Chinese Guideline on Allergen Immunotherapy for Allergic Rhinitis: The 2022 Update

Chengshuo Wang^#^{1

2

3

4}, Yixiao Bao^#⁵, Jianjun Chen^#⁶, Xiaoyang Chen^#⁷, Lei Cheng^#⁸, Yin Shi Guo^#⁹, Chuangli Hao^#¹⁰, He Lai^#¹¹, Huabin Li^#¹², Jing Li^#¹³, Changshan Liu^#¹⁴, Yun Liu^#¹⁵, Zheng Liu^#¹⁶, Hongfei Lou^#^{1

3}, Wei Lv^#¹⁷, Guangmin Nong^#¹⁸, Qianhui Qiu^#¹⁹, Xiumin Ren^#²⁰, Jie Shao^#²¹, Yi-Hong Shen^#²², Li Shi^#²³, Xi-Cheng Song^#²⁴, Yuxin Song^#²⁵, Suping Tang^#²⁶, Hongtian Wang^#²⁷, Xiangdong Wang^#^{1

2}, Xueyan Wang^#²⁷, Zhenlin Wang^#²⁸, Qingyu Wei^#²⁹, Hua Xie^#³⁰, Zhimin Xing^#³¹, Rui Xu^#³², Yu Xu^#³³, Qintai Yang^#³⁴, Hongmei Yao^#³⁵, Jing Ye^#³⁶, Yiwen You^#³⁷, Hongmeng Yu^#¹², Yongmei Yu^#³⁸, Huanping Zhang^#³⁹, Gehua Zhang^#³⁴, Yuan Zhang^#⁴, Yuxiang Zhi^#⁴⁰, Weikang Zhou^#⁴¹, Li Zhu^#⁴², Xinhua Zhu^#⁴³, Ruonan Chai³⁰, Dehua Chen³², Kai Guan⁴⁰, Zizhen Huang³⁴, Yanran Huang¹, Tingting Ma²⁷, Yuemei Ma⁴⁴, Yifan Meng¹, Lei Ren⁴, Jianxing Wang²⁰, Nan Wang¹⁶, Mo Xian¹³, Rong Xiang³³, Ming Zheng¹, Luo Zhang^{1

45}; Chinese Society of Allergy (CSA) and Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G)

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
² Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, China.
³ Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.
⁴ Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
⁵ Shanghai Tonxin Clinic, Shanghai, China.
⁶ Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
⁷ Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospitial of Fujian Medical University, Respiratory Medicine Center of Fujian Province, Quanzhou, China.
⁸ Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
⁹ Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
¹⁰ Department of Respiratory Diseases, Children's Hospital of Soochow University, Suzhou, China.
¹¹ Department of Allergy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
¹² Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
¹³ Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
¹⁴ Department of Pediatrics, The Second Hospital of Tianjin Medical University, Tianjin, China.
¹⁵ Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁷ Department of Otorhinolaryngology, Peking Union Medical College Hospital, Beijing, China.
¹⁸ Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
²⁰ Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
²¹ Department of Pediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²² Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China.
²³ Department of Otolaryngology,The Second Hospital of Shandong University, Jinan, China.
²⁴ Department of Otorhinolaryngology Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, China.
²⁵ Department of Allergy, Harbin Children's Hospital, Harbin, China.
²⁶ Department of Allergy, Fuzhou Children's Hospital Affiliated to Fujian Medical University, Fuzhou, China.
²⁷ Department of Allergy, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China.
²⁸ Department of Otorhinolaryngology Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
²⁹ Department of Allergy, Shengjing Hospital of China Medical University, Shenyang, China.
³⁰ Department of Allergy, Northern Theatre General Hospital, Shenyang, China.
³¹ Department of Otolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China.
³² Department of Allergy of Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³³ Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
³⁴ Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³⁵ Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China.
³⁶ Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
³⁷ Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong, China.
³⁸ Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
³⁹ Department of Allergy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
⁴⁰ Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
⁴¹ Department of Allergy, Chongqing General Hospital, Chongqing, China.
⁴² Department of Otorhinolaryngology, The Third Hospital of Peking University, Beijing, China.
⁴³ Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
⁴⁴ Department of Allergy, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
⁴⁵ Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China. dr.luozhang@139.com.

^# Contributed equally.

PMID: 36426395
PMCID: PMC9709690
DOI: 10.4168/aair.2022.14.6.604

Review

Chinese Guideline on Allergen Immunotherapy for Allergic Rhinitis: The 2022 Update

Chengshuo Wang et al. Allergy Asthma Immunol Res. 2022 Nov.

. 2022 Nov;14(6):604-652.

doi: 10.4168/aair.2022.14.6.604.

Authors

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
² Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, China.
³ Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.
⁴ Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
⁵ Shanghai Tonxin Clinic, Shanghai, China.
⁶ Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
⁷ Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospitial of Fujian Medical University, Respiratory Medicine Center of Fujian Province, Quanzhou, China.
⁸ Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
⁹ Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
¹⁰ Department of Respiratory Diseases, Children's Hospital of Soochow University, Suzhou, China.
¹¹ Department of Allergy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
¹² Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
¹³ Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
¹⁴ Department of Pediatrics, The Second Hospital of Tianjin Medical University, Tianjin, China.
¹⁵ Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁷ Department of Otorhinolaryngology, Peking Union Medical College Hospital, Beijing, China.
¹⁸ Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
²⁰ Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
²¹ Department of Pediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²² Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China.
²³ Department of Otolaryngology,The Second Hospital of Shandong University, Jinan, China.
²⁴ Department of Otorhinolaryngology Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, China.
²⁵ Department of Allergy, Harbin Children's Hospital, Harbin, China.
²⁶ Department of Allergy, Fuzhou Children's Hospital Affiliated to Fujian Medical University, Fuzhou, China.
²⁷ Department of Allergy, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China.
²⁸ Department of Otorhinolaryngology Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
²⁹ Department of Allergy, Shengjing Hospital of China Medical University, Shenyang, China.
³⁰ Department of Allergy, Northern Theatre General Hospital, Shenyang, China.
³¹ Department of Otolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China.
³² Department of Allergy of Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³³ Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
³⁴ Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³⁵ Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China.
³⁶ Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
³⁷ Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong, China.
³⁸ Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
³⁹ Department of Allergy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
⁴⁰ Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
⁴¹ Department of Allergy, Chongqing General Hospital, Chongqing, China.
⁴² Department of Otorhinolaryngology, The Third Hospital of Peking University, Beijing, China.
⁴³ Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
⁴⁴ Department of Allergy, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
⁴⁵ Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China. dr.luozhang@139.com.

^# Contributed equally.

PMID: 36426395
PMCID: PMC9709690
DOI: 10.4168/aair.2022.14.6.604

Abstract

In the last few decades, there has been a progressive increase in the prevalence of allergic rhinitis (AR) in China, where it now affects approximately 250 million people. AR prevention and treatment include allergen avoidance, pharmacotherapy, allergen immunotherapy (AIT), and patient education, among which AIT is the only curative intervention. AIT targets the disease etiology and may potentially modify the immune system as well as induce allergen-specific immune tolerance in patients with AR. In 2017, a team of experts from the Chinese Society of Allergy (CSA) and the Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G) produced the first English version of Chinese AIT guidelines for AR. Since then, there has been considerable progress in basic research of and clinical practice for AIT, especially regarding the role of follicular regulatory T (TFR) cells in the pathogenesis of AR and the use of allergen-specific immunoglobulin E (sIgE) in nasal secretions for the diagnosis of AR. Additionally, potential biomarkers, including TFR cells, sIgG4, and sIgE, have been used to monitor the incidence and progression of AR. Moreover, there has been a novel understanding of AIT during the coronavirus disease 2019 pandemic. Hence, there was an urgent need to update the AIT guideline for AR by a team of experts from CSA and C2AR2G. This document aims to serve as professional reference material on AIT for AR treatment in China, thus improving the development of AIT across the world.

Keywords: Allergen immunotherapy; China; allergic rhinitis; biomarkers; guidelines; house dust mites; immunoglobulin E; rush immunotherapy; subcutaneous immunotherapy.

PubMed Disclaimer

Conflict of interest statement

There are no financial or other issues that might lead to conflict of interest.

Figures

**Fig. 1. Mechanisms of immunotherapy.**
IL, interleukin; TGF, transforming growth factor; Ig, immunoglobulin.

**Fig. 2. Stages for the diagnosis of different chronic rhinitis endotypes.**
Ig, immunoglobulin; AR, allergic rhinitis; LAR, local allergic rhinitis; NARES, nonallergic rhinitis with eosinophilia syndrome; IR, idiopathic rhinitis; NAPT, nasal allergen provocation test.

**Fig. 3. Risk levels of allergen-immunotherapy-related diagnosis and treatment activities during the pandemic. FeNO, fractional exhaled nitric oxide.**

See this image and copyright information in PMC

References

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Chinese Guideline on Allergen Immunotherapy for Allergic Rhinitis: The 2022 Update

Affiliations

Chinese Guideline on Allergen Immunotherapy for Allergic Rhinitis: The 2022 Update

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources

Research Materials