<scp>EAACI</scp> Guidelines on Allergen Immunotherapy: House dust mite‐driven allergic asthma

<jats:title>Abstract</jats:title><jats:p>Allergen immunotherapy (<jats:styled-content style="fixed-case">AIT</jats:styled-content>) 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. <jats:styled-content style="fixed-case">AIT</jats:styled-content> 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 (<jats:styled-content style="fixed-case">HDM</jats:styled-content>) <jats:styled-content style="fixed-case">AIT</jats:styled-content> as add‐on treatment for <jats:styled-content style="fixed-case">HDM</jats:styled-content>‐driven allergic asthma. This guideline was developed by a multi‐disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation (<jats:styled-content style="fixed-case">GRADE</jats:styled-content>) approach. <jats:styled-content style="fixed-case">HDM AIT</jats:styled-content> was separately evaluated by route of administration and children and adults: subcutaneous (<jats:styled-content style="fixed-case">SCIT</jats:styled-content>) and sublingual <jats:styled-content style="fixed-case">AIT</jats:styled-content> (<jats:styled-content style="fixed-case">SLIT</jats:styled-content>), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with <jats:styled-content style="fixed-case">HDM AIT</jats:styled-content> are (a) selection of patients most likely to respond to <jats:styled-content style="fixed-case">AIT</jats:styled-content> and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only <jats:styled-content style="fixed-case">AIT</jats:styled-content> with <jats:styled-content style="fixed-case">HDM SLIT</jats:styled-content>‐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 <jats:styled-content style="fixed-case">HDM</jats:styled-content>‐driven allergic asthma (conditional recommendation, moderate‐quality evidence). <jats:styled-content style="fixed-case">HDM SCIT</jats:styled-content> is recommended for adults and children, and <jats:styled-content style="fixed-case">SLIT</jats:styled-content> drops are recommended for children with controlled <jats:styled-content style="fixed-case">HDM</jats:styled-content>‐driven allergic asthma as the add‐on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low‐quality evidence).</jats:p>