EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma

Ioana Agache¹, Susanne Lau², Cezmi A Akdis^{3

4}, Sylwia Smolinska^{5

6}, Matteo Bonini⁷, Ozlem Cavkaytar⁸, Breda Flood⁹, Pawe Gajdanowicz⁵, Kenji Izuhara¹⁰, Omer Kalayci¹¹, Ralph Mosges¹², Oscar Palomares¹³, Nikolaos G Papadopoulos^{14

15}, Milena Sokolowska^{3

4}, Elisabeth Angier¹⁶, Montserrat Fernandez-Rivas¹⁷, Giovanni Pajno¹⁸, Oliver Pfaar¹⁹, Graham C Roberts^{20

21

16}, Dermot Ryan^{22

23}, Gunter J Sturm^{24

25}, Ronald van Ree^{26

27}, Eva M Varga²⁸, Roy Gerth van Wijk²⁹, Juan José Yepes-Nuñez³⁰, Marek Jutel^{5

6}

Affiliations

¹ Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania.
² Department for Pediatric Pneumology, Immunology and Intensive Care, Charité Universität Medizin, Berlin, Germany.
³ University of Zürich, Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
⁴ Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
⁵ Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland.
⁶ "ALL-MED" Medical Research Institute, Wroclaw, Poland.
⁷ National Heart and Lung Institute (NHLI), Royal Brompton Hospital & Imperial College, London, UK.
⁸ Faculty of Medicine, Department of Pediatric Allergy, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
⁹ European Federation of Allergy and Airways Diseases, Patients Association, Brussels, Belgium.
¹⁰ Saga Medical School, Saga, Japan.
¹¹ Hacettepe University, School of Medicine, Ankara, Turkey.
¹² Universität zu Koln, Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), Koln, Germany.
¹³ Department of Biochemistry and Molecular Biology, Complutense University of Madrid, Madrid, Spain.
¹⁴ Division of Infection, Immunity and respiratory medicine, University of Manchester, Manchester, UK.
¹⁵ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
¹⁶ Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁷ Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
¹⁸ Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy.
¹⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²⁰ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK.
²¹ NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
²² Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
²³ Asthma UK Centre for Applied Research, The University of Edinburgh, Edinburgh, UK.
²⁴ Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
²⁵ Outpatient Allergy Clinic Reumannplaz, Vienna, Austria.
²⁶ Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
²⁷ Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
²⁸ Department of Pediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria.
²⁹ Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
³⁰ School of Medicine, Universidad de Los Andes, Bogotá, Colombia.

PMID: 31095767
DOI: 10.1111/all.13749

Practice Guideline

EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma

Ioana Agache et al. Allergy. 2019 May.

. 2019 May;74(5):855-873.

doi: 10.1111/all.13749.

Authors

Affiliations

¹ Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania.
² Department for Pediatric Pneumology, Immunology and Intensive Care, Charité Universität Medizin, Berlin, Germany.
³ University of Zürich, Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
⁴ Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
⁵ Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland.
⁶ "ALL-MED" Medical Research Institute, Wroclaw, Poland.
⁷ National Heart and Lung Institute (NHLI), Royal Brompton Hospital & Imperial College, London, UK.
⁸ Faculty of Medicine, Department of Pediatric Allergy, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
⁹ European Federation of Allergy and Airways Diseases, Patients Association, Brussels, Belgium.
¹⁰ Saga Medical School, Saga, Japan.
¹¹ Hacettepe University, School of Medicine, Ankara, Turkey.
¹² Universität zu Koln, Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), Koln, Germany.
¹³ Department of Biochemistry and Molecular Biology, Complutense University of Madrid, Madrid, Spain.
¹⁴ Division of Infection, Immunity and respiratory medicine, University of Manchester, Manchester, UK.
¹⁵ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
¹⁶ Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁷ Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
¹⁸ Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy.
¹⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²⁰ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK.
²¹ NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
²² Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
²³ Asthma UK Centre for Applied Research, The University of Edinburgh, Edinburgh, UK.
²⁴ Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
²⁵ Outpatient Allergy Clinic Reumannplaz, Vienna, Austria.
²⁶ Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
²⁷ Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
²⁸ Department of Pediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria.
²⁹ Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
³⁰ School of Medicine, Universidad de Los Andes, Bogotá, Colombia.

PMID: 31095767
DOI: 10.1111/all.13749

Abstract

Allergen immunotherapy (AIT) has been in use for the treatment of allergic disease for more than 100 years. Asthma treatment relies mainly on corticosteroids and other controllers recommended to achieve and maintain asthma control, prevent exacerbations, and improve quality of life. AIT is underused in asthma, both in children and in adults. Notably, patients with allergic asthma not adequately controlled on pharmacotherapy (including biologics) represent an unmet health need. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline providing evidence-based recommendations for the use of house dust mites (HDM) AIT as add-on treatment for HDM-driven allergic asthma. This guideline was developed by a multi-disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. HDM AIT was separately evaluated by route of administration and children and adults: subcutaneous (SCIT) and sublingual AIT (SLIT), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with HDM AIT are (a) selection of patients most likely to respond to AIT and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only AIT with HDM SLIT-tablet has demonstrated a robust effect in adults for critical end points (exacerbations, asthma control, and safety). Thus, it is recommended as an add-on to regular asthma therapy for adults with controlled or partially controlled HDM-driven allergic asthma (conditional recommendation, moderate-quality evidence). HDM SCIT is recommended for adults and children, and SLIT drops are recommended for children with controlled HDM-driven allergic asthma as the add-on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low-quality evidence).

Keywords: GRADE; allergen immunotherapy; allergy; asthma; asthma control; asthma exacerbations; house dust mites; lung function.

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EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma

Affiliations

EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma

Authors

Affiliations

Abstract

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Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical