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EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy

EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy
EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy
Food allergy can result in considerable morbidity, impairment of quality of life and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food allergy allergen immunotherapy (FA-AIT) through the oral (OIT), sublingual (SLIT) or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE-mediated Food Allergy, aims to provide evidence-based recommendations for active treatment of IgE-mediated food allergy with FA-AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post-discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA-AIT has most frequently been assessed: here the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cow’s milk, hen’s egg and peanut allergies. A benefit post-discontinuation is also suggested, but not confirmed. Adverse events during FA-AIT have been frequently reported, but few subjects discontinue FA-AIT as a result of these. Taking into account the current evidence, FA-AIT should only be performed in research centers or in clinical centers with an extensive experience in FA-AIT. Patients and their families should be provided with information about the use of allergen immunotherapy for IgE-mediated food allergy to allow them to make an informed decision about the therapy.
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Pajno, G. B.
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O'mahony, L.
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Sackesen, C.
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Sturm, G.
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Van Wijk, R. G.
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Sheikh, A.
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Muraro, A.
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Pajno, G. B.
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Ebisawa, M.
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Halken, S.
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Jutel, M.
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Lau, S.
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Pfaar, O.
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Ryan, D.
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Sturm, G.
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Varga, E.-m.
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Van Wijk, R. G.
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Sheikh, A.
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Muraro, A.
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Pajno, G. B., Fernandez-rivas, M., Arasi, S., Roberts, G., Akdis, C. A., Alvaro-lozano, M., Beyer, K., Bindslev-jensen, C., Burks, W., Ebisawa, M., Eigenmann, P., Knol, E., Nadeau, K. C., Poulsen, L. K., Van Ree, R., Santos, A. F., Du Toit, G., Dhami, S., Nurmatov, U., Boloh, Y., Makela, M., O'mahony, L., Papadopoulos, N., Sackesen, C., Agache, I., Angier, E., Halken, S., Jutel, M., Lau, S., Pfaar, O., Ryan, D., Sturm, G., Varga, E.-m., Van Wijk, R. G., Sheikh, A. and Muraro, A. (2017) EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy. Allergy. (doi:10.1111/all.13319).

Record type: Article

Abstract

Food allergy can result in considerable morbidity, impairment of quality of life and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food allergy allergen immunotherapy (FA-AIT) through the oral (OIT), sublingual (SLIT) or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE-mediated Food Allergy, aims to provide evidence-based recommendations for active treatment of IgE-mediated food allergy with FA-AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post-discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA-AIT has most frequently been assessed: here the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cow’s milk, hen’s egg and peanut allergies. A benefit post-discontinuation is also suggested, but not confirmed. Adverse events during FA-AIT have been frequently reported, but few subjects discontinue FA-AIT as a result of these. Taking into account the current evidence, FA-AIT should only be performed in research centers or in clinical centers with an extensive experience in FA-AIT. Patients and their families should be provided with information about the use of allergen immunotherapy for IgE-mediated food allergy to allow them to make an informed decision about the therapy.

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Accepted/In Press date: 21 September 2017
e-pub ahead of print date: 5 December 2017

Identifiers

Local EPrints ID: 416157
URI: http://eprints.soton.ac.uk/id/eprint/416157
ISSN: 0105-4538
PURE UUID: 8a826c30-7f20-4964-abc2-0e47419d8d21
ORCID for G. Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 06 Dec 2017 17:30
Last modified: 26 Nov 2021 06:05

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Contributors

Author: G. B. Pajno
Author: M. Fernandez-rivas
Author: S. Arasi
Author: G. Roberts ORCID iD
Author: C. A. Akdis
Author: M. Alvaro-lozano
Author: K. Beyer
Author: C. Bindslev-jensen
Author: W. Burks
Author: M. Ebisawa
Author: P. Eigenmann
Author: E. Knol
Author: K. C. Nadeau
Author: L. K. Poulsen
Author: R. Van Ree
Author: A. F. Santos
Author: G. Du Toit
Author: S. Dhami
Author: U. Nurmatov
Author: Y. Boloh
Author: M. Makela
Author: L. O'mahony
Author: N. Papadopoulos
Author: C. Sackesen
Author: I. Agache
Author: E. Angier
Author: S. Halken
Author: M. Jutel
Author: S. Lau
Author: O. Pfaar
Author: D. Ryan
Author: G. Sturm
Author: E.-m. Varga
Author: R. G. Van Wijk
Author: A. Sheikh
Author: A. Muraro

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