EAACI Biologicals Guidelines-Recommendations for severe asthma

Ioana Agache¹, Cezmi A Akdis^{2

3}, Mubeccel Akdis², Giorgio Walter Canonica⁴, Thomas Casale⁵, Tomas Chivato⁶, Jonathan Corren⁷, Derek K Chu⁸, Stefano Del Giacco⁹, Thomas Eiwegger^{10

11

12}, Breda Flood¹³, Davide Firinu⁹, James E Gern¹⁴, Eckard Hamelmann¹⁵, Nicola Hanania¹⁶, Irene Hernández-Martín¹⁷, Rebeca Knibb¹⁸, Mika Mäkelä¹⁹, Parameswaran Nair^{20

21}, Liam O'Mahony²², Nikolaos G Papadopoulos^{23

24}, Alberto Papi²⁵, Hae-Sim Park²⁶, Luis Pérez de Llano²⁷, Oliver Pfaar²⁸, Santiago Quirce²⁹, Joaquin Sastre³⁰, Mohamed Shamji^{31

32}, Jurgen Schwarze³³, Oscar Palomares³⁴, Marek Jutel^{35

36}

Affiliations

¹ Faculty of Medicine, Transylvania University, Brasov, Romania.
² Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
³ Christine-Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
⁴ Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
⁵ Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
⁶ School of Medicine, University CEU San Pablo, Madrid, Spain.
⁷ David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁸ Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, and Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁹ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
¹⁰ Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
¹¹ Department of Immunology, University of Toronto, Toronto, ON, Canada.
¹² Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Departments of Paediatrics and Immunology, University of Toronto, Toronto, ON, Canada.
¹³ European Federation of Allergy and Airway Diseases, Brussels, Belgium.
¹⁴ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
¹⁵ Children's Center Bethel, Evangelical Hospital Bethel, University of Bielefeld, Bielefeld, Germany.
¹⁶ Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
¹⁷ Department of Allergy, Hospital Universitario La Paz, Madrid, Spain.
¹⁸ Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK.
¹⁹ Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁰ Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
²¹ Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada.
²² Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland.
²³ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
²⁴ Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece.
²⁵ Research Center on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
²⁶ Department of Allergy and Clinical Immunology, Ajou University, Ajou, Korea.
²⁷ Department of Respiratory Medicine, Hospital Lucus Augusti, Lugo, Spain.
²⁸ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²⁹ Department of Allergy, La Paz University Hospital, IdiPAZ, CIBER of Respiratory Diseases (CIBERES), Universidad Autónoma de Madrid, Madrid, Spain.
³⁰ Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
³¹ Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair, Development, National Heart and Lung Institute, London, UK.
³² Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
³³ Centre for Inflammation Research, Child Life and Health, The University of Edinburgh, Edinburgh, UK.
³⁴ Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain.
³⁵ Department of Clinical Immunology, University of Wroclaw, Wroclaw, Poland.
³⁶ ALL-MED" Medical Research Institute, Wroclaw, Poland.

PMID: 32484954
DOI: 10.1111/all.14425

EAACI Biologicals Guidelines-Recommendations for severe asthma

Ioana Agache et al. Allergy. 2021 Jan.

. 2021 Jan;76(1):14-44.

doi: 10.1111/all.14425. Epub 2020 Aug 10.

Authors

Affiliations

¹ Faculty of Medicine, Transylvania University, Brasov, Romania.
² Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
³ Christine-Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
⁴ Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
⁵ Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
⁶ School of Medicine, University CEU San Pablo, Madrid, Spain.
⁷ David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁸ Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, and Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁹ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
¹⁰ Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
¹¹ Department of Immunology, University of Toronto, Toronto, ON, Canada.
¹² Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Departments of Paediatrics and Immunology, University of Toronto, Toronto, ON, Canada.
¹³ European Federation of Allergy and Airway Diseases, Brussels, Belgium.
¹⁴ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
¹⁵ Children's Center Bethel, Evangelical Hospital Bethel, University of Bielefeld, Bielefeld, Germany.
¹⁶ Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
¹⁷ Department of Allergy, Hospital Universitario La Paz, Madrid, Spain.
¹⁸ Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK.
¹⁹ Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁰ Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
²¹ Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada.
²² Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland.
²³ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
²⁴ Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece.
²⁵ Research Center on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
²⁶ Department of Allergy and Clinical Immunology, Ajou University, Ajou, Korea.
²⁷ Department of Respiratory Medicine, Hospital Lucus Augusti, Lugo, Spain.
²⁸ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²⁹ Department of Allergy, La Paz University Hospital, IdiPAZ, CIBER of Respiratory Diseases (CIBERES), Universidad Autónoma de Madrid, Madrid, Spain.
³⁰ Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
³¹ Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair, Development, National Heart and Lung Institute, London, UK.
³² Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
³³ Centre for Inflammation Research, Child Life and Health, The University of Edinburgh, Edinburgh, UK.
³⁴ Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain.
³⁵ Department of Clinical Immunology, University of Wroclaw, Wroclaw, Poland.
³⁶ ALL-MED" Medical Research Institute, Wroclaw, Poland.

PMID: 32484954
DOI: 10.1111/all.14425

Abstract

Severe asthma imposes a significant burden on patients, families and healthcare systems. Management is difficult, due to disease heterogeneity, co-morbidities, complexity in care pathways and differences between national or regional healthcare systems. Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals. However, there are still many issues that require further clarification. These include selection of a certain biological (as they all target overlapping disease phenotypes), the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen (in the clinic or home-based) and its cost-effectiveness. The EAACI Guidelines on the use of biologicals in severe asthma follow the GRADE approach in formulating recommendations for each biological and each outcome. In addition, a management algorithm for the use of biologicals in the clinic is proposed, together with future approaches and research priorities.

Keywords: GRADE; biologicals; cost-effectiveness; guidelines; severe asthma.

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References

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EAACI Biologicals Guidelines-Recommendations for severe asthma

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EAACI Biologicals Guidelines-Recommendations for severe asthma

Authors

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