⁴¹ CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
⁴² Medida, Lda, Porto, Portugal.
⁴³ Allergist, Reims, France.
⁴⁴ Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, The Netherlands.
⁴⁵ Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁴⁶ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
⁴⁷ Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.
⁴⁸ Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁴⁹ Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan.
⁵⁰ Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
⁵¹ Allergy Learning and Consulting, Copenhagen, Denmark.
⁵² Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland.
⁵³ Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
⁵⁴ Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology, National Research Center, Moscow, Russian Federation.
⁵⁵ Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey.
⁵⁶ Allergy & Asthma Center Westend, Berlin, Germany.
⁵⁷ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁵⁸ Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Lodz, Poland.
⁵⁹ Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
⁶⁰ Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
⁶¹ Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania.
⁶² Faculty of Medicine, Institute of Clinical medicine, Clinic of Chest diseases and Allergology, Vilnius University, Vilnius, Lithuania.
⁶³ Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy.
⁶⁴ Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
⁶⁵ Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany.
⁶⁶ KYomed INNOV, Montpellier, France.
⁶⁷ University of Medicine and Pharmacy, Hochiminh City, Vietnam.
⁶⁸ Department of Paediatrics, Oslo University Hospital, Oslo, Norway.
⁶⁹ Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷⁰ Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
⁷¹ Danish Allergy Centre, University of Copenhagen, Copenhagen, Denmark.
⁷² CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.
⁷³ Département de l'Information Médicale, Unité Médico-Economie, University Hospital, Montpellier, France.
⁷⁴ Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain.
⁷⁵ Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain.
⁷⁶ Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
⁷⁷ Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁷⁸ Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.
⁷⁹ Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
⁸⁰ Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
⁸¹ Allergy and Respiratory Diseases, Ospedale Policlino San Martino -University of Genoa, Genoa, Italy.
⁸² Allergy Department, Pasteur Institute, Paris, France.
⁸³ David Hide Centre, St Mary's Hospital, Isle of Wight and University of Southampton, Southampton, UK.
⁸⁴ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁸⁵ Association Asthme et Allergie, Paris, France.
⁸⁶ Hospital de Clinicas, University of Parana, Parana, Brazil.
⁸⁷ Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁸⁸ Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.
⁸⁹ Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela.
⁹⁰ The Royal National TNE Hospital, University College London, London, UK.
⁹¹ Immunomodulation and Tolerance Group, Imperial College London, London, UK.
⁹² Allergy and Clinical Immunology, Imperial College London, London, UK.
⁹³ The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
⁹⁴ Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
⁹⁵ Outpatient Allergy Clinic Reumannplatz, Vienna, Austria.
⁹⁶ Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁹⁷ Allergist, Montevideo, Uruguay.
⁹⁸ Clinic of Children's Diseases, Vilnius University Institute of Clinical Medicine, Vilnius, Lithuania.
⁹⁹ Department of Public Health, Institute of Health Sciences, Vilnius, Lithuania.
¹⁰⁰ European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium.
¹⁰¹ Department of Lung Diseases and Clinical Immunology, Terveystalo Allergy Clinic, University of Turku, Turku, Finland.
¹⁰² Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy.
¹⁰³ Pediatric Department, Charité, Berlin, Germany.
¹⁰⁴ Asthma UK, London, UK.
¹⁰⁵ Nova Southeastern University, Fort Lauderdale, Florida.
¹⁰⁶ Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario.
¹⁰⁷ Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.

PMID: 30955224
DOI: 10.1111/all.13805

Review

2019 ARIA Care pathways for allergen immunotherapy

Jean Bousquet et al. Allergy. 2019 Nov.

. 2019 Nov;74(11):2087-2102.

doi: 10.1111/all.13805. Epub 2019 Jul 15.

Authors

Affiliations

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, France.
³ UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France.
⁴ Euforea, Brussels, Belgium.
⁵ Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
⁶ Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany.
⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
⁸ Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland.
⁹ Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Hospital Quirónsalud Bizkaia, Bilbao, Spain.
¹¹ Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK.
¹² Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece.
¹³ Department of Social Medicine, Faculty of Medicine, University of Crete and International Primary Care Respiratory Group, Crete, Greece.
¹⁴ Faculty of Medicine, Transylvania University, Brasov, Romania.
¹⁵ Centre for Research in Environmental Epidemiology (CREAL), ISGlobAL, Barcelona, Spain.
¹⁶ IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
¹⁷ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
¹⁸ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
¹⁹ ENT Department, Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium.
²⁰ 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.
²¹ Woolcock Institute of Medical Research, Woolcock Emphysema Centre and Local Health District, University of Sydney, Glebe, New South Wales, Australia.
²² Allergist, La Rochelle, France.
²³ Imperial College London - National Heart and Lung Institute, Royal Brompton Hospital NHS, London, UK.
²⁴ Personalized Medicine Clinic Asthma & Allergy, Humanitas Research Hospital, Humanitas University, Milan, Italy.
²⁵ Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Cartagena, Colombia.
²⁶ Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia.
²⁷ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain.
²⁸ Division of Allergy/Immunology, University of South Florida, Tampa, Florida.
²⁹ SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
³⁰ UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork), University of Porto, Porto, Portugal.
³¹ ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil.
³² WHO GARD Planning Group, Salvador, Brazil.
³³ Medical Consulting Czarlewski, Levallois, France.
³⁴ Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK.
³⁵ Guy's and st Thomas' NHS Trust, Kings College London, London, UK.
³⁶ Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri.
³⁷ Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.
³⁸ Unité de pneumo-allergologie de l'enfant, pôle pédiatrique, CHU de Clermont-Ferrand-Estaing, Clermont-Ferrand, France.
³⁹ Allergy Department, IdISSC, Hospital Clinico San Carlos, Madrid, Spain.
⁴⁰ Department of Otorhinolaryngology, Academic Medical Centres, Amsterdam, The Netherlands.
⁴¹ CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
⁴² Medida, Lda, Porto, Portugal.
⁴³ Allergist, Reims, France.
⁴⁴ Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, The Netherlands.
⁴⁵ Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁴⁶ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
⁴⁷ Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.
⁴⁸ Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁴⁹ Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan.
⁵⁰ Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
⁵¹ Allergy Learning and Consulting, Copenhagen, Denmark.
⁵² Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland.
⁵³ Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
⁵⁴ Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology, National Research Center, Moscow, Russian Federation.
⁵⁵ Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey.
⁵⁶ Allergy & Asthma Center Westend, Berlin, Germany.
⁵⁷ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁵⁸ Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Lodz, Poland.
⁵⁹ Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
⁶⁰ Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
⁶¹ Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania.
⁶² Faculty of Medicine, Institute of Clinical medicine, Clinic of Chest diseases and Allergology, Vilnius University, Vilnius, Lithuania.
⁶³ Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy.
⁶⁴ Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
⁶⁵ Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany.
⁶⁶ KYomed INNOV, Montpellier, France.
⁶⁷ University of Medicine and Pharmacy, Hochiminh City, Vietnam.
⁶⁸ Department of Paediatrics, Oslo University Hospital, Oslo, Norway.
⁶⁹ Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷⁰ Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
⁷¹ Danish Allergy Centre, University of Copenhagen, Copenhagen, Denmark.
⁷² CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.
⁷³ Département de l'Information Médicale, Unité Médico-Economie, University Hospital, Montpellier, France.
⁷⁴ Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain.
⁷⁵ Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain.
⁷⁶ Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
⁷⁷ Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁷⁸ Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.
⁷⁹ Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
⁸⁰ Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
⁸¹ Allergy and Respiratory Diseases, Ospedale Policlino San Martino -University of Genoa, Genoa, Italy.
⁸² Allergy Department, Pasteur Institute, Paris, France.
⁸³ David Hide Centre, St Mary's Hospital, Isle of Wight and University of Southampton, Southampton, UK.
⁸⁴ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁸⁵ Association Asthme et Allergie, Paris, France.
⁸⁶ Hospital de Clinicas, University of Parana, Parana, Brazil.
⁸⁷ Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁸⁸ Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.
⁸⁹ Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela.
⁹⁰ The Royal National TNE Hospital, University College London, London, UK.
⁹¹ Immunomodulation and Tolerance Group, Imperial College London, London, UK.
⁹² Allergy and Clinical Immunology, Imperial College London, London, UK.
⁹³ The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
⁹⁴ Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
⁹⁵ Outpatient Allergy Clinic Reumannplatz, Vienna, Austria.
⁹⁶ Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁹⁷ Allergist, Montevideo, Uruguay.
⁹⁸ Clinic of Children's Diseases, Vilnius University Institute of Clinical Medicine, Vilnius, Lithuania.
⁹⁹ Department of Public Health, Institute of Health Sciences, Vilnius, Lithuania.
¹⁰⁰ European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium.
¹⁰¹ Department of Lung Diseases and Clinical Immunology, Terveystalo Allergy Clinic, University of Turku, Turku, Finland.
¹⁰² Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy.
¹⁰³ Pediatric Department, Charité, Berlin, Germany.
¹⁰⁴ Asthma UK, London, UK.
¹⁰⁵ Nova Southeastern University, Fort Lauderdale, Florida.
¹⁰⁶ Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario.
¹⁰⁷ Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.

PMID: 30955224
DOI: 10.1111/all.13805

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 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.

Keywords: allergen immunotherapy; asthma; children; mHealth; rhinitis; stratification.

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References

REFERENCES

1. Bousquet J, Hellings PW, Agache I, et al. ARIA Phase 4 (2018): Change management in allergic rhinitis and asthma multimorbidity using mobile technology. J Allergy Clin Immunol. 2018;pii:S0091-6749(18)31359-9. https://doi.org/10.1016/j.jaci.2018.08.049
1. Bousquet J, Arnavielhe S, Bedbrook A, et al. MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence. Clin Transl Allergy. 2018;8:45.
1. Bousquet J, Anto JM, Annesi-Maesano I, et al. POLLAR: Impact of air pollution on Asthma and Rhinitis; a European Institute of Innovation and Technology Health (EIT Health) project. Clin Transl Allergy. 2018;8:36.
1. Bousquet J, Hellings P, Agache I, et al. ARIA Phase 4 (2018): Change management in allergic rhinitis and asthma multimorbidity using mobile technology. J Allergy Clin Immunol. 2018;66:179-181.
1. Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. BMJ. 1998;316(7125):133-137.

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2019 ARIA Care pathways for allergen immunotherapy

Affiliations

2019 ARIA Care pathways for allergen immunotherapy

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical