2019 ARIA Care pathways for allergen immunotherapy

  • Jean Bousquet
    MACVIA‐France, Fondation partenariale FMC VIA‐LR Montpellier France
  • Oliver Pfaar
    Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
  • Alkis Togias
    Division of Allergy, Immunology, and Transplantation (DAIT) National Institute of Allergy and Infectious Diseases, NIH Bethesda Maryland
  • Holger J. Schünemann
    Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
  • Ignacio Ansotegui
    Hospital Quirónsalud Bizkaia Bilbao Spain
  • Nikolaos G. Papadopoulos
    Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital University of Manchester Manchester UK
  • Ioanna Tsiligianni
    Department of Social Medicine, Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece
  • Ioana Agache
    Faculty of Medicine Transylvania University Brasov Romania
  • Josep M. Anto
    Centre for Research in Environmental Epidemiology (CREAL) ISGlobAL Barcelona Spain
  • Claus Bachert
    ENT Department, Upper Airways Research Laboratory Ghent University Hospital Ghent Belgium
  • Anna Bedbrook
    MACVIA‐France, Fondation partenariale FMC VIA‐LR Montpellier France
  • Karl‐Christian Bergmann
    Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GA<sup>2</sup>LEN, Humboldt‐Uniersität zu Berlin Berlin Germany
  • Sinthia Bosnic‐Anticevich
    Woolcock Institute of Medical Research, Woolcock Emphysema Centre and Local Health District University of Sydney Glebe New South Wales Australia
  • Isabelle Bosse
    Allergist La Rochelle France
  • Jan Brozek
    Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
  • Moises A. Calderon
    Imperial College London ‐ National Heart and Lung Institute Royal Brompton Hospital NHS London UK
  • Giorgio W. Canonica
    Personalized Medicine Clinic Asthma & Allergy, Humanitas Research Hospital Humanitas University Milan Italy
  • Luigi Caraballo
    Institute for Immunological Research University of Cartagena, Campus de Zaragocilla Cartagena Colombia
  • Victoria Cardona
    Allergy Section, Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL Research Network Barcelona Spain
  • Thomas Casale
    Division of Allergy/Immunology University of South Florida Tampa Florida
  • Lorenzo Cecchi
    SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy
  • Derek Chu
    Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
  • Elisio Costa
    UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork) University of Porto Porto Portugal
  • Alvaro A. Cruz
    ProAR – Nucleo de Excelencia em Asma Federal University of Bahia Salvador Brazil
  • Wienczyslawa Czarlewski
    Medical Consulting Czarlewski Levallois France
  • Stephen R. Durham
    Allergy and Clinical Immunology Section, National Heart and Lung Institute Imperial College London London UK
  • George Du Toit
    Guy's and st Thomas' NHS Trust, Kings College London London UK
  • Mark Dykewicz
    Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri
  • Motohiro Ebisawa
    Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan
  • Jean Luc Fauquert
    Unité de pneumo‐allergologie de l'enfant, pôle pédiatrique CHU de Clermont‐Ferrand‐Estaing Clermont‐Ferrand France
  • Montserrat Fernandez‐Rivas
    Allergy Department IdISSC, Hospital Clinico San Carlos Madrid Spain
  • Wytske J. Fokkens
    Department of Otorhinolaryngology Academic Medical Centres Amsterdam The Netherlands
  • João Fonseca
    CINTESIS, Center for Research in Health Technology and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal
  • Jean‐François Fontaine
    Allergist Reims France
  • Roy Gerth van Wijk
    Department of Internal Medicine, Section of Allergology Erasmus MC Rotterdam The Netherlands
  • Tari Haahtela
    Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
  • Susanne Halken
    Hans Christian Andersen Children's Hospital Odense University Hospital Odense Denmark
  • Peter W. Hellings
    Department of Otorhinolaryngology University Hospitals Leuven Leuven Belgium
  • Despo Ierodiakonou
    Department of Social Medicine, Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece
  • Tomohisa Iinuma
    Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
  • Juan Carlos Ivancevich
    Servicio de Alergia e Immunologia Clinica Santa Isabel Buenos Aires Argentina
  • Lars Jacobsen
    Allergy Learning and Consulting Copenhagen Denmark
  • Marek Jutel
    Department of Clinical Immunology Wrocław Medical University Wrocław Poland
  • Igor Kaidashev
    Ukrainian Medical Stomatological Academy Poltava Ukraine
  • Musa Khaitov
    Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology National Research Center Moscow Russian Federation
  • Omer Kalayci
    Pediatric Allergy and Asthma Unit Hacettepe University School of Medicine Ankara Turkey
  • Jörg Kleine Tebbe
    Allergy & Asthma Center Westend Berlin Germany
  • Ludger Klimek
    Center for Rhinology and Allergology Wiesbaden Germany
  • Marek L. Kowalski
    Department of Immunology and Allergy, Healthy Ageing Research Center Medical University of Lodz Lodz Poland
  • Piotr Kuna
    Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital Medical University of Lodz Lodz Poland
  • Violeta Kvedariene
    Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences Vilnius University Vilnius Lithuania
  • Stefania La Grutta
    Institute of Biomedicine and Molecular Immunology (IBIM) National Research Council (CNR) Palermo Italy
  • Désirée Larenas‐Linemann
    Center of Excellence in Asthma and Allergy Médica Sur Clinical Foundation and Hospital México City Mexico
  • Susanne Lau
    Department of Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Germany
  • Daniel Laune
    KYomed INNOV Montpellier France
  • Lan Le
    University of Medicine and Pharmacy Hochiminh City Vietnam
  • Karin Lodrup Carlsen
    Department of Paediatrics Oslo University Hospital Oslo Norway
  • Olga Lourenço
    Faculty of Health Sciences and CICS – UBI, Health Sciences Research Centre University of Beira Interior Covilhã Portugal
  • Hans‐Jørgen Malling
    Danish Allergy Centre University of Copenhagen Copenhagen Denmark
  • Gert Marien
    Euforea Brussels Belgium
  • Enrica Menditto
    CIRFF, Center of Pharmacoeconomics University of Naples Federico II Naples Italy
  • Gregoire Mercier
    Département de l’Information Médicale, Unité Médico‐Economie University Hospital Montpellier France
  • Joaquim Mullol
    Rhinology Unit & Smell Clinic, ENT Department Hospital Clínic Barcelona Spain
  • Antonella Muraro
    Food Allergy Referral Centre Veneto Region, Department of Women and Child Health Padua General University Hospital Padua Italy
  • Robyn O’Hehir
    Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia
  • Yoshitaka Okamoto
    Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
  • Giovanni B. Pajno
    Department of Pediatrics, Allergy Unit University of Messina Messina Italy
  • Hae‐Sim Park
    Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
  • Petr Panzner
    Department of Immunology and Allergology, Faculty of Medicine in Pilsen Charles University in Prague Pilsen Czech Republic
  • Giovanni Passalacqua
    Allergy and Respiratory Diseases Ospedale Policlino San Martino ‐University of Genoa Genoa Italy
  • Nhan Pham‐Thi
    Allergy Department Pasteur Institute Paris France
  • Graham Roberts
    David Hide Centre, St Mary's Hospital Isle of Wight and University of Southampton Southampton UK
  • Ruby Pawankar
    Department of Pediatrics Nippon Medical School Tokyo Japan
  • Christine Rolland
    Association Asthme et Allergie Paris France
  • Nelson Rosario
    Hospital de Clinicas University of Parana Parana Brazil
  • Dermot Ryan
    Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
  • Bolesław Samolinski
    Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
  • Mario Sanchez‐Borges
    Allergy and Clinical Immunology Department Centro Medico‐Docente La Trinidad Caracas Venezuela
  • Glenis Scadding
    The Royal National TNE Hospital University College London London UK
  • Mohamed H. Shamji
    Immunomodulation and Tolerance Group Imperial College London London UK
  • Aziz Sheikh
    The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
  • Gunter J. Sturm
    Department of Dermatology and Venerology Medical University of Graz Graz Austria
  • Ana Todo Bom
    Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine University of Coimbra Coimbra Portugal
  • Sanna Toppila‐Salmi
    Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
  • Maryline Valentin‐Rostan
    Allergist Montevideo Uruguay
  • Arunas Valiulis
    Clinic of Children's Diseases Vilnius University Institute of Clinical Medicine Vilnius Lithuania
  • Erkka Valovirta
    Department of Lung Diseases and Clinical Immunology, Terveystalo Allergy Clinic University of Turku Turku Finland
  • Maria‐Teresa Ventura
    Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
  • Ulrich Wahn
    Pediatric Department Charité, Berlin Germany
  • Samantha Walker
    Asthma UK London UK
  • Dana Wallace
    Nova Southeastern University Fort Lauderdale Florida
  • Susan Waserman
    Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario
  • Arzu Yorgancioglu
    Department of Pulmonary Diseases, Faculty of Medicine Celal Bayar University Manisa Turkey
  • Torsten Zuberbier
    Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GA<sup>2</sup>LEN, Humboldt‐Uniersität zu Berlin Berlin Germany

抄録

<jats:title>Abstract</jats:title><jats:p>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.</jats:p>

収録刊行物

  • Allergy

    Allergy 74 (11), 2087-2102, 2019-07-15

    Wiley

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