2019 ARIA Care pathways for allergen immunotherapy
Jean Bousquet
(1, 2)
,
Oliver Pfaar
(3)
,
Alkis Togias
(4)
,
Holger J. Schünemann
(5)
,
Ignacio Ansotegui
(6)
,
Nikolaos Papadopoulos
(7)
,
Ioanna Tsiligianni
(8)
,
Ioana Agache
(9)
,
Josep M. Anto
(10)
,
Claus Bachert
(11)
,
Anna Bedbrook
(1)
,
Karl‐christian Bergmann
(12, 13)
,
Sinthia Bosnic‐anticevich
(14, 15)
,
Isabelle Bosse
(16)
,
Jan Brozek
(17)
,
Moises A. Calderon
(18)
,
Giorgio Canonica
(19)
,
Luigi Caraballo
(20, 21)
,
Victoria Cardona
(22)
,
Thomas B. Casale
(23)
,
Lorenzo Cecchi
(20)
,
Derek Chu
(24)
,
Elísio Costa
(25)
,
Alvaro Cruz
(26)
,
Wienczyslawa Czarlewski
(27)
,
Stephen Durham
(28)
,
George Du Toit
(29)
,
Mark Dykewicz
(30)
,
Motohiro Ebisawa
(31)
,
Jean Luc Fauquert
(32)
,
Montserrat Fernandez‐rivas
(33)
,
Wytske Fokkens
(34)
,
Joao Fonseca
(35)
,
Jean‐françois Fontaine
,
Roy Gerth van Wijk
(36)
,
Tari Haahtela
(37)
,
Susanne Halken
(38)
,
Peter W. Hellings
(39)
,
Despo Ierodiakonou
,
Tomohisa Iinuma
(40)
,
Juan Carlos Ivancevich
(41)
,
Lars Jacobsen
(42)
,
Marek Jutel
(43)
,
Igor Kaidashev
(44)
,
Musa Khaitov
(45)
,
Ömer Kalayci
(46)
,
Jörg Kleine Tebbe
(47)
,
Ludger Klimek
(3)
,
Marek Kowalski
(48)
,
Piotr Kuna
(49)
,
Violeta Kvedariene
(50)
,
Stefania La Grutta
(51)
,
Désirée Larenas‐linemann
,
Susanne Lau
(52, 12)
,
Daniel Laune
(1)
,
Lan Le
(53)
,
Karin C. Lodrup Carlsen
(54)
,
Olga Lourenço
(55)
,
Hans‐jørgen Malling
,
Gert Marien
(34)
,
Enrica Menditto
(56)
,
Grégoire Mercier
(2)
,
Joaquim Mullol
(57)
,
Antonella Muraro
(58)
,
Robyn O’hehir
(59)
,
Yoshitaka Okamoto
(60)
,
Giovanni Pajno
(61)
,
Hae‐sim Park
(62)
,
Petr Panzner
(63)
,
Giovanni Passalacqua
(64)
,
Nhan Pham‐thi
,
Graham Roberts
(65)
,
Ruby Pawankar
(66)
,
Nelson Rosario
(67)
,
Dermot Ryan
(68)
,
Bolesław Samolinski
(69, 70)
,
Mario Sanchez‐borges
(71)
,
Glenis Scadding
(72)
,
Mohamed H Shamji
(73)
,
Aziz Sheikh
(74)
,
Gunter J Sturm
(75)
,
Ana Todo Bom
(76)
,
Sanna Toppila‐salmi
(37)
,
Maryline Valentin‐rostan
,
Arunas Valiulis
(77)
,
Erkka Valovirta
(78)
,
Maria‐teresa Ventura
(79)
,
Ulrich Wahn
(80)
,
Samantha Walker
(29)
,
Dana Wallace
(81)
,
Susan Waserman
(82)
,
Arzu Yorgancioglu
(83)
,
Torsten Zuberbier
(84)
,
Christine Rolland
(85)
1
MACVIA-LR -
Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 Center for Rhinology and Allergology = Zentrum für Rhinologie und Allergologie
4 NIAID-NIH - National Institute of Allergy and Infectious Diseases [Bethesda]
5 Department of Clinical Epidemiology and Biostatistics and Medicine
6 Department of Allergy and Immunology
7 UPC Research Laboratories, Allergy Department
8 UOC - University of Crete [Heraklion]
9 Department of Allergy and Clinical Immunology
10 UPF - Universitat Pompeu Fabra [Barcelona]
11 Ghent University Hospital
12 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
13 Department of Dermatology and Allergy [Berlin, Allemagne]
14 The University of Sydney
15 Woolcock Institute of Medical Research [Sydney]
16 CHU Montpellier
17 Departments of Clinical Epidemiology and Biostatistics and Medicine [Ontario]
18 Section of Allergy and Clinical Immunology [London, UK]
19 Humanitas Clinical and Research Center [Rozzano, Milan, Italy]
20 University of Cartagena - Institute for Immunological Research
21 University of Cartagena
22 Allergy Section, Department of Internal Medicine
23 Division of Allergy and Immunology, Department of Medicine
24 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
25 Universidade do Porto
26 UFBA - Universidade Federal da Bahia
27 UCB Pharma, Colombes
28 Section of Allergy and Clinical Immunology
29 King‘s College London
30 Saint Louis University School of Medicine [St Louis]
31 Sagamihara National Hospital [Kanagawa, Japan]
32 CHU Estaing [Clermont-Ferrand]
33 IdISSC - Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain]
34 EUFOREA - European Forum for Research and Education in Allergy and Airway Diseases
35 CINTESIS - Center of Research in Health Technologies and Information Systems
36 Department of Allergology
37 HUS - Helsinki University Hospital [Finland]
38 Odense University Hospital
39 University Hospitals Leuven [Leuven]
40 Chiba University Hospital
41 Clinica Santa Isabel - Servicio de Alergia e ImmunologiaBuenos Aires
42 RCPH - Research Centre for Prevention and Health
43 Department of Clinical Immunology
44 Ukrainina Medical Stomatological Academy [Poltava, Ukraine]
45 National Research Center - Laboratory of Molecular Immunology [Moscow, Russian Federation]
46 Hacettepe University = Hacettepe Üniversitesi
47 Allergy & Asthma Center Westend
48 Department of Immunology
49 Division of Internal Medicine, Asthma and Allergy
50 Vilnius University [Vilnius]
51 CNR-IBIM : National Research Council-Institute of Biomedicine and Molecular Immunology
52 Department of Pediatric Pneumology and Immunology
53 HCMUT - Ho Chi Minh City University of Technology [Vietnam National University, HCM]
54 UiO - University of Oslo
55 Health Sciences Research Centre - Faculty of Health Sciences and CICS-UB
56 "Federico II" University of Naples Medical School
57 CIBERES - Centro de Investigación Biomédica en Red Enfermedades Respiratorias
58 Food Allergy Referral Centre Veneto Region [Padua, Italy]
59 Monash University [Melbourne]
60 Department of Otorhinolaryngology
61 Department of Pediatrics, Allergy Unit
62 Ajou University School of Medicine
63 Department of Allergology and Clinical Immunology
64 Allergy and Respiratory Diseases
65 Saint Mary's Hospital [London]
66 Department of Pediatrics
67 Pediatrics
68 Medical Centre
69 Medical University of Warsaw - Poland
70 Department of Prevention of Environmental Hazards and Allergology
71 Department of Allergy and Clinical Immunology [Caracas, Venezuela]
72 The Royal National Throat, Nose and Ear Hospital
73 Imperial College London
74 Centre for Population Health Sciences
75 Medical University of Graz = Medizinische Universität Graz
76 UC - University of Coimbra [Portugal]
77 Vilnius University Clinic of Children's Diseases
78 Suomen Terveystalo Allergy Clinic
79 UNIBA - Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro
80 Department for Pediatric Pneumology and Immunology
81 NSU - Nova Southeastern University
82 McMaster University [Hamilton, Ontario]
83 Department of Pulmonology
84 Department of Dermatology
85 Association Asthme et Allergie
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 Center for Rhinology and Allergology = Zentrum für Rhinologie und Allergologie
4 NIAID-NIH - National Institute of Allergy and Infectious Diseases [Bethesda]
5 Department of Clinical Epidemiology and Biostatistics and Medicine
6 Department of Allergy and Immunology
7 UPC Research Laboratories, Allergy Department
8 UOC - University of Crete [Heraklion]
9 Department of Allergy and Clinical Immunology
10 UPF - Universitat Pompeu Fabra [Barcelona]
11 Ghent University Hospital
12 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
13 Department of Dermatology and Allergy [Berlin, Allemagne]
14 The University of Sydney
15 Woolcock Institute of Medical Research [Sydney]
16 CHU Montpellier
17 Departments of Clinical Epidemiology and Biostatistics and Medicine [Ontario]
18 Section of Allergy and Clinical Immunology [London, UK]
19 Humanitas Clinical and Research Center [Rozzano, Milan, Italy]
20 University of Cartagena - Institute for Immunological Research
21 University of Cartagena
22 Allergy Section, Department of Internal Medicine
23 Division of Allergy and Immunology, Department of Medicine
24 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
25 Universidade do Porto
26 UFBA - Universidade Federal da Bahia
27 UCB Pharma, Colombes
28 Section of Allergy and Clinical Immunology
29 King‘s College London
30 Saint Louis University School of Medicine [St Louis]
31 Sagamihara National Hospital [Kanagawa, Japan]
32 CHU Estaing [Clermont-Ferrand]
33 IdISSC - Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain]
34 EUFOREA - European Forum for Research and Education in Allergy and Airway Diseases
35 CINTESIS - Center of Research in Health Technologies and Information Systems
36 Department of Allergology
37 HUS - Helsinki University Hospital [Finland]
38 Odense University Hospital
39 University Hospitals Leuven [Leuven]
40 Chiba University Hospital
41 Clinica Santa Isabel - Servicio de Alergia e ImmunologiaBuenos Aires
42 RCPH - Research Centre for Prevention and Health
43 Department of Clinical Immunology
44 Ukrainina Medical Stomatological Academy [Poltava, Ukraine]
45 National Research Center - Laboratory of Molecular Immunology [Moscow, Russian Federation]
46 Hacettepe University = Hacettepe Üniversitesi
47 Allergy & Asthma Center Westend
48 Department of Immunology
49 Division of Internal Medicine, Asthma and Allergy
50 Vilnius University [Vilnius]
51 CNR-IBIM : National Research Council-Institute of Biomedicine and Molecular Immunology
52 Department of Pediatric Pneumology and Immunology
53 HCMUT - Ho Chi Minh City University of Technology [Vietnam National University, HCM]
54 UiO - University of Oslo
55 Health Sciences Research Centre - Faculty of Health Sciences and CICS-UB
56 "Federico II" University of Naples Medical School
57 CIBERES - Centro de Investigación Biomédica en Red Enfermedades Respiratorias
58 Food Allergy Referral Centre Veneto Region [Padua, Italy]
59 Monash University [Melbourne]
60 Department of Otorhinolaryngology
61 Department of Pediatrics, Allergy Unit
62 Ajou University School of Medicine
63 Department of Allergology and Clinical Immunology
64 Allergy and Respiratory Diseases
65 Saint Mary's Hospital [London]
66 Department of Pediatrics
67 Pediatrics
68 Medical Centre
69 Medical University of Warsaw - Poland
70 Department of Prevention of Environmental Hazards and Allergology
71 Department of Allergy and Clinical Immunology [Caracas, Venezuela]
72 The Royal National Throat, Nose and Ear Hospital
73 Imperial College London
74 Centre for Population Health Sciences
75 Medical University of Graz = Medizinische Universität Graz
76 UC - University of Coimbra [Portugal]
77 Vilnius University Clinic of Children's Diseases
78 Suomen Terveystalo Allergy Clinic
79 UNIBA - Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro
80 Department for Pediatric Pneumology and Immunology
81 NSU - Nova Southeastern University
82 McMaster University [Hamilton, Ontario]
83 Department of Pulmonology
84 Department of Dermatology
85 Association Asthme et Allergie
Jean Bousquet
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- ORCID : 0000-0002-4061-4766
Oliver Pfaar
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Nikolaos Papadopoulos
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Ioanna Tsiligianni
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Ioana Agache
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Claus Bachert
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Anna Bedbrook
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Moises A. Calderon
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Victoria Cardona
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Lorenzo Cecchi
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- ORCID : 0000-0002-0658-2449
Alvaro Cruz
- Fonction : Auteur
- PersonId : 786592
- ORCID : 0000-0002-7403-3871
Wienczyslawa Czarlewski
- Fonction : Auteur
- PersonId : 794700
- ORCID : 0000-0002-6180-3232
Motohiro Ebisawa
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- ORCID : 0000-0003-4117-558X
- IdRef : 186089961
Wytske Fokkens
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- ORCID : 0000-0003-4852-229X
Joao Fonseca
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- PersonId : 764741
- ORCID : 0000-0002-0887-8796
Jean‐françois Fontaine
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Tari Haahtela
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- ORCID : 0000-0003-4757-2156
Despo Ierodiakonou
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Tomohisa Iinuma
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- ORCID : 0000-0002-9940-5520
Juan Carlos Ivancevich
- Fonction : Auteur
- PersonId : 786645
- ORCID : 0000-0001-8713-6258
Musa Khaitov
- Fonction : Auteur
- PersonId : 774118
- ORCID : 0000-0003-4961-9640
Ludger Klimek
- Fonction : Auteur
- PersonId : 933616
Piotr Kuna
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- ORCID : 0000-0003-2401-0070
Stefania La Grutta
- Fonction : Auteur
- PersonId : 801487
- ORCID : 0000-0001-8026-0715
Désirée Larenas‐linemann
- Fonction : Auteur
Olga Lourenço
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Hans‐jørgen Malling
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Enrica Menditto
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Grégoire Mercier
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Joaquim Mullol
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Antonella Muraro
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Robyn O’hehir
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Hae‐sim Park
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Petr Panzner
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Nhan Pham‐thi
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Ruby Pawankar
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Mario Sanchez‐borges
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- ORCID : 0000-0002-9308-6418
Glenis Scadding
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Gunter J Sturm
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Sanna Toppila‐salmi
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Maryline Valentin‐rostan
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Arunas Valiulis
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Arzu Yorgancioglu
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Torsten Zuberbier
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Résumé
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.