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EAACI guidelines on allergen immunotherapy: house dust mite-driven allergic asthma

EAACI guidelines on allergen immunotherapy: house dust mite-driven allergic asthma
EAACI guidelines on allergen immunotherapy: house dust mite-driven allergic asthma

Allergen immunotherapy (AIT) has been in use for the treatment of allergic disease for more than 100 years. Asthma treatment relies mainly on corticosteroids and other controllers recommended to achieve and maintain asthma control, prevent exacerbations, and improve quality of life. AIT is underused in asthma, both in children and in adults. Notably, patients with allergic asthma not adequately controlled on pharmacotherapy (including biologics) represent an unmet health need. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline providing evidence-based recommendations for the use of house dust mites (HDM) AIT as add-on treatment for HDM-driven allergic asthma. This guideline was developed by a multi-disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. HDM AIT was separately evaluated by route of administration and children and adults: subcutaneous (SCIT) and sublingual AIT (SLIT), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with HDM AIT are (a) selection of patients most likely to respond to AIT and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only AIT with HDM SLIT-tablet has demonstrated a robust effect in adults for critical end points (exacerbations, asthma control, and safety). Thus, it is recommended as an add-on to regular asthma therapy for adults with controlled or partially controlled HDM-driven allergic asthma (conditional recommendation, moderate-quality evidence). HDM SCIT is recommended for adults and children, and SLIT drops are recommended for children with controlled HDM-driven allergic asthma as the add-on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low-quality evidence).

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855-873
Agache, Ioana
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Akdis, Cezmi A.
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Bonini, Matteo
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Agache, Ioana, Lau, Susanne, Akdis, Cezmi A., Smolinska, Sylwia, Bonini, Matteo, Cavkaytar, Ozlem, Flood, Breda, Gajdanowicz, Pawe, Izuhara, Kenji, Kalayci, Omer, Mosges, Ralph, Palomares, Oscar, Papadopoulos, Nikolaos G., Sokolowska, Milena, Angier, Elisabeth, Fernandez-Rivas, Montserrat, Pajno, Giovanni, Pfaar, Oliver, Roberts, Graham C., Ryan, Dermot, Sturm, Gunter J., van Ree, Ronald, Varga, Eva M., van Wijk, Roy Gerth, Yepes-Nuñez, Juan José and Jutel, Marek (2019) EAACI guidelines on allergen immunotherapy: house dust mite-driven allergic asthma. Allergy, 74 (5), 855-873. (doi:10.1111/all.13749).

Record type: Article

Abstract

Allergen immunotherapy (AIT) has been in use for the treatment of allergic disease for more than 100 years. Asthma treatment relies mainly on corticosteroids and other controllers recommended to achieve and maintain asthma control, prevent exacerbations, and improve quality of life. AIT is underused in asthma, both in children and in adults. Notably, patients with allergic asthma not adequately controlled on pharmacotherapy (including biologics) represent an unmet health need. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline providing evidence-based recommendations for the use of house dust mites (HDM) AIT as add-on treatment for HDM-driven allergic asthma. This guideline was developed by a multi-disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. HDM AIT was separately evaluated by route of administration and children and adults: subcutaneous (SCIT) and sublingual AIT (SLIT), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with HDM AIT are (a) selection of patients most likely to respond to AIT and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only AIT with HDM SLIT-tablet has demonstrated a robust effect in adults for critical end points (exacerbations, asthma control, and safety). Thus, it is recommended as an add-on to regular asthma therapy for adults with controlled or partially controlled HDM-driven allergic asthma (conditional recommendation, moderate-quality evidence). HDM SCIT is recommended for adults and children, and SLIT drops are recommended for children with controlled HDM-driven allergic asthma as the add-on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low-quality evidence).

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HDM AIT for asthma - final version submitted - Accepted Manuscript
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More information

Accepted/In Press date: 12 February 2019
e-pub ahead of print date: 16 May 2019
Published date: May 2019

Identifiers

Local EPrints ID: 431644
URI: http://eprints.soton.ac.uk/id/eprint/431644
ISSN: 0105-4538
PURE UUID: 336e3ae1-7773-45d1-a22b-d356d3b6e589
ORCID for Graham C. Roberts: ORCID iD orcid.org/0000-0003-2252-1248

Catalogue record

Date deposited: 11 Jun 2019 16:30
Last modified: 26 Nov 2021 05:33

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Contributors

Author: Ioana Agache
Author: Susanne Lau
Author: Cezmi A. Akdis
Author: Sylwia Smolinska
Author: Matteo Bonini
Author: Ozlem Cavkaytar
Author: Breda Flood
Author: Pawe Gajdanowicz
Author: Kenji Izuhara
Author: Omer Kalayci
Author: Ralph Mosges
Author: Oscar Palomares
Author: Nikolaos G. Papadopoulos
Author: Milena Sokolowska
Author: Elisabeth Angier
Author: Montserrat Fernandez-Rivas
Author: Giovanni Pajno
Author: Oliver Pfaar
Author: Dermot Ryan
Author: Gunter J. Sturm
Author: Ronald van Ree
Author: Eva M. Varga
Author: Roy Gerth van Wijk
Author: Juan José Yepes-Nuñez
Author: Marek Jutel

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