July 15, 2019

2019 ARIA Care pathways for allergen immunotherapy

REVIEW 
 
Free Access
Jean Bousquet  Oliver Pfaar  Alkis Togias  Holger J. Schünemann  Ignacio Ansotegui  Nikolaos G. Papadopoulos  Ioanna Tsiligianni  Ioana Agache  Josep M. Anto  Claus Bachert  Anna Bedbrook  Karl‐Christian Bergmann  Sinthia Bosnic‐Anticevich  Isabelle Bosse  Jan Brozek  Moises A. Calderon  Giorgio W. Canonica  Luigi Caraballo  Victoria Cardona  Thomas Casale  Lorenzo Cecchi  Derek Chu  Elisio Costa  Alvaro A. Cruz  Wienczyslawa Czarlewski  Stephen R. Durham  George Du Toit  Mark Dykewicz Motohiro Ebisawa  Jean Luc Fauquert  Montserrat Fernandez‐Rivas  Wytske J. Fokkens  João Fonseca Jean‐François Fontaine  Roy Gerth van Wijk  Tari Haahtela  Susanne Halken  Peter W. Hellings  Despo Ierodiakonou  Tomohisa Iinuma  Juan Carlos Ivancevich  Lars Jacobsen  Marek Jutel  Igor Kaidashev Musa Khaitov  Omer Kalayci  Jörg Kleine Tebbe  Ludger Klimek  Marek L. Kowalski  Piotr Kuna  Violeta Kvedariene  Stefania La Grutta  Désirée Larenas‐Linemann  Susanne Lau  Daniel Laune  Lan Le  Karin Lodrup Carlsen  Olga Lourenço  Hans‐Jørgen Malling  Gert Marien  Enrica Menditto  Gregoire Mercier Joaquim Mullol  Antonella Muraro  Robyn O’Hehir  Yoshitaka Okamoto  Giovanni B. Pajno  Hae‐Sim Park  Petr Panzner  Giovanni Passalacqua  Nhan Pham‐Thi  Graham Roberts  Ruby Pawankar  Christine Rolland  Nelson Rosario  Dermot Ryan  Bolesław Samolinski  Mario Sanchez‐Borges  Glenis Scadding Mohamed H. Shamji  Aziz Sheikh  Gunter J. Sturm  Ana Todo Bom  Sanna Toppila‐Salmi  Maryline Valentin‐Rostan  Arunas Valiulis  Erkka Valovirta  Maria‐Teresa Ventura  Ulrich Wahn  Samantha Walker  Dana Wallace  Susan Waserman  Arzu Yorgancioglu  Torsten Zuberbier  the ARIA Working Group

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.






No comments:

Post a Comment